TY - JOUR
T1 - Poor long-term outcomes in stroke patients with asymptomatic coronary artery disease in heart CT
AU - Yoo, Joonsang
AU - Song, Dongbeom
AU - Baek, Jang Hyun
AU - Kim, Kyoungsub
AU - Kim, Jinkwon
AU - Song, Tae Jin
AU - Lee, Hye Sun
AU - Choi, Donghoon
AU - Kim, Young Dae
AU - Nam, Hyo Suk
AU - Heo, Ji Hoe
N1 - Publisher Copyright:
© 2017 Elsevier B.V.
PY - 2017/10
Y1 - 2017/10
N2 - 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.
AB - 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.
KW - Coronary artery disease
KW - Ischemic stroke
KW - Major adverse cardiac event
KW - Mortality
KW - Multidetector computerized tomography
UR - http://www.scopus.com/inward/record.url?scp=85027570633&partnerID=8YFLogxK
U2 - 10.1016/j.atherosclerosis.2017.07.029
DO - 10.1016/j.atherosclerosis.2017.07.029
M3 - Article
C2 - 28825975
AN - SCOPUS:85027570633
SN - 0021-9150
VL - 265
SP - 7
EP - 13
JO - Atherosclerosis
JF - Atherosclerosis
ER -