title: Prevalence of coronary atherosclerosis in patients with cerebral infarction.
abstract: OBJECTIVE
  there is an overlap between stroke and coronary heart disease, but the exact prevalence of coronary artery disease in patients with nonfatal cerebral infarction is unclear, particularly when there is no known history of coronary heart disease.
  
  
  METHODS
  we consecutively enrolled 405 patients presenting with acute cerebral infarction documented by neuroimaging who underwent carotid and femoral artery, thoracic, and abdominal aorta ultrasound examinations. Of the 342 patients with no known coronary heart disease, 315 underwent coronary angiography a median of 8 days (interquartile range, 6-11) after stroke onset.
  
  
  RESULTS
  coronary plaques on angiography, regardless of stenosis severity, were present in 61.9% of patients (95% confidence interval [CI], 56.5-67.3) and coronary stenoses ≥ 50% were found in 25.7% (95% CI, 20.9-30.5). The overall prevalence of coronary plaque increased with the number of arterial territories (carotid or femoral arteries) involved, with an adjusted odds ratio of coronary artery disease of 1.25 (95% CI, 0.58-2.71) for presence of plaque in 1 territory, and 4.31 (95% CI, 1.92-9.68) for presence of plaque in both territories, compared with no plaque in either territory. The presence of plaque in both femoral and carotid arteries had an age- and sex-adjusted positive predictive value of 84% for presence of coronary plaque and a negative predictive value of 44%.
  
  
  CONCLUSIONS
  there is a high burden of silent coronary artery disease in patients with nonfatal cerebral infarction and no known coronary heart disease, even in the absence of systemic atherosclerosis. The prevalence is even higher in patients with evidence of carotid and/or femoral plaque.
authors.affiliation: INSERM U-698 and Paris-Diderot University, Paris, France. pierre.amarenco@bch.aphp.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
authors.forename: Philippa C
authors.initials: PC
authors.lastname: Lavallée
authors.forename: Julien
authors.initials: J
authors.lastname: Labreuche
authors.forename: Gregory
authors.initials: G
authors.lastname: Ducrocq
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Juliard
authors.forename: Laurent
authors.initials: L
authors.lastname: Feldman
authors.forename: Lucie
authors.initials: L
authors.lastname: Cabrejo
authors.forename: Elena
authors.initials: E
authors.lastname: Meseguer
authors.forename: Celine
authors.initials: C
authors.lastname: Guidoux
authors.forename: Valérie
authors.initials: V
authors.lastname: Adraï
authors.forename: Samina
authors.initials: S
authors.lastname: Ratani
authors.forename: Jérôme
authors.initials: J
authors.lastname: Kusmierek
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lapergue
authors.forename: Isabelle F
authors.initials: IF
authors.lastname: Klein
authors.forename: Fernando
authors.initials: F
authors.lastname: Gongora-Rivera
authors.forename: Arturo
authors.initials: A
authors.lastname: Jaramillo
authors.forename: Mikael
authors.initials: M
authors.lastname: Mazighi
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Touboul
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002544:Cerebral Infarction / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D020521:Stroke