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Prevalencia de la enfermedad coronaria asintomática en pacientes con accidente cerebrovascular isquémico: el estudio
David Calvet1, Emmanuel Touzé, Olivier Varenne
1Department of Neurology, Centre HospitalierSainte-Anne, Paris Descartes University, Centre de Psychiatrie et Neurosciences INSERM UMR 894, Paris, France.
Circulation
|March 31, 2010
Resumen
Aproximadamente una quinta parte de los pacientes que experimentan un accidente cerebrovascular isquémico o un ataque isquémico transitorio tienen una enfermedad coronaria asintomática significativa (CAD). Esta prevalencia está relacionada con los factores de riesgo vascular y la estenosis de la arteria carótida, lo que pone de relieve la necesidad de una evaluación cardiovascular integral.
Área de la Ciencia:
- Cardiología Cardiología.
- Neurología Neurología.
- La medicina vascular es una medicina vascular.
Sus antecedentes:
- La enfermedad de las arterias coronarias (CAD) es una de las principales causas de muerte y discapacidad en pacientes con accidente cerebrovascular isquémico.
- La prevalencia de CAD asintomática en pacientes con accidente cerebrovascular no está bien establecida, sin embargo, puede influir en las estrategias preventivas.
- La identificación de CAD asintomático es crucial para el manejo eficaz de los pacientes con accidente cerebrovascular.
Objetivo del estudio:
- Para determinar la prevalencia de la enfermedad coronaria asintomática significativa (CAD) en pacientes con accidente cerebrovascular isquémico o ataque isquémico transitorio (TIA).
- Investigar la asociación entre el CAD asintomático y los factores de riesgo vasculares tradicionales.
- Para explorar la relación entre el CAD asintomático y la aterosclerosis cervicocefálica.
Principales métodos:
- Un estudio en el que participaron 300 pacientes de entre 45 y 75 años con accidente cerebrovascular isquémico no incapacitante, no cardioembólico o AIT sin antecedentes de CAD.
- Utilizó tomografía computarizada de 64 secciones angiografía coronaria para evaluar la gravedad de CAD (> o = 50% estenosis).
- Se realizó un examen detallado de las arterias cervicocefálicas y se evaluaron los factores de riesgo vascular, incluido el Índice de Riesgo Framingham.
Principales resultados:
- La prevalencia de CAD asintomática significativa (> o = 50% estenosis) fue del 18% entre los pacientes estudiados.
- La CAD asintomática se asoció de manera independiente con puntajes de riesgo vascular más altos, consumo excesivo de alcohol y índice tobillo-braquial <0.9.
- Se encontró una fuerte correlación entre la CAD asintomática y la presencia de estenosis significativa de la arteria cervicocefálica.
Conclusiones:
- Casi una quinta parte de los pacientes con accidente cerebrovascular isquémico o AIT presentan una enfermedad coronaria asintomática significativa.
- La estenosis de la arteria cervicocefálica es un predictor significativo de CAD asintomático, junto con los factores de riesgo vasculares tradicionales.
- Estos hallazgos subrayan la importancia de evaluar la aterosclerosis coronaria en pacientes con accidente cerebrovascular, incluso en ausencia de síntomas cardíacos.
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