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Prognostic value of coronary computed tomography angiography in stroke patients.
Atherosclerosis. 2015 Feb; 238(2):271-7.A

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).

CONCLUSION

In ischemic stroke patients without chest pain, CCTA findings of CAD provide additional risk-discrimination over CACS.

Authors+Show Affiliations

Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.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.Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.Department of Biostatistics, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Republic of Korea.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.

Pub Type(s)

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

Language

eng

PubMed ID

25544177

Citation

Hur, Jin, et al. "Prognostic Value of Coronary Computed Tomography Angiography in Stroke Patients." Atherosclerosis, vol. 238, no. 2, 2015, pp. 271-7.
Hur J, Lee KH, Hong SR, et al. Prognostic value of coronary computed tomography angiography in stroke patients. Atherosclerosis. 2015;238(2):271-7.
Hur, J., Lee, K. H., Hong, S. R., Suh, Y. J., Hong, Y. J., Lee, H. J., Kim, Y. J., Lee, H. S., Chang, H. J., & Choi, B. W. (2015). Prognostic value of coronary computed tomography angiography in stroke patients. Atherosclerosis, 238(2), 271-7. https://doi.org/10.1016/j.atherosclerosis.2014.10.102
Hur J, et al. Prognostic Value of Coronary Computed Tomography Angiography in Stroke Patients. Atherosclerosis. 2015;238(2):271-7. PubMed PMID: 25544177.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prognostic value of coronary computed tomography angiography in stroke patients. AU - Hur,Jin, AU - Lee,Kye Ho, AU - Hong,Sae Rom, AU - Suh,Young Joo, AU - Hong,Yoo Jin, AU - Lee,Hye-Jeong, AU - Kim,Young Jin, AU - Lee,Hye Sun, AU - Chang,Hyuk-Jae, AU - Choi,Byoung Wook, Y1 - 2014/11/04/ PY - 2014/06/27/received PY - 2014/10/28/revised PY - 2014/10/28/accepted PY - 2014/12/30/entrez PY - 2014/12/30/pubmed PY - 2015/9/22/medline KW - Coronary artery disease (CAD) KW - Coronary computed tomography angiography (CCTA) KW - Major adverse cardiac events (MACE) KW - Prognosis KW - Stroke SP - 271 EP - 7 JF - Atherosclerosis JO - Atherosclerosis VL - 238 IS - 2 N2 - 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). CONCLUSION: In ischemic stroke patients without chest pain, CCTA findings of CAD provide additional risk-discrimination over CACS. SN - 1879-1484 UR - https://www.unboundmedicine.com/medline/citation/25544177/Prognostic_value_of_coronary_computed_tomography_angiography_in_stroke_patients_ DB - PRIME DP - Unbound Medicine ER -