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Coronary artery disease in patients with cerebrovascular disease: a prospective study
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Most patients experiencing transient ischemic attacks or stroke have underlying coronary artery disease. Routine cardiac evaluation is crucial for these patients, as it significantly impacts clinical management.
Area of Science:
- Cardiology
- Neurology
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) is a leading cause of mortality in patients with transient ischemic attacks (TIAs) or stroke.
- Current clinical practice often overlooks routine cardiac evaluation in these patients.
- No prior prospective studies have investigated the prevalence of CAD in this specific population.
Purpose of the Study:
- To prospectively determine the prevalence and clinical significance of coronary artery disease in patients presenting with TIAs or mild stroke.
- To assess the utility of non-invasive cardiac imaging in identifying CAD in this at-risk group.
Main Methods:
- Prospective study of 50 consecutive patients with TIAs or mild stroke.
- Comprehensive cardiac evaluation including clinical assessment by a cardiologist.
- Exercise thallium-201 scintigraphy and exercise radionuclide ventriculography were performed on all participants.
Main Results:
- A high prevalence of significant coronary artery disease was found in 29 out of 50 patients (58%).
- Cardiac scans revealed abnormalities in 14 patients (41%) with no prior clinical suspicion of heart disease.
- Cardiac catheterization confirmed significant CAD or cardiomyopathy in 20 of 22 patients with abnormal scans.
- Clinical management was altered in 13 patients following the discovery of underlying heart disease.
Conclusions:
- Coronary artery disease is highly prevalent in patients with transient ischemic attacks or mild stroke, significantly exceeding rates in the general population.
- Non-invasive cardiac imaging plays a vital role in detecting occult coronary artery disease in these patients.
- Early detection and management of coronary artery disease in TIA/stroke patients can alter clinical outcomes.
Abstract:
Coronary artery disease is the cause of death in most patients who have transient ischemic attacks or stroke. Evaluation for this condition is not routinely performed in such patients, and no prospective studies have been reported. We prospectively examined 50 consecutive patients with transient ischemic attacks or mild stroke to determine the prevalence and importance of coronary artery disease. All patients were examined by a cardiologist and underwent both exercise thallium-201 scintigraphy and exercise radionuclide ventriculography. Sixteen patients were suspected to have coronary artery disease on the basis of clinical evaluation. In 15 of these the was confirmed by the nuclear scans. The remaining 34 patients had no clinical evidence of heart disease, yet 14 had abnormal cardiac scans. Twenty of 22 patients with abnormal scans who underwent cardiac catheterization had significant coronary artery disease or a cardiomyopathy. The discovery of heart disease altered clinical management in 13 patients. Overall, 29 of 50 patients had significant coronary artery disease, compared with a 7% prevalence of the condition in other patients of similar age at the same institution.