Predicting asymptomatic coronary artery disease in first-ever acute ischemic stroke patients: a cross-sectional study
Chen Wang1,2, Chong Zheng1,2, Jie Bao1,2
1Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
Insights
Ulcerative aortic arch plaque (AAP) is a strong predictor of asymptomatic coronary artery disease (CAD) in patients with first-ever acute ischemic stroke (AIS). This finding aids in early detection and improved management of cardiovascular risk in stroke patients.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Asymptomatic coronary artery disease (CAD) is common in patients with first-ever acute ischemic stroke (AIS) and is linked to poor outcomes.
- Early detection of CAD in AIS patients can optimize clinical management and improve patient prognosis.
- Aortic arch plaque (AAP) is a potential early indicator of systemic atherosclerosis.
Purpose of the Study:
- To investigate the role of aortic arch plaque (AAP) detected via computed tomography angiography (CTA) as an early predictor of asymptomatic CAD in first-ever AIS patients.
- To identify risk factors associated with asymptomatic CAD in AIS patients.
- To compare the predictive value of AAP versus cervicocephalic atherosclerotic characteristics for asymptomatic CAD.
Main Methods:
- A cross-sectional study included 182 patients with first-ever AIS due to large arterial atherosclerosis.
- Coronary and cervicocephalic CTA was used to evaluate atherosclerosis in the aorta, cervicocephalic, and coronary arteries.
- Multivariate logistic regression identified independent risk factors for asymptomatic CAD, including AAP characteristics.
Main Results:
- 46.2% of AIS patients had asymptomatic CAD.
- Increased AAP thickness, severe AAP, mixed AAP, and ulcerative AAP were independently associated with asymptomatic CAD.
- Ulcerative AAP was a more valuable predictor of asymptomatic CAD than cervicocephalic atherosclerotic characteristics.
Conclusions:
- Ulcerative aortic arch plaque (AAP) is significantly associated with asymptomatic coronary artery disease (CAD) in patients experiencing their first acute ischemic stroke (AIS).
- Ulcerative AAP serves as an early systemic atherosclerosis marker, offering greater predictive value for asymptomatic CAD in AIS patients compared to cervicocephalic atherosclerotic features.
Background:
It is frequently observed that patients with first-ever acute ischemic stroke (AIS) have a common occurrence of asymptomatic coronary artery disease (CAD). This condition is associated with a poor prognosis. Early detection and recognition of asymptomatic CAD in first-ever AIS patients may optimize the clinical management and ultimately lead to improved outcomes. The aim of this study was to investigate the role of aortic arch plaque (AAP) detected through combined computed tomography angiography (CTA) as an early predictor of asymptomatic CAD in patients with first-ever AIS without prior diagnosis of CAD.
Methods:
A cross-sectional study was conducted at Xuanwu Hospital, Capital Medical University from January 2019 to December 2021, involving patients with first-ever AIS caused by large arterial atherosclerosis. Patients with a history of recognized cardiovascular disease, nonatherosclerotic arterial stenosis, atrial fibrillation related to cardioembolism, and complete carotid occlusions were excluded. The study utilized a combined coronary and cervicocephalic CTA to evaluate atherosclerosis in the cervicocephalic, aortic, and coronary arteries simultaneously. First-ever AIS patients without prior diagnosis of CAD were divided into 2 groups: 1 with asymptomatic CAD detected through CTA and the other without. Multivariate logistic regression was used to identify independent risk factors associated with the presence of asymptomatic CAD, including aortic arch, cervical and intracranial atherosclerotic characteristics (e.g., vascular stenosis, plaque thickness, extent, and complexity).
Results:
Among 182 AIS patients, 84 (46.2%) had asymptomatic CAD. Increased aortic arch plaque (AAP) thickness per millimeter [adjusted odds ratio (aOR): 1.26; 95% confidence interval (CI): 1.08-1.47], presence of severe AAP (aOR: 4.24; 95% CI: 1.59-12.03), mixed AAP (aOR: 2.65; 95% CI: 1.09-6.62), and ulcerative AAP (aOR: 11.76; 95% CI: 2.05-222.84) raised the risk of asymptomatic CAD in stroke patients, independent of other factors. The combination of ulcerative AAP, diabetes mellitus, and smoking could predict asymptomatic CAD with an area under the receiver operating characteristic curve (AUC) of 0.71 (95% CI: 0.64-0.79; P<0.001). Ulcerative AAP was found to be more valuable than cervicocephalic atherosclerotic characteristics for predicting asymptomatic CAD in first-ever AIS patients.
Conclusions:
The presence of ulcerative AAP was associated with asymptomatic CAD in first-ever AIS patients. As an early systemic atherosclerosis feature, ulcerative AAP is probably a more valuable indicator than cervicocephalic atherosclerotic characteristics for predicting asymptomatic CAD in AIS patients.
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