Yonsei Med J.  2017 Jan;58(1):114-122. 10.3349/ymj.2017.58.1.114.

Increased Risk of Cardiovascular Events in Stroke Patients Who had Not Undergone Evaluation for Coronary Artery Disease

• Kim YD
• Song D
• Nam HS
• Choi D
• Kim JS
• Kim BK
• Chang HJ
• Choi HY
• Lee K
• Yoo J
• Lee HS
• Nam CM
• Heo JH

• KMID: 2374196
• DOI: http://doi.org/10.3349/ymj.2017.58.1.114

Abstract

PURPOSE
Although asymptomatic coronary artery occlusive disease is common in stroke patients, the long-term advantages of undergoing evaluation for coronary arterial disease using multi-detector coronary computed tomography (MDCT) have not been well established in stroke patients. We compared long-term cardio-cerebrovascular outcomes between patients who underwent MDCT and those who did not.
MATERIALS AND METHODS
This was a retrospective study in a prospective cohort of consecutive ischemic stroke patients. Of the 3117 patients who were registered between July 2006 and December 2012, MDCT was performed in 1842 patients [MDCT (+) group] and not in 1275 patients [MDCT (−) group]. Occurrences of death, cardiovascular events, and recurrent stroke were compared between the groups using Cox proportional hazards models and propensity score analyses.
RESULTS
During the mean follow-up of 38.0±24.8 months, 486 (15.6%) patients died, recurrent stroke occurred in 297 (9.5%), and cardiovascular events occurred in 60 patients (1.9%). Mean annual risks of death (9.34% vs. 2.47%), cardiovascular events (1.2% vs. 0.29%), and recurrent stroke (4.7% vs. 2.56%) were higher in the MDCT (−) group than in the MDCT (+) group. The Cox proportional hazards model and the five propensity score-adjusted models consistently demonstrated that the MDCT (−) group was at a high risk of cardiovascular events (hazard ratios 3.200, 95% confidence interval 1.172-8.735 in 1:1 propensity matching analysis) as well as death. The MDCT (−) group seemed to also have a higher risk of recurrent stroke.
CONCLUSION
Acute stroke patients who underwent MDCT experienced fewer deaths, cardiovascular events, and recurrent strokes during follow-up.

Keyword

Stroke; coronary disease; outcome; multi-detector coronary computed tomography

MeSH Terms

Asymptomatic Diseases
Coronary Artery Disease/*diagnostic imaging/mortality
Female
Follow-Up Studies
Humans
Male
Multidetector Computed Tomography/*utilization
Propensity Score
Proportional Hazards Models
Prospective Studies
Recurrence
Retrospective Studies
Risk Assessment
Risk Factors
Stroke/*complications/mortality

Figure

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  Fig. 1 Patient selection for this study. TIA, transient ischemic attack; CAOD, coronary artery occlusive disease; MDCT, multi-detector coronary computed tomography.

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  Fig. 2 Kaplan-Meier survival curves for (A) death (B) cardiovascular events, and (C) recurrent stroke according to the performance of MDCT in the entire population. MDCT, multi-detector coronary computed tomography.

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  Fig. 3 Kaplan-Meier survival curves for (A) death (B) cardiovascular events, and (C) recurrent stroke according to the performance of MDCT in the propensity score-matched population. MDCT, multi-detector coronary computed tomography.

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