Key result
Asymptomatic obstructive CAD is linked to an ~8-fold higher risk of MACE after ischemic stroke.
Why the study?
Stroke survivors experience high rates of cardiac events and may have a high burden of asymptomatic CAD, prompting this review to estimate CAD prevalence and assess its association with future MACE.
Does the presence of asymptomatic coronary atherosclerosis increase the risk of future MACE in ischaemic stroke survivors?
Meta-Analysis (n=6,862)
Does the presence of asymptomatic coronary atherosclerosis increase the risk of future MACE in ischaemic stroke survivors?
Hazard Ratio: 8 (95% CI 1.7–37.1)
p-value: p=0.007
Asymptomatic coronary artery disease is highly prevalent in ischaemic stroke survivors and its presence strongly predicts future major adverse cardiovascular events, highlighting the potential value of routine coronary assessment.
May warrant coronary assessment in ischaemic stroke survivors; leaves open whether screening improves outcomes.
Background: Ischaemic stroke and coronary artery disease share risk factors and stroke survivors experience a high rate of cardiac events. Recent work suggests a high burden of asymptomatic coronary artery disease (CAD) in ischaemic stroke survivors. Thus, we performed this systematic review and meta-analysis to A) estimate the prevalence of CAD in ischaemic stroke survivors without known CAD and B) evaluate the association between coronary atherosclerosis and future major adverse cardiovascular events (MACE) in stroke survivors. Patients and Methods: We conducted a systematic review and meta-analysis according to the PRISMA statement. We included studies investigating acute ischaemic stroke or transient ischaemic attack where participants underwent anatomical assessment of all coronary arteries. For objective B) we included studies that reported an association between coronary atherosclerosis and MACE. Two reviewers used the Newcastle-Ottawa Scale to assess risk of bias. We used random-effects modelling for our analyses. Results: We identified 2983 studies of which 17 were included. These studies had a total of 6862 participants between 2008 and 2022. The pooled prevalence of any coronary atherosclerosis was 66.8% (95% CI 57.2%–75.1%) with substantial heterogeneity (I 2 = 95.2%). The pooled prevalence of obstructive (>50%) stenosis was 29.3% with substantial heterogeneity (I 2 = 91%). High-risk coronary anatomy (triple vessel disease or left main stenosis) was found in 7.0% (95% CI 4%–12%) with high heterogeneity I 2 = 72%. One study examined high-risk plaques and found a prevalence of 5.9%. Five studies reported the association of coronary atherosclerosis with future MACE. The presence of obstructive CAD confers a HR of 8.0 (95% CI 1.7–37.1, p = 0.007) for future MACE. Discussion and Conclusions: Asymptomatic CAD is common in ischaemic stroke survivors. The presence and severity of asymptomatic CAD strongly associates with the risk of future MACE. Further evaluation of the benefits of routine coronary assessment in ischaemic stroke is warranted.
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Muthalaly et al. (2024) conducted a meta-analysis in Ischaemic stroke or transient ischaemic attack without known coronary artery disease (n=6,862). Asymptomatic obstructive coronary artery disease vs. No obstructive coronary artery disease was evaluated on Future major adverse cardiovascular events (MACE) (HR 8.0, 95% CI 1.7-37.1, p=0.007). The presence of asymptomatic obstructive coronary artery disease in ischaemic stroke survivors is associated with an eightfold increase in the risk of future major adverse cardiovascular events (HR 8.0).
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