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Increased Risk of Cardiovascular Events in Stroke Patients Who had Not Undergone Evaluation for Coronary Artery Disease

 Young Dae Kim  ;  Dongbeom Song  ;  Hyo Suk Nam  ;  Donghoon Choi  ;  Jung-Sun Kim  ;  Byeong-Keuk Kim  ;  Hyuk-Jae Chang  ;  Hye-Yeon Choi  ;  Kijeong Lee  ;  Joonsang Yoo  ;  Hye Sun Lee  ;  Chung Mo Nam  ;  Ji Hoe Heo 
 YONSEI MEDICAL JOURNAL, Vol.58(1) : 114-122, 2017 
Journal Title
Issue Date
Asymptomatic Diseases ; Coronary Artery Disease/diagnostic imaging* ; Coronary Artery Disease/mortality ; Female ; Follow-Up Studies ; Humans ; Male ; Multidetector Computed Tomography/utilization* ; Propensity Score ; Proportional Hazards Models ; Prospective Studies ; Recurrence ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stroke/complications* ; Stroke/mortality
Stroke ; coronary disease ; multi-detector coronary computed tomography ; outcome
PURPOSE: Although asymptomatic coronary artery occlusive disease is common in stroke patients, the long-term advantages of undergoing evaluation for coronary arterial disease using multi-detector coronary computed tomography (MDCT) have not been well established in stroke patients. We compared long-term cardio-cerebrovascular outcomes between patients who underwent MDCT and those who did not.

MATERIALS AND METHODS: This was a retrospective study in a prospective cohort of consecutive ischemic stroke patients. Of the 3117 patients who were registered between July 2006 and December 2012, MDCT was performed in 1842 patients [MDCT (+) group] and not in 1275 patients [MDCT (-) group]. Occurrences of death, cardiovascular events, and recurrent stroke were compared between the groups using Cox proportional hazards models and propensity score analyses.

RESULTS: During the mean follow-up of 38.0±24.8 months, 486 (15.6%) patients died, recurrent stroke occurred in 297 (9.5%), and cardiovascular events occurred in 60 patients (1.9%). Mean annual risks of death (9.34% vs. 2.47%), cardiovascular events (1.2% vs. 0.29%), and recurrent stroke (4.7% vs. 2.56%) were higher in the MDCT (-) group than in the MDCT (+) group. The Cox proportional hazards model and the five propensity score-adjusted models consistently demonstrated that the MDCT (-) group was at a high risk of cardiovascular events (hazard ratios 3.200, 95% confidence interval 1.172-8.735 in 1:1 propensity matching analysis) as well as death. The MDCT (-) group seemed to also have a higher risk of recurrent stroke.

CONCLUSION: Acute stroke patients who underwent MDCT experienced fewer deaths, cardiovascular events, and recurrent strokes during follow-up.
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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 Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Nam, Chung Mo(남정모) ORCID logo https://orcid.org/0000-0003-0985-0928
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Song, Dong Beom(송동범)
Yoo, Joon Sang(유준상) ORCID logo https://orcid.org/0000-0003-1169-6798
Lee, Ki Jeong(이기정)
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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