Key result
Adding coronary calcium score to the CAD2 model accurately predicts obstructive stenosis in acute ischemic stroke.
Why the study?
Pre-test probability assessment for obstructive CAD is often deferred in acute ischemic stroke patients despite their higher CAD prevalence because urgent stroke management takes priority.
Does the CCS-CAD2 model improve the prediction of obstructive coronary stenosis in patients with acute ischemic stroke compared to basic clinical models?
Observational (n=50)
Does the CCS-CAD2 model improve the prediction of obstructive coronary stenosis in patients with acute ischemic stroke compared to basic clinical models?
Effect estimate: AUC 0.818 (95% CI 0.694-0.942)
p-value: p=<0.001
The inclusion of coronary calcium score in the CAD consortium model significantly improves the prediction of obstructive coronary artery disease in patients with acute ischemic stroke.
Should not yet change PTP assessment in stroke; leaves open incremental value of CCS>117 for obstructive CAD pending larger studies.
Background and aims Patients with ischemic stroke (IS) have a significantly higher prevalence of obstructive coronary artery disease (CAD) compared to those without stroke. Pre-test probability (PTP) assessment for obstructive CAD is often deferred in acute IS patients because the focus shifts to the urgent stroke cause. We tried to evaluate the performance of the model of coronary calcium score (CCS) and the CAD consortium PTP models (basic CAD1, clinical CAD2 and CCS-CAD2) in predicting obstructive coronary stenosis in patients with acute IS and chest pain or dyspnea. Methods In a prospective registry study, 50 patients (median age 60 (52; 66) years, 56% male) with confirmed IS underwent coronary computed tomography angiography (CTCA). Clinical, laboratory, electro- and echocardiographic data were recorded. We analyzed area under the ROC-curve (AUC), sensitivity, specificity, predictive values and calibration of PTP models. Results CTCA detected obstructive CAD in 24 (48%) patients with IS. The model CCS-CAD2 showed the best discrimination capability (AUC 0,818 [95% CI 0,694-0,942], p<0,001) and calibration (χ2 =10,982; p=0,203). Compared with the CAD model the CCS-CAD2 model significantly reduced the number of patients with moderate PTP (7 (29%) vs 2 (8%), correspondingly, p=0,006). Multivariate regression analysis revealed an independent association CCS>117 with obstructive CAD (OR 9,220 [95% CI 1,482-57,346], p=0,017). Conclusions The inclusion of CCS improved calibration, discrimination and classification in the CAD2 model in patients with acute IS. CCS has priority over clinical, laboratory and echocardiographic parameters in identifying obstructive CAD. Conflict of interest All authors: nothing to disclose
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Shavarov et al. (2026) conducted an observational in Acute ischemic stroke (n=50). CCS-CAD2 model vs. CAD1 and CAD2 models was evaluated on Obstructive coronary stenosis (AUC 0.818, 95% CI 0.694-0.942, p=<0.001). The inclusion of coronary calcium score in the CAD2 model (CCS-CAD2) accurately predicted obstructive coronary stenosis in acute ischemic stroke patients (AUC 0.818; 95% CI 0.694-0.942; p<0.001).
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