title: The frequency and risk of preclinical coronary artery disease detected using multichannel cardiac computed tomography in patients with ischemic stroke.
abstract: BACKGROUND
  Atherosclerosis is a systemic disease. Many ischemic stroke patients may have concomitant coronary artery disease (CAD). Detection and treatment of preclinical CAD in stroke patients may improve long-term outcome and survival because CAD is a major cause of death during follow-up in stroke patients. However, association between coronary and cerebral artery atherosclerosis in stroke patients has not fully been investigated. This study aimed at examining the frequency and high-risk groups of CAD in ischemic stroke patients.
  
  
  METHODS
  Consecutive patients who were admitted due to acute ischemic stroke between July 2006 and June 2010 were prospectively enrolled in this study. A total of 1,304 patients who underwent MSCT coronary angiography and cerebral angiography were included in this study. By using 64-multislice computed tomography coronary angiography, we investigated the frequency of CAD and association between coronary and cerebral artery atherosclerosis in terms of location and burden (severity and extent) in stroke patients. We also sought to identify high-risk groups for CAD among stroke patients.
  
  
  RESULTS
  The frequency of significant (≥50%) CAD was 32.3% and the frequency of any degree of CAD was 70.1%. Diabetes mellitus, serum levels of total cholesterol, high-density lipoprotein cholesterol and triglyceride, and significant stenosis of the extracranial carotid, intracranial vertebral and basilar arteries were independently associated with CAD. However, no association was found between CAD and significant stenosis of the anterior, middle and posterior cerebral arteries. The association between CAD and cerebral atherosclerosis was stronger with increased severity and extent of cerebral atherosclerosis. When compared to patients with <2 risk factors and without significant cerebral atherosclerosis, those with multiple (≥2) risk factors and atherosclerosis in both the carotid and the vertebrobasilar arteries had very high risks of CAD [odds ratio (OR) 8.36; 95% confidence interval (CI) 4.15-16.87]. The risk was also high in patients with multiple risk factors and atherosclerosis in either the carotid or the vertebrobasilar artery (OR 4.13; 95% CI 2.62-6.51), and in those with <2 risk factors but atherosclerosis in both the carotid and the vertebrobasilar arteries (OR 3.40; 95% CI 1.22-9.47).
  
  
  CONCLUSIONS
  A substantial portion of stroke patients had preclinical CAD, and there was a clear relationship between coronary and cerebral artery atherosclerosis in terms of location and burden. The risk of CAD was particularly high in stroke patients with multiple risk factors and atherosclerosis of the carotid and/or vertebrobasilar arteries.
authors.affiliation: Department of Neurology, Severance Integrative Research Institute for Cerebral and Cardiovascular Disease, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Joonsang
authors.initials: J
authors.lastname: Yoo
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Yang
authors.forename: Byoung Wook
authors.initials: BW
authors.lastname: Choi
authors.forename: Young Dae
authors.initials: YD
authors.lastname: Kim
authors.forename: Hyo Suk
authors.initials: HS
authors.lastname: Nam
authors.forename: Hye-Yeon
authors.initials: HY
authors.lastname: Choi
authors.forename: Hyun-Ji
authors.initials: HJ
authors.lastname: Cho
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.forename: Myoung-Jin
authors.initials: MJ
authors.lastname: Cha
authors.forename: Donghoon
authors.initials: D
authors.lastname: Choi
authors.forename: Chung Mo
authors.initials: CM
authors.lastname: Nam
authors.forename: Yangsoo
authors.initials: Y
authors.lastname: Jang
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Lee
authors.forename: Jinkwon
authors.initials: J
authors.lastname: Kim
authors.forename: Ji Hoe
authors.initials: JH
authors.lastname: Heo
mesh_terms: D000368:Aged; D002536:Cerebral Arteries / Q000000981:diagnostic imaging; D015897:Comorbidity; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000453:epidemiology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology*