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Incidence of subclinical coronary atherosclerosis in patients with suspected embolic stroke using cardiac computed tomography.
Int J Cardiovasc Imaging. 2011 Oct; 27(7):1035-44.IJ

Abstract

The purpose of this study was to investigate the incidence of subclinical coronary artery disease (CAD) in patients with suspected acute embolic stroke or transient ischemic attack (TIA) using 64-row multi-slice computed tomography (MSCT) and to examine its association with conventional risk stratification. We consecutively enrolled 175 patients (66 ± 13 years, 50% men) suspected to have had embolic stroke/TIA clinically or radiologically, and underwent 64-row MSCT to evaluate for a possible cardiac source of embolism. Both coronary artery calcium scoring (CACS) and coronary CT angiography (CCTA) were concurrently performed based on standard scanning protocols. Patients with a history of angina or documented CAD, and those with significant carotid stenosis were excluded. Atherosclerotic plaques were indentified in 105 (60%) individuals; 37 (21%) had occult CAD of ≥50% diameter stenosis on CCTA. Subjects with and without ≥50% occult CAD on CCTA had similar prevalence of cardiovascular risk factors. Thirty out of 175 (17%) individuals with ≥50% occult CAD would have missed further cardiac testing based on the American Heart association and the American Stroke Association guideline. However, these numbers would be reduced to 2% (4/175) using CACS. In logistic regression analysis, only CACS independently predicted the presence ≥50% occult CAD evidenced by CCTA. Subclinical CAD, including ≥50% stenotic disease, is highly prevalent in patients who had suffered a suspected embolic stroke. The current guideline for further cardiac testing may have limited value to identify patients with ≥50% CAD in this patient population, which can be improved by adopting CACS.

Authors+Show Affiliations

Division of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, South Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21063781

Citation

Yoon, Yeonyee E., et al. "Incidence of Subclinical Coronary Atherosclerosis in Patients With Suspected Embolic Stroke Using Cardiac Computed Tomography." The International Journal of Cardiovascular Imaging, vol. 27, no. 7, 2011, pp. 1035-44.
Yoon YE, Chang HJ, Cho I, et al. Incidence of subclinical coronary atherosclerosis in patients with suspected embolic stroke using cardiac computed tomography. Int J Cardiovasc Imaging. 2011;27(7):1035-44.
Yoon, Y. E., Chang, H. J., Cho, I., Jeon, K. H., Chun, E. J., Choi, S. I., Bae, H. J., Rivera, J. J., Nasir, K., Blumenthal, R. S., & Lim, T. H. (2011). Incidence of subclinical coronary atherosclerosis in patients with suspected embolic stroke using cardiac computed tomography. The International Journal of Cardiovascular Imaging, 27(7), 1035-44. https://doi.org/10.1007/s10554-010-9743-8
Yoon YE, et al. Incidence of Subclinical Coronary Atherosclerosis in Patients With Suspected Embolic Stroke Using Cardiac Computed Tomography. Int J Cardiovasc Imaging. 2011;27(7):1035-44. PubMed PMID: 21063781.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence of subclinical coronary atherosclerosis in patients with suspected embolic stroke using cardiac computed tomography. AU - Yoon,Yeonyee E, AU - Chang,Hyuk-Jae, AU - Cho,Iksung, AU - Jeon,Ki-Hyun, AU - Chun,Eun-Ju, AU - Choi,Sang-Il, AU - Bae,Hee-Jun, AU - Rivera,Juan J, AU - Nasir,Khurram, AU - Blumenthal,Roger S, AU - Lim,Tae-Hwan, Y1 - 2010/11/10/ PY - 2010/05/17/received PY - 2010/10/27/accepted PY - 2010/11/11/entrez PY - 2010/11/11/pubmed PY - 2012/2/7/medline SP - 1035 EP - 44 JF - The international journal of cardiovascular imaging JO - Int J Cardiovasc Imaging VL - 27 IS - 7 N2 - The purpose of this study was to investigate the incidence of subclinical coronary artery disease (CAD) in patients with suspected acute embolic stroke or transient ischemic attack (TIA) using 64-row multi-slice computed tomography (MSCT) and to examine its association with conventional risk stratification. We consecutively enrolled 175 patients (66 ± 13 years, 50% men) suspected to have had embolic stroke/TIA clinically or radiologically, and underwent 64-row MSCT to evaluate for a possible cardiac source of embolism. Both coronary artery calcium scoring (CACS) and coronary CT angiography (CCTA) were concurrently performed based on standard scanning protocols. Patients with a history of angina or documented CAD, and those with significant carotid stenosis were excluded. Atherosclerotic plaques were indentified in 105 (60%) individuals; 37 (21%) had occult CAD of ≥50% diameter stenosis on CCTA. Subjects with and without ≥50% occult CAD on CCTA had similar prevalence of cardiovascular risk factors. Thirty out of 175 (17%) individuals with ≥50% occult CAD would have missed further cardiac testing based on the American Heart association and the American Stroke Association guideline. However, these numbers would be reduced to 2% (4/175) using CACS. In logistic regression analysis, only CACS independently predicted the presence ≥50% occult CAD evidenced by CCTA. Subclinical CAD, including ≥50% stenotic disease, is highly prevalent in patients who had suffered a suspected embolic stroke. The current guideline for further cardiac testing may have limited value to identify patients with ≥50% CAD in this patient population, which can be improved by adopting CACS. SN - 1875-8312 UR - https://www.unboundmedicine.com/medline/citation/21063781/Incidence_of_subclinical_coronary_atherosclerosis_in_patients_with_suspected_embolic_stroke_using_cardiac_computed_tomography_ L2 - https://doi.org/10.1007/s10554-010-9743-8 DB - PRIME DP - Unbound Medicine ER -