Increased Risk of Cardiovascular Events in Stroke Patients Who had Not Undergone Evaluation for Coronary Artery Disease

• Published in: Yonsei medical journal Vol. 58; no. 1; pp. 114 - 122
• Main Authors: Kim, Young Dae, Song, Dongbeom, Nam, Hyo Suk, Choi, Donghoon, Kim, Jung-Sun, Kim, Byeong-Keuk, Chang, Hyuk-Jae, Choi, Hye-Yeon, Lee, Kijeong, Yoo, Joonsang, Lee, Hye Sun, Nam, Chung Mo, Heo, Ji Hoe
• Format: Journal Article
• Language: English
• Published: Korea (South) Yonsei University College of Medicine 01.01.2017; 연세대학교의과대학
• Subjects: Asymptomatic Diseases; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Female; Follow-Up Studies; Humans; Male; Multidetector Computed Tomography - utilization; Original; Propensity Score; Proportional Hazards Models; Prospective Studies; Recurrence; Retrospective Studies; Risk Assessment; Risk Factors; Stroke - complications; Stroke - mortality; 의학일반; coronary disease; Stroke; multi-detector coronary computed tomography; outcome
• ISSN: 0513-5796; 1976-2437; 1976-2437
• DOI: 10.3349/ymj.2017.58.1.114

Although asymptomatic coronary artery occlusive disease is common in stroke patients, the long-term advantages of undergoing evaluation for coronary arterial disease using multi-detector coronary computed tomography (MDCT) have not been well established in stroke patients. We compared long-term cardio-cerebrovascular outcomes between patients who underwent MDCT and those who did not. This was a retrospective study in a prospective cohort of consecutive ischemic stroke patients. Of the 3117 patients who were registered between July 2006 and December 2012, MDCT was performed in 1842 patients [MDCT (+) group] and not in 1275 patients [MDCT (-) group]. Occurrences of death, cardiovascular events, and recurrent stroke were compared between the groups using Cox proportional hazards models and propensity score analyses. During the mean follow-up of 38.0±24.8 months, 486 (15.6%) patients died, recurrent stroke occurred in 297 (9.5%), and cardiovascular events occurred in 60 patients (1.9%). Mean annual risks of death (9.34% vs. 2.47%), cardiovascular events (1.2% vs. 0.29%), and recurrent stroke (4.7% vs. 2.56%) were higher in the MDCT (-) group than in the MDCT (+) group. The Cox proportional hazards model and the five propensity score-adjusted models consistently demonstrated that the MDCT (-) group was at a high risk of cardiovascular events (hazard ratios 3.200, 95% confidence interval 1.172-8.735 in 1:1 propensity matching analysis) as well as death. The MDCT (-) group seemed to also have a higher risk of recurrent stroke. Acute stroke patients who underwent MDCT experienced fewer deaths, cardiovascular events, and recurrent strokes during follow-up.