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Prognostic value of coronary computed tomography angiography in stroke patients

 Jin Hur  ;  Kye Ho Lee  ;  Sae Rom Hong  ;  Young Joo Suh  ;  Yoo Jin Hong  ;  Hye-Jeong Lee  ;  Young Jin Kim  ;  Hye Sun Lee  ;  Hyuk-Jae Chang  ;  Byoung Wook Choi 
 ATHEROSCLEROSIS, Vol.238(2) : 271-277, 2015 
Journal Title
Issue Date
Aged ; Angina, Unstable/mortality ; Angina, Unstable/therapy ; Area Under Curve ; Coronary Angiography/methods* ; Coronary Artery Disease/diagnostic imaging* ; Coronary Artery Disease/mortality ; Female ; Hospitalization ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Myocardial Infarction/mortality ; Myocardial Infarction/therapy ; Myocardial Revascularization ; Predictive Value of Tests ; Prevalence ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; ROC Curve ; Republic of Korea ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Stroke/diagnostic imaging* ; Stroke/mortality ; Time Factors ; Tomography, X-Ray Computed* ; Vascular Calcification/diagnostic imaging ; Vascular Calcification/mortality
Coronary artery disease (CAD) ; Coronary computed tomography angiography (CCTA) ; Major adverse cardiac events (MACE) ; Prognosis ; Stroke
OBJECTIVE: The predictive value of coronary computed tomography angiography (CCTA) in stroke patients has not yet been established. We investigated the prognostic value of coronary artery disease (CAD) detection by CCTA, and determined the incremental risk stratification benefit of CCTA findings as compared to coronary artery calcium scores (CACS) in ischemic stroke patients without chest pain.

METHODS: Among 914 consecutive ischemic stroke patients, 317 (68.5% were male with a mean age of 64 years) who had at least one clinical risk factor for CAD without chest pain were prospectively enrolled to undergo CCTA. CT images were assessed for CAC, presence of CAD and extent of CAD. The primary endpoint was major adverse cardiac events (MACEs) defined as cardiac death, non-fatal myocardial infarction, unstable angina requiring hospitalization, or revascularization after 90 days from index CCTA.

RESULTS: The prevalence of CAC ≥1 was 73.1% (232/317) and the average CACS was 346.6 ± 693.5 (Agatston unit). During the median follow-up period of 409 days, there were a total of 26 MACEs. Both CACS [CAC (101-400, and >400)] and CCTA findings [presence of obstructive CAD, 1-vessel disease (VD), 2-VD, and 3-VD] independently stratified risk of future MACEs (all p < 0.05). The time-dependent receiver operating characteristic curve analysis revealed that CAD findings (presence of obstructive CAD and number of involved vessels) based on CCTA improved risk stratification beyond clinical risk factors and CACS (iAUC: 0.863 vs 0.752, p < 0.05).

CONCLUSION: In ischemic stroke patients without chest pain, CCTA findings of CAD provide additional risk-discrimination over CACS.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Medical Engineering (의학공학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Young Jin(김영진) ORCID logo https://orcid.org/0000-0002-6235-6550
Suh, Young Joo(서영주) ORCID logo https://orcid.org/0000-0002-2078-5832
Lee, Kye Ho(이계호) ORCID logo https://orcid.org/0000-0001-5568-1833
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Lee, Hye Jeong(이혜정) ORCID logo https://orcid.org/0000-0003-4349-9174
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
Choi, Byoung Wook(최병욱) ORCID logo https://orcid.org/0000-0002-8873-5444
Hur, Jin(허진) ORCID logo https://orcid.org/0000-0002-8651-6571
Hong, Sae Rom(홍새롬)
Hong, Yoo Jin(홍유진) ORCID logo https://orcid.org/0000-0002-7276-0944
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