Autopsy prevalence of coronary atherosclerosis in patients with fatal stroke.
OBJECTIVE
Myocardial infarction (MI) is the leading cause of long-term mortality in patients with stroke, yet the prevalence of coronary atherosclerosis in these individuals is unknown. The objective of the study was to establish the prevalence of coronary atherosclerosis and MI after fatal stroke.


METHODS
Using an autopsy data bank, we studied the prevalence of coronary plaques and coronary stenoses >50% and pathologic evidence of MI in 803 consecutive autopsies of neurologic patients.


RESULTS
Coronary plaques, coronary stenoses, and MI were present in 72.4%, 37.5%, and 40.8%, respectively, of the 341 patients with stroke and in 26.8%, 10.1%, and 12.8%, respectively, of the 462 patients with other neurologic diseases (P<0.001). Two-thirds of cases of MI were clinically silent and found at autopsy. Compared with other neurologic diseases, and after adjusting for age, gender, and heart weight, the odds ratios (95% confidence intervals) of the presence of coronary plaques, coronary stenosis, and MI in stroke patients were 3.81 (2.66 to 5.46), 2.80 (1.85 to 4.25), and 2.34 (1.58 to 3.46), respectively. The frequency of coronary atherosclerosis and MI was similar between stroke subtypes. The prevalence of coronary plaques, coronary stenosis, and MI was 79.0%, 42.9%, and 46.0%, respectively, in the presence of plaques in any segment of the extracranial and intracranial brain arteries, and 50.8%, 17.9%, and 23.9%, respectively, in the absence of plaques (adjusted P<0.01). Coronary atherosclerosis was also related to the severity of atherosclerosis in any segment of the cerebral arteries (adjusted probability value for linear trend <.005).


CONCLUSIONS
Coronary atherosclerosis and MI are highly prevalent in patients who died from a stroke regardless of the etiology. They are more frequent when atherosclerosis is present in the carotid and cerebral arteries. They are also common in stroke patients with no evidence of carotid or cerebral atherosclerosis.
Gongora-Rivera
Fernando
F
Department of Neuropathology Raymond Escourolle, La Salpêtrière Hospital, France.
Labreuche
Julien
J
Jaramillo
Arturo
A
Steg
Philippe Gabriel
PG
Hauw
Jean-Jacques
JJ
Amarenco
Pierre
P
D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D002536:Cerebral Arteries / Q000473:pathology* / Q000503:physiopathology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D003331:Coronary Vessels / Q000473:pathology* / Q000503:physiopathology; D019992:Databases as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009203:Myocardial Infarction / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D020521:Stroke / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology