Poor long-term outcomes in stroke patients with asymptomatic coronary artery disease in heart CT

Authors
Joonsang YooDongbeom SongJang-Hyun BaekKyoungsub KimJinkwon KimTae-Jin SongHye Sun LeeDonghoon ChoiYoung Dae KimHyo Suk NamJi Hoe Heo
Department
Dept. of Neurology (신경과학)
Issue Date
2017
Citation
Atherosclerosis, Vol.265() : 7-13, 2017
ISSN
0021-9150
Abstract
BACKGROUND AND AIMS: Although stroke patients have a high risk of ischemic heart disease, little information is available on the risk of coronary events in stroke patients with asymptomatic coronary artery disease (CAD). We investigated the long-term vascular outcomes in stroke patients with asymptomatic CAD diagnosed with multi-detector coronary computed tomography (MDCT). METHODS: This study was a retrospective analysis using a prospective cohort of ischemic stroke patients. We included consecutive stroke patients without history or symptoms of CAD who underwent MDCT. We investigated the long-term risk of major adverse cardiovascular events (MACE: cardiovascular mortality, ischemic stroke, myocardial infarction, unstable angina, and urgent coronary revascularization) and composite of MACE/all-cause mortality/elective coronary revascularization. We further investigated the value of MDCT for MACE prediction. RESULTS: Among the 1893 included patients, 1349 (71.3%) patients had some degree of CAD and 654 patients (34.5%) had significant (≥50%) CAD. At follow-up (median, 4.4 years), MACE occurred in 230 patients (12.2%). Event rates of MACE increased with the increasing extent of CAD. After adjustment for age, sex, and risk factors, the hazard ratios for MACE in mild CAD, 1-VD, 2-VD, and 3-VD or left main coronary disease were 1.28 (95% confidence interval [CI]: 0.88-1.87), 1.39 (95% CI: 0.90-2.16), 2.22 (95% CI: 1.39-3.55), and 2.91 (95% CI: 1.82-4.65), respectively (no CAD as a reference). Diagnosis of asymptomatic CAD significantly improved the prediction of MACE. CONCLUSIONS: Asymptomatic CAD detected on MDCT was associated with increased risks of vascular events or deaths in acute stroke patients.
Keywords
Ischemic stroke Coronary artery diseaseMajor adverse cardiac eventMortalityMultidetector computerized tomography
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/41391
Appears in Collections:
1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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Full Text
https://linkinghub.elsevier.com/retrieve/pii/S0021-9150(17)31216-9
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