title: Long-term outcomes of ischemic stroke patients with concurrent intracranial and extracranial stenoses and ischemic heart disease.
abstract: OBJECTIVE
  Coexisting ischemic heart disease (IHD) and concurrent atherosclerosis of intracranial and extracranial vessels is common in Asians. This study aims to investigate the long-term outcomes of ischemic stroke patients with concurrent stenoses and IHD.
  
  
  METHODS
  This was a prospective cohort study in Hong Kong. Consecutive Chinese patients with acute ischemic stroke underwent MRI, magnetic resonance angiography and carotid duplex sonography.
  
  
  RESULTS
  A total of 428 patients were included. The mean follow-up period was 65 months (up to 87 months). Ninety-three patients (22%) died of any cause and 104 patients (22%) suffered from nonfatal vascular events. Fifty-four patients (13%) had IHD. Among them, 27 patients (50%) had concurrent stenoses. In patients with concurrent stenoses and IHD, only 3 (11%) were free of death and recurrent vascular events. Eight (30%) had recurrent nonfatal stroke, 7 (26%) had nonfatal myocardial infarct (MI) and 11 (41%) died, 6 (22%) of them due to fatal MI. The overall 5-year cumulative rates of mortality, recurrent vascular events and combined poor outcomes were 21, 23 and 43%, respectively. In patients with concurrent stenoses and IHD, these rates were 40, 50 and 83%, respectively. More deaths (log rank: 6.56; p = 0.01), recurrent vascular events (log rank: 25.24; p < 0.001) and poor outcomes (log rank: 27.50; p < 0.001) were found among patients with concurrent stenoses and IHD.
  
  
  CONCLUSIONS
  Ischemic stroke patients with concurrent stenoses and IHD had high risks of death and recurrent vascular events. Future studies on aggressive medical therapy and early cardiac interventions in this high-risk group of stroke patients are warranted.
authors.affiliation: Division of Neurology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, SAR, China. manbikling@gmail.com
authors.forename: B L
authors.initials: BL
authors.lastname: Man
authors.forename: Y P
authors.initials: YP
authors.lastname: Fu
authors.forename: Y Y
authors.initials: YY
authors.lastname: Chan
authors.forename: W
authors.initials: W
authors.lastname: Lam
authors.forename: C F
authors.initials: CF
authors.lastname: Hui
authors.forename: W H
authors.initials: WH
authors.lastname: Leung
authors.forename: V
authors.initials: V
authors.lastname: Mok
authors.forename: K S
authors.initials: KS
authors.lastname: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D016893:Carotid Stenosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006723:Hong Kong; D006801:Humans; D053208:Kaplan-Meier Estimate; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex