In a cohort of stroke patients, 20% had significant coronary artery stenosis over 70%, while 69% exhibited any degree of stenosis, indicating high prevalence of non-critical disease.
What is the prevalence of coronary artery stenosis detected by CTCA in stroke patients?
A high proportion of stroke patients have asymptomatic coronary artery stenosis on CTCA, providing insight into the high risk of subsequent coronary events in this population.
Absolute Event Rate: 0% vs 0%
Introduction: Both cerebrovascular and coronary artery disease are leading causes of mortality and share common vascular risk factors such as hypertension, diabetes, hypercholesterolemia and smoking. Following a stroke, there is an approximate 25% risk of a vascular endpoint occurring at 5 years of which the majority are coronary events. Computerised Tomogram coronary angiography (CTCA) is a non invasive imaging modality allowing rapid characterization of coronary artery stenosis(CAS). We therefore hypothesize that in a cohort of stroke patients that a significant proportion of these patients would have significant CAS of greater than 70%. Methods: A consecutive cohort of stroke patients (n=100) seen at a secondary stroke prevention clinic were analysed. Each subject underwent CTCA under standard protocols. Subjects stroke were classified using both TOAST and the Oxfordshire stroke classification. Risk factors such as hypertension, diabetes, hypercholesterolemia, family medical history of arteriosclerosis and atrial fibrillation were recorded. Data was extracted from existing medical records by study staff. The senior author verified each record in turn. Results: The mean age was 67 years, with 53% females. Hypercholesterolemia (65%) and hypertension (63%) were the 2 most common individual vascular risk factors. The point prevalence of significant CAS of more than 70% was 20%. The point of prevalence of there being any CAS was 69%. Using a binary logistic regression model, the predictor of a significant CAS was male gender OR = 9.73 (2.3 – 55); age OR = 1.14 (1.07 – 1.24); and the presence of hypertension OR = 4.8 (95% CI: 1.33 – 20.0). Discussion: While the majority of our cohort had non critical CAS with only 20% having a stenosis of more than 70% and thus our primary hypothesis was not proved, nevertheless our data provides insight as to why coronary vascular events occur 5 years after the index stroke. The presence of CAS < 70% may explain this delay as it may take several years for a non critical stenosis to become critical. The regression analysis demonstrating that non modifiable vascular risk factors such as age and gender play a role in the progression to this critical stage could also explain that despite the best efforts for risk modification, 25% of individuals may still experience a coronary event post stroke.
Lin et al. (Thu,) reported a other. In a cohort of stroke patients, 20% had significant coronary artery stenosis over 70%, while 69% exhibited any degree of stenosis, indicating high prevalence of non-critical disease.