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

Joonsang Yooa, Dongbeom Song, Jang-Hyun Baeka, Kyoungsub Kim, Jinkwon Kim, Tae-jin Song, Hye Sun Lee, Donghoon Choi, Young Dae Kim, Hyo Suk Nam, Ji Hoe Heo

Atherosclerosis, 265:7-13. doi: 10.1016/j.atherosclerosis.2017.07.029

ABSTRACT

Background: 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).

Materials and 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.

- PMID: 28825975

- Fulltext: http://www.sciencedirect.com/science/article/pii/S0021915017312169?via%3Dihub