title: Prognostic value of coronary computed tomography angiography in stroke patients.
abstract: OBJECTIVE
  The predictive value of coronary computed tomography angiography (CCTA) in stroke patients has not yet been established. We investigated the prognostic value of coronary artery disease (CAD) detection by CCTA, and determined the incremental risk stratification benefit of CCTA findings as compared to coronary artery calcium scores (CACS) in ischemic stroke patients without chest pain.
  
  
  METHODS
  Among 914 consecutive ischemic stroke patients, 317 (68.5% were male with a mean age of 64 years) who had at least one clinical risk factor for CAD without chest pain were prospectively enrolled to undergo CCTA. CT images were assessed for CAC, presence of CAD and extent of CAD. The primary endpoint was major adverse cardiac events (MACEs) defined as cardiac death, non-fatal myocardial infarction, unstable angina requiring hospitalization, or revascularization after 90 days from index CCTA.
  
  
  RESULTS
  The prevalence of CAC ≥1 was 73.1% (232/317) and the average CACS was 346.6 ± 693.5 (Agatston unit). During the median follow-up period of 409 days, there were a total of 26 MACEs. Both CACS [CAC (101-400, and >400)] and CCTA findings [presence of obstructive CAD, 1-vessel disease (VD), 2-VD, and 3-VD] independently stratified risk of future MACEs (all p < 0.05). The time-dependent receiver operating characteristic curve analysis revealed that CAD findings (presence of obstructive CAD and number of involved vessels) based on CCTA improved risk stratification beyond clinical risk factors and CACS (iAUC: 0.863 vs 0.752, p < 0.05).
  
  
  CONCLUSIONS
  In ischemic stroke patients without chest pain, CCTA findings of CAD provide additional risk-discrimination over CACS.
authors.affiliation: Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jin
authors.initials: J
authors.lastname: Hur
authors.affiliation: Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Dankook University Hospital, Cheonan City, Chungnam Province, Republic of Korea.
authors.forename: Kye Ho
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sae Rom
authors.initials: SR
authors.lastname: Hong
authors.affiliation: Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Young Joo
authors.initials: YJ
authors.lastname: Suh
authors.affiliation: Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Yoo Jin
authors.initials: YJ
authors.lastname: Hong
authors.affiliation: Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hye-Jeong
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Biostatistics, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hyuk-Jae
authors.initials: HJ
authors.lastname: Chang
authors.affiliation: Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: bchoi@yuhs.ac.
authors.forename: Byoung Wook
authors.initials: BW
authors.lastname: Choi
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000401:mortality / Q000628:therapy; D019540:Area Under Curve; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality; D005260:Female; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging* / Q000401:mortality; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000401:mortality
keywords: Coronary artery disease (CAD); Coronary computed tomography angiography (CCTA); Major adverse cardiac events (MACE); Prognosis; Stroke