Cervicocerebral Atherosclerosis Burden Increases Long-Term Mortality in Patients With Ischemic Stroke or Transient
Kati Lainelehto1,2, Juha-Pekka Pienimäki3, Sirpa Savilahti3
1Department of Neurology Kanta Häme Central Hospital Hämeenlinna Finland.
Insights
The burden of atherosclerosis in brain arteries, measured by the Cervicocerebral Atherosclerosis Burden (CAB) score, significantly predicts long-term mortality after stroke. Higher CAB scores indicate increased risk of death following ischemic events.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Radiology
Background:
- Atherosclerosis in arteries supplying the brain is a known risk factor for stroke.
- The impact of the total burden of this atherosclerosis on long-term mortality after acute ischemic stroke or transient ischemic attack remains unclear.
Purpose of the Study:
- To assess the association between the total burden of cervicocerebral artery atherosclerosis and long-term mortality in patients with acute ischemic stroke or transient ischemic attack.
- To determine if the Cervicocerebral Atherosclerosis Burden (CAB) score independently predicts all-cause mortality.
Main Methods:
- Computed tomography angiography was used to image cervicocerebral arteries in 406 patients.
- Atherosclerotic findings were scored across 25 artery segments, summed into a Cervicocerebral Atherosclerosis Burden (CAB) score.
- Mortality data was collected from Statistics Finland over a median follow-up of 7.3 years.
Main Results:
- Patients who died had a significantly higher median CAB score compared to survivors (11 vs. 5).
- Cumulative mortality increased with higher quartiles of the CAB score, reaching 61.4% in the highest quartile.
- Each point increase in CAB score was associated with a 3% increased probability of death, and the highest CAB quartile showed a 2.5-fold increased likelihood of all-cause mortality, even after adjustments.
Conclusions:
- The total burden of atherosclerosis in brain-supplying arteries, as defined by computed tomography angiography, is associated with increased mortality after ischemic stroke or transient ischemic attack.
- The Cervicocerebral Atherosclerosis Burden (CAB) score independently predicts long-term all-cause mortality in this patient population.
Background:
The influence of burden of atherosclerosis in the brain supplying arteries on mortality in patients with acute ischemic stroke or transient ischemic attack is poorly known. We assessed whether total burden of atherosclerosis within cervicocerebral arteries is associated with long-term mortality.
Methods And Results:
A total of 406 patients (median age, 71.8 years; 57.9% male) with acute ischemic stroke or transient ischemic attack were included and their cervicocerebral arteries imaged with computed tomography angiography. The presence of atherosclerotic findings was scored for 25 artery segments and points were summed as a Cervicocerebral Atherosclerosis Burden (CAB) score, analyzed as quartiles. Data on all-cause mortality came from Statistics Finland. After a median follow-up of 7.3 years, 147 (33.5%) patients had died. Compared with surviving patients, those who died had a higher median CAB score (5, interquartile range 2-10 versus 11, 7-16; P<0.001). Cumulative mortality increased from 8.9% (95% CI, 7.0-10.8) in the lowest to 61.4% (95% CI, 55.4-67.4) in the highest quartile of CAB score. Adjusted for demographics, cardiovascular risk factors, secondary preventive medication, and admission National Institute of Health Stroke Scale score, every CAB score point increased probability of death by 3%. Analyzed in quartiles, the highest CAB quartile was associated with a 2.5-fold likelihood of all-cause mortality.
Conclusions:
The main findings of our study were the increasing mortality with the total burden of computed tomography angiography-defined atherosclerosis in the brain supplying arteries after ischemic stroke or transient ischemic attack and that the CAB score-integrating this pathology-independently increased all-cause mortality.
