Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke

Abstract

Stroke and myocardial infarction (MI) share common risk factors and pathological mechanisms, and coronary artery disease (CHD) is an important cause of death in patients with cerebrovascular disease. This Scientific Statement addresses issues in management of the relatively healthy patient with brain ischemia (a transient ischemic attack [TIA] or an ischemic stroke) who does not have recognized CHD but often has risk factors in addition to having had a TIA or stroke that indicate an increased likelihood of disability or death from cardiac disease in the future. This Statement should not be confused with the official American College of Cardiology (ACC)/American Heart Association (AHA) practice guidelines. The reader is referred to the ACC/AHA guidelines for management of recognized and symptomatic CHD 1 and the American College of Chest Physicians (ACCP) 2 and American Stroke Association (ASA) 3-5 guidelines for evaluation of cardiac causes of TIA and stroke, which are important related but separate issues.

Cardiac Vulnerability to Cerebrogenic Stress as a Possible Cause of Troponin Elevation in Stroke

“…Stroke and myocardial infarction share common risk factors and pathological mechanisms;1 therefore, a higher proportion of patients with ischemic stroke have concomitant coronary artery disease, which in turn leads to an increased risk of death as well as development of ischemic stroke 2. Thus, since 2007, the guidelines for the management of ischemic stroke recommend to perform a 12‐lead electrocardiography and cardiac enzyme test,3, 4 particularly cardiac troponin, which is a highly sensitive and specific biomarker of myocardial damage 5…”

Silent Coronaropathy: Usefulness of Dobutamine Stress Echocardiography in Ischemic Stroke

“…Data from several studies [1] suggest that 25–60% of patients with carotid disease and no symptoms of coronary heart disease (CHD) have abnormal provocative test results for myocardial ischemia or angiographic evidence of severe CHD. Medical treatment and revascularization procedures affect the outcome of asymptomatic CAD beyond risk factor reduction [1].…”

“…Coronary artery disease (CAD) is an important cause of death in patients with cerebrovascular disease [1]. The risk of cardiac-related events after stroke in the intermediate term (30 days to 2 years) in patients treated with antiplatelet agents without an established history of cardiovascular disease is in the range of 2–3% per year [1].…”

“…The risk of cardiac-related events after stroke in the intermediate term (30 days to 2 years) in patients treated with antiplatelet agents without an established history of cardiovascular disease is in the range of 2–3% per year [1]. Several studies have shown that patients with transient ischemic attack (TIA) and stroke may have asymptomatic CAD [2,3,4,5,6].…”

“…Several studies have shown that patients with transient ischemic attack (TIA) and stroke may have asymptomatic CAD [2,3,4,5,6]. The frequency of abnormal tests for silent cardiac ischemia in stroke patients may range from 20 to 40% [1]. This variation may be related to the use of different methods and the prevalence of CAD in the population tested.…”