Key result
Pre-existing coronary artery disease increased 5-year all-cause mortality risk in acute ischemic stroke patients with high-grade carotid stenosis (HR 2.26; 95% CI 1.35-3.79; p=0.002).
Why the study?
Although coronary artery disease and carotid artery stenosis frequently coincide, the association between pre-existing CAD and ischemic stroke outcomes in patients with high-grade CAS remains unclear.
Does pre-existing CAD increase the risk of 5-year mortality in acute ischemic stroke patients with high-grade carotid artery stenosis?
Cohort (n=372)
Does pre-existing CAD increase the risk of 5-year mortality in acute ischemic stroke patients with high-grade carotid artery stenosis?
Effect estimate: HR 2.26 (95% CI 1.35-3.79)
p-value: p=0.002
Pre-existing CAD is associated with a more than twofold increased risk of 5-year all-cause mortality in acute ischemic stroke patients with high-grade carotid artery stenosis.
May inform CAD-inclusive risk stratification in this stroke population; leaves open whether targeted interventions improve survival.
BACKGROUND: The coincidence of coronary artery disease (CAD) and carotid artery stenosis (CAS) was observed. However, the association between pre-existing CAD and ischemic stroke (IS) outcome in patients with high-grade CAS remains unclear. We aimed to investigate the association between pre-existing CAD and outcomes of acute IS patients with high-grade CAS. METHODS: From January 1, 2007, to April 30, 2012, we enrolled 372 acute IS patients with high-grade CAS and prospectively observed them for 5 years. Demographic features, vascular risk factors, comorbidities, and outcomes were compared between patients with and without pre-existing CAD. RESULTS: Among 372 individuals, 75 (20.2%) patients had pre-existing CAD and 297 (79.8%) patients did not have pre-existing CAD. The prevalence rates of hypertension, congestive heart failure, chronic kidney disease, and gout in patients with pre-existing CAD were significantly higher than in those without pre-existing CAD (p = 0.017, p < 0.001, p = 0.002, and p < 0.001, respectively). The multivariate Cox proportional hazards model revealed that pre-existing CAD was a significant risk factor for a 5-year all-cause mortality in acute IS patients with high-grade CAS (hazard ratio = 2.26; 95% confidence interval = 1.35-3.79; p = 0.002). CONCLUSION: Pre-existing CAD was associated with an increased risk of 5-year mortality in acute IS patients with high-grade CAS. Intensive treatment for the pre-existing CAD may reduce long-term mortality in acute IS patients with high-grade CAS.
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Wu et al. (2020) conducted a cohort in Acute ischemic stroke with high-grade carotid artery stenosis (n=372). Pre-existing coronary artery disease vs. No pre-existing coronary artery disease was evaluated on 5-year all-cause mortality (HR 2.26, 95% CI 1.35-3.79, p=0.002). Pre-existing coronary artery disease increased 5-year all-cause mortality risk in acute ischemic stroke patients with high-grade carotid stenosis (HR 2.26; 95% CI 1.35-3.79; p=0.002).
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