The Incidence of Cardiovascular Events in Small Versus Large Ischemic Stroke; A Three-Year Cohort Study
Marzieh Tajmirriahi1, Mohammad Saadatnia2, Hasan Shemirani3
1Hypertension Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
Patients with large-vessel ischemic stroke face a doubled risk of coronary artery disease (CAD) events within three years compared to those with small-vessel stroke. This highlights the critical link between stroke type and subsequent heart disease incidence.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Cerebral ischemia and coronary artery disease (CAD) are leading global causes of mortality and morbidity.
- Cerebral ischemic events are classified by the affected vessel size: large or small.
- Understanding the relationship between stroke type and CAD incidence is crucial for patient outcomes.
Purpose of the Study:
- To compare the incidence of CAD events following large-vessel versus small-vessel ischemic stroke.
- To identify risk factors associated with CAD events in different stroke classifications.
Main Methods:
- A cohort study of 225 ischemic stroke patients (75 large-vessel, 150 small-vessel) from 2018-19.
- Three-year follow-up for CAD events, including myocardial infarction and sudden cardiac death.
- Data collected on patient characteristics, coronary angiography, CTA, SPECT, and treatment approaches.
Main Results:
- No significant initial differences in CAD event types or diagnostic findings between large and small vessel stroke groups.
- Cox regression revealed a significantly increased risk (HR=2.005) of CAD events in large-vessel stroke patients.
- Adjustments were made for hypertension, diabetes, dyslipidemia, re-stroke, and prior ischemic heart disease (IHD).
Conclusions:
- Large-vessel ischemic stroke is independently associated with a greater than two-fold increased risk of ischemic heart disease incidence over three years.
- This finding underscores the importance of considering stroke etiology in cardiovascular risk assessment.
Introduction:
Cerebral ischemia and coronary artery disease (CAD), the major leading causes of mortality and morbidity worldwide, are pathophysiologically interrelated. Cerebral ischemic events are categorized as large or small vessels disease. The current study compares the factors related to CAD events incidence following ischemic large versus small disease CVA.
Method:
The current cohort study was conducted on 225 patients with ischemic stroke in two groups of large (n=75) and small (n=150) vessel disease during 2018-19. The patients' demographic, medical, and clinical characteristics were recruited. They were followed for three years regarding the incidence of CAD events, including ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), unstable angina (UA), and sudden cardiac death (SCD). Data about the coronary angiography, computed tomography angiography (CTA), Single Photon Emission Computed Tomography (SPECT), and the therapeutic approach were gathered.
Results:
There were insignificant differences between the patients with small versus large vessels CVA in terms of ACS incidence (P-value=0.105), type of the events (P-value=0.836), angiographic (P-value=0.671), SPECT (P-value=0.99) and CTA findings (P-value>0.99) and approached CAD (P-value=0.728). Cox regression assessments revealed an increased risk of CAD events due to large versus small vessels disease after adjustments for hypertension, diabetes mellitus, dyslipidemia, re-stroke, and the previous history of IHD (HR=2.005, 95%CI: 1.093-2.988, P-value=0.021).
Conclusion:
According to the findings of this study, large-vessel involvement in an ischemic stroke was associated with more than a two-fold increase in the three-year probability of ischemic heart disease incidencet.
