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Frequency and severity of asymptomatic coronary disease in patients with different causes of stroke
M I Chimowitz1, R M Poole, M R Starling
1Department of Neurology, University of Michigan Medical Center, Ann Arbor, USA. mchimo@neuro.emory.edu
Insights
Patients with large-artery cerebrovascular disease have a higher risk of asymptomatic coronary artery disease (CAD) than those with other stroke causes. Smoking and veteran status may indicate higher CAD risk in stroke patients.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Asymptomatic coronary artery disease (CAD) is a concern in patients experiencing brain ischemia.
- Understanding the link between stroke etiology and CAD prevalence is crucial for risk stratification.
Purpose of the Study:
- To compare the frequency and severity of asymptomatic CAD in patients with different causes of brain ischemia.
- To identify patient profiles at highest risk for asymptomatic CAD among those with brain ischemia.
Main Methods:
- Sixty-nine patients with transient ischemic attack or stroke underwent cardiac stress testing and etiological evaluation.
- Comparison of abnormal stress test frequencies based on cerebrovascular disease type (large-artery vs. others).
- Analysis of vascular risk factors, ECG abnormalities, and stroke cause in relation to stress test results.
Main Results:
- Abnormal stress tests occurred in 50% of large-artery cerebrovascular disease patients versus 23% of others (P = .04).
- Severe CAD was suggested in 60% of abnormal tests in large-artery disease patients.
- Smoking, large-artery disease, veteran status, and left ventricular hypertrophy were associated with abnormal stress tests.
Conclusions:
- Patients with penetrating artery disease or cryptogenic stroke have significantly less asymptomatic CAD than those with large-artery cerebrovascular disease.
- Large-artery cerebrovascular disease, smoking, veteran status, and possibly left ventricular hypertrophy are key indicators for high asymptomatic CAD risk in stroke patients.
Background And Purpose:
We sought (1) to compare the frequency and severity of asymptomatic coronary artery disease (CAD) in patients with different causes of brain ischemia and (2) to determine profiles of patients with brain ischemia who are at highest risk of asymptomatic CAD.
Methods:
Sixty-nine patients with transient ischemic attack or stroke and without overt CAD underwent a cardiac stress test and a diagnostic evaluation to determine the cause of brain ischemia. The frequency of abnormal cardiac stress tests was compared in patients with large-artery cerebrovascular disease versus other causes of brain ischemia (90% of whom had penetrating artery disease or cryptogenic stroke). Additionally, the frequencies of vascular risk factors, resting electrocardiographic abnormalities, and cause of stroke (large-artery disease versus other causes) were compared in patients with abnormal stress tests versus patients with normal stress tests.
Results:
The frequency of abnormal stress tests was 50% (15 of 30) in patients with large-artery cerebrovascular disease versus 23% (9 of 39) in patients with other causes of brain ischemia (P = .04). Moreover, 60% of abnormal stress tests (9 of 15) in patients with large-artery cerebrovascular disease suggested severe underlying CAD that was confirmed in 7 of 7 patients who underwent coronary angiography. On the other hand, less than 25% of abnormal stress tests (2 of 9) in patients with other causes of brain ischemia suggested severe underlying CAD. Features that were more common in patients with abnormal stress tests were smoking (P = .006), large-artery cerebrovascular disease (P = .02), veteran status (P = .02), and left ventricular hypertrophy (P = .07).
Conclusions:
Patients with penetrating artery disease or cryptogenic stroke have a significantly lower frequency of asymptomatic CAD than patients with large-artery cerebrovascular disease. Large-artery cerebrovascular disease, smoking, veteran status, and possibly left ventricular hypertrophy may be useful features for identifying patients with transient ischemic attack or stroke who are at highest risk of harboring asymptomatic CAD.