Incidence of subclinical coronary atherosclerosis in patients with suspected embolic stroke using cardiac computed tomography.
The purpose of this study was to investigate the incidence of subclinical coronary artery disease (CAD) in patients with suspected acute embolic stroke or transient ischemic attack (TIA) using 64-row multi-slice computed tomography (MSCT) and to examine its association with conventional risk stratification. We consecutively enrolled 175 patients (66 ± 13 years, 50% men) suspected to have had embolic stroke/TIA clinically or radiologically, and underwent 64-row MSCT to evaluate for a possible cardiac source of embolism. Both coronary artery calcium scoring (CACS) and coronary CT angiography (CCTA) were concurrently performed based on standard scanning protocols. Patients with a history of angina or documented CAD, and those with significant carotid stenosis were excluded. Atherosclerotic plaques were indentified in 105 (60%) individuals; 37 (21%) had occult CAD of ≥50% diameter stenosis on CCTA. Subjects with and without ≥50% occult CAD on CCTA had similar prevalence of cardiovascular risk factors. Thirty out of 175 (17%) individuals with ≥50% occult CAD would have missed further cardiac testing based on the American Heart association and the American Stroke Association guideline. However, these numbers would be reduced to 2% (4/175) using CACS. In logistic regression analysis, only CACS independently predicted the presence ≥50% occult CAD evidenced by CCTA. Subclinical CAD, including ≥50% stenotic disease, is highly prevalent in patients who had suffered a suspected embolic stroke. The current guideline for further cardiac testing may have limited value to identify patients with ≥50% CAD in this patient population, which can be improved by adopting CACS.
Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
Yeonyee E
YE
Yoon
Hyuk-Jae
HJ
Chang
Iksung
I
Cho
Ki-Hyun
KH
Jeon
Eun-Ju
EJ
Chun
Sang-Il
SI
Choi
Hee-Jun
HJ
Bae
Juan J
JJ
Rivera
Khurram
K
Nasir
Roger S
RS
Blumenthal
Tae-Hwan
TH
Lim
D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000453:epidemiology*; D002546:Ischemic Attack, Transient / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000453:epidemiology