title: Coronary artery disease and risk of major vascular events after cerebral infarction.
abstract: OBJECTIVE
  The impact of asymptomatic coronary artery disease on the risk of major vascular events in patients with cerebral infarction is unknown.
  
  
  METHODS
  Four hundred five patients with acute cerebral infarction underwent carotid, femoral artery, thoracic, and abdominal aorta ultrasound examination. Of 342 patients with no known coronary heart disease, 315 underwent coronary angiography. We evaluated the 2-year risk of major vascular events (myocardial infarction, resuscitation after cardiac arrest, hospitalization for unstable angina or heart failure, stroke, or major peripheral arterial disease events) in patients with known coronary heart disease (n=63), and in the no known coronary heart disease group (n=315) as a function of coronary angiographic status (n=315).
  
  
  RESULTS
  At 2 years, the estimated risk of major vascular events was 11.0% (95% confidence interval, 8.2-14.7). According to baseline coronary angiography, estimated risk was 3.4% in patients with no coronary artery disease (n=120), 8.0% with asymptomatic coronary artery stenosis <50% (n=113), 16.2% with asymptomatic coronary artery stenosis ≥ 50% (n=81), and 24.1% with known coronary heart disease (P<0.0001). Using no coronary artery disease as the reference, the age- and sex-adjusted hazard ratio (95% confidence interval) of vascular events was 2.10 (0.63-6.96) for asymptomatic coronary stenosis <50%, 4.36 (1.35-14.12) for asymptomatic coronary stenosis ≥ 50%, and 6.86 (2.15-21.31) for known coronary artery disease.
  
  
  CONCLUSIONS
  In patients with nonfatal cerebral infarction, presence and extent of asymptomatic stenoses on coronary angiography are strong predictors of major vascular events within 2 years.
authors.affiliation: INSERM U 698, 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: Céline
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: Halim
authors.initials: H
authors.lastname: Abboud
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Olivot
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: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002544:Cerebral Infarction / Q000150:complications* / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000453:epidemiology*; D003331:Coronary Vessels; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000453:epidemiology*; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography
keywords: atherosclerosis; cerebral infarction; infarction