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

Authors
 Joonsang Yoo  ;  Dongbeom Song  ;  Jang-Hyun Baek  ;  Kyoungsub Kim  ;  Jinkwon Kim  ;  Tae-Jin Song  ;  Hye Sun Lee  ;  Donghoon Choi  ;  Young Dae Kim  ;  Hyo Suk Nam  ;  Ji Hoe Heo 
Citation
 Atherosclerosis, Vol.265 : 7-13, 2017 
Journal Title
 Atherosclerosis 
ISSN
 0021-9150 
Issue Date
2017
Keywords
Coronary artery disease ; Ischemic stroke ; Major adverse cardiac event ; Mortality ; Multidetector computerized tomography
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.
Full Text
https://www.sciencedirect.com/science/article/pii/S0021915017312169
DOI
10.1016/j.atherosclerosis.2017.07.029
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
김경섭(Kim, Kyoung Sub)
김영대(Kim, Young Dae) ORCID logo https://orcid.org/0000-0001-5750-2616
남효석(Nam, Hyo Suk) ORCID logo https://orcid.org/0000-0002-4415-3995
백장현(Baek, Jang Hyun)
송동범(Song, Dong Beom)
유준상(Yoo, Joon Sang)
이혜선(Lee, Hye Sun) ORCID logo https://orcid.org/0000-0001-6328-6948
최동훈(Choi, Dong Hoon) ORCID logo https://orcid.org/0000-0002-2009-9760
허지회(Heo, Ji Hoe) ORCID logo https://orcid.org/0000-0001-9898-3321
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160746
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