Prevalence of asymptomatic coronary artery disease in ischemic stroke patients: the PRECORIS study.
BACKGROUND
Coronary artery disease (CAD) is a significant cause of morbidity and mortality in stroke patients. Some patients with asymptomatic CAD might benefit from specific prevention, but the prevalence of asymptomatic CAD is not well known. We assessed the prevalence of >or=50% asymptomatic CAD in patients with ischemic stroke or transient ischemic attack and whether the prevalence is related to traditional vascular risk factors and cervicocephalic atherosclerosis.


RESULTS
From January 2006 to February 2009, consecutive patients between 45 and 75 years of age with nondisabling, noncardioembolic ischemic stroke or transient ischemic attack and no prior history of CAD were enrolled in the study. All patients had a 64-section computed tomography coronary angiography and a detailed cervicocephalic arterial workup. Risk factors were assessed individually and through the Framingham Risk Score. Among 300 patients included in the study, 274 had computed tomography coronary angiography. The prevalence of >or=50% asymptomatic CAD was 18% (95% confidence interval [CI], 14 to 23; n=50). Asymptomatic CAD was independently associated with traditional risk factors assessed individually and through the Framingham Risk Score (odds ratio [OR], 2.6; 95% CI, 1.0 to 7.6 for a 10-year risk of coronary heart disease of 10% to 19%; and OR, 7.3; 95% CI, 2.8 to 19.1 for a 10 year-risk of coronary heart disease >or=20%), the presence of at least 1 >or=50% cervicocephalic artery stenosis (OR, 4.0; 95% CI, 1.4 to 11.2), excessive alcohol consumption (OR, 3.1; 95% CI 1.3 to 7.3), and ankle brachial index <0.9 (OR, 2.2; 95% CI, 0.9 to 5.2). The prevalence of >or=50% asymptomatic CAD was also related to the extent of cervicocephalic atherosclerosis.


CONCLUSIONS
About one fifth of patients with nondisabling, noncardioembolic ischemic stroke or transient ischemic attack have >or=50% asymptomatic CAD. In addition to vascular risk factors, the presence of >or=50% cervicocephalic artery stenosis is strongly related to >or=50% asymptomatic CAD.
Calvet
David
D
Department of Neurology, Centre HospitalierSainte-Anne, Paris Descartes University, Centre de Psychiatrie et Neurosciences INSERM UMR 894, Paris, France.
Touzé
Emmanuel
E
Varenne
Olivier
O
Sablayrolles
Jean-Louis
JL
Weber
Simon
S
Mas
Jean-Louis
JL
D000368:Aged; D002548:Cerebral Revascularization / Q000706:statistics & numerical data; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D018579:Patient Selection; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D016312:Treatment Refusal