Optimizing screening and management of asymptomatic coronary artery disease in patients with stroke and patients with transient ischemic attack.
OBJECTIVE
The feasibility of implementing an expert consensus guideline recommending use of a stroke patient's profile to manage undiagnosed coronary artery disease remains unclear.


METHODS
Following a guideline-based algorithm, we screened consecutive patients with ischemic stroke and patients with transient ischemic attack for asymptomatic coronary artery disease using the Framingham Heart Study Coronary Risk Score (FCRS) cutoff of high risk (> or = 20%) for experiencing a hard coronary artery disease event over a 10-year period. Patients with high FCRS received dobutamine stress echocardiogram outpatient screening, additional treatment (beta-blocker), or further management (cardiologist referral).


RESULTS
From July 2004 to September 2007, among 693 patients, 501 (72%) met study criteria, of which 80 (16%) had FCRS > or = 20%. Elevated serum glucose, nonhigh-density lipoprotein, triglycerides, homocysteine, glycosylated hemoglobin as well as large vessel atherosclerotic stroke mechanism were more frequent in high versus low FCRS patients (P<0.05). Among high FCRS patients, 35 (44%) had dobutamine stress echocardiogram performed. Leading reasons for dobutamine stress echocardiogram nonperformance were patient noncompliance (42%) and primary care physician refusal (33%).


CONCLUSIONS
Screening for coronary artery disease risk using FCRS is feasible in hospitalized patients with stroke, but outpatient adherence to stress testing is challenging largely due to patient and primary care physician-related factors.
Ovbiagele
Bruce
B
Liebeskind
David S
DS
Kim
Doojin
D
Ali
Latisha K
LK
Pineda
Sandra
S
Saver
Jeffrey L
JL
D000368:Aged; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000175:diagnosis / Q000453:epidemiology; D002537:Intracranial Arteriosclerosis / Q000175:diagnosis / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D010821:Physicians, Family / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*