Comprehensive Evaluation of Coronary Artery Disease and Aortic Atherosclerosis in Acute Ischemic Stroke Patients: Usefulness Based on Framingham Risk Score and Stroke Subtype

Cho, Hyun-Ji; Lee, Joon‐Hwa; Kim, Young‐Jin; Moon, Yeonsil; Ko, Sung Min; Kim, Hahn Young

doi:10.1159/000326075

Cited by 19 publications

(22 citation statements)

References 75 publications

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“…In a recent study of Cho et al [18], 22.3% of patients with acute IS had an unknown CAD. They performed dual-source CT to identify these patients (high-risk patients).…”

Section: Discussionmentioning

confidence: 99%

What Does Elevated High-Sensitive Troponin I in Stroke Patients Mean: Concomitant Acute Myocardial Infarction or a Marker for High-Risk Patients

et al. 2013

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Background: Acute ischemic stroke patients may occasionally suffer from concomitant acute coronary syndrome (ACS). Troponin I and T are established biomarkers to detect ACS. Recently introduced high-sensitive cardiac troponin (hs-TNI and hs-TNT) assays are increasingly used to identify ACS in stroke patients even without signs or symptoms of ACS. These new test systems very often detect elevated values of hs-troponin, although clinical relevance and consequences of elevated hs-TNI values in these patients are unclear so far. Patients and Methods: We examined hs-TNI values in 834 consecutive ischemic stroke patients admitted to our Comprehensive Stroke Center during a 1-year period. hs-TNI was measured immediately after admission and after 3 h if initial hs-TNI was elevated above the 99th percentile of normal values (>0.045 ng/ml). Patients with elevated values were divided into two groups: (1) constant and (2) dynamic hs-TNI values. The dynamic approach was defined as a 30% rise or fall of the hs-TNI value above the critical value within 3 h. All patients received stroke diagnostic and continuous monitoring according to international stroke unit standards, including a 12-lead ECG, blood pressure, body temperature and continuous ECG monitoring, as well as regular 6-hourly neurological and general physical examination (including NIHSS scores). The cardiologists - as members of the Stroke Unit team - evaluated clinical symptoms/examination, as well as laboratory, echocardiographic and ECG findings for the diagnosis of ACS. Results: 172/834 (20.6%) patients showed elevated hs-TNI levels on admission. Patients with elevated hs-TNI values exhibited a significantly (p < 0.001) increased rate of hypertension (89 vs. 77.2%), history of stroke (24.4 vs. 14.8%), history of coronary artery disease (65.7 vs. 34.1%), history of myocardial infarction (22.1 vs. 7.6%), heart failure (12.8 vs. 5.7%) and atrial fibrillation (44.2 vs. 23.6%). 82/136 patients showed constant and 54/136 patients dynamic hs-TNI values: among the latter, 5 patients were diagnosed with ST segment elevation myocardial infarction (STEMI) and 24 with non-STEMI (NSTEMI). Conclusion: Our data demonstrate that hs-TNI was elevated in about 20.6% of acute ischemic stroke patients but therapeutically relevant ACS was diagnosed only in the dynamic group. hs-TNI elevations without dynamic changes may occur in stroke patients without ACS due to different reasons that stress the heart. Therefore, we suppose that hs-TNI is a sensitive marker to detect high-risk patients but serial measurements are mandatory and expert cardiological workup is essential for best medical treatment and to accurately diagnose ACS in acute ischemic stroke patients.

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“…In a recent study of Cho et al [18], 22.3% of patients with acute IS had an unknown CAD. They performed dual-source CT to identify these patients (high-risk patients).…”

Section: Discussionmentioning

confidence: 99%

What Does Elevated High-Sensitive Troponin I in Stroke Patients Mean: Concomitant Acute Myocardial Infarction or a Marker for High-Risk Patients

et al. 2013

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“…For the purpose of this study, we used data of women between 55 and 75 years old and of men between 45 and 75 years old. 6,10 Cervicocephalic atherosclerosis and coronary artery stenosis were categorized using the same criteria as those used in the derivation cohort.…”

Section: Validation Cohortmentioning

confidence: 99%

Predicting Asymptomatic Coronary Artery Diseasein Patients With Ischemic Stroke and Transient Ischemic Attack

Calvet

Song

Yoo

et al. 2014

Stroke

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“…MSCT coronary angiography is an attractive diagnostic tool for detecting coronary atherosclerosis because it is noninvasive and has a sensitivity of 85–97% and a specificity of 90–98% in the detection of obstructive CAD when compared with conventional coronary angiography [15,16,17,18]. Due to these advantages, MSCT coronary angiography was recently introduced to evaluate the presence of CAD in ischemic stroke patients [19,20,21]. …”

Section: Introductionmentioning

confidence: 99%

The Frequency and Risk of Preclinical Coronary Artery Disease Detected Using Multichannel Cardiac Computed Tomography in Patients with Ischemic Stroke

Yoo

Yang

Choi³

et al. 2012

Cerebrovasc Dis

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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.

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Comprehensive Evaluation of Coronary Artery Disease and Aortic Atherosclerosis in Acute Ischemic Stroke Patients: Usefulness Based on Framingham Risk Score and Stroke Subtype

Cited by 19 publications

References 75 publications

What Does Elevated High-Sensitive Troponin I in Stroke Patients Mean: Concomitant Acute Myocardial Infarction or a Marker for High-Risk Patients

What Does Elevated High-Sensitive Troponin I in Stroke Patients Mean: Concomitant Acute Myocardial Infarction or a Marker for High-Risk Patients

Predicting Asymptomatic Coronary Artery Diseasein Patients With Ischemic Stroke and Transient Ischemic Attack

The Frequency and Risk of Preclinical Coronary Artery Disease Detected Using Multichannel Cardiac Computed Tomography in Patients with Ischemic Stroke

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