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Yonsei Med J. 2017 Jan;58(1):114-122. doi: 10.3349/ymj.2017.58.1.114.

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

Author information

1
Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
2
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
3
Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
4
Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea.
5
Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
6
Department of Neurology, Yonsei University College of Medicine, Seoul, Korea. jhheo@yuhs.ac.

Abstract

PURPOSE:

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.

MATERIALS AND METHODS:

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.

RESULTS:

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.

CONCLUSION:

Acute stroke patients who underwent MDCT experienced fewer deaths, cardiovascular events, and recurrent strokes during follow-up.

KEYWORDS:

Stroke; coronary disease; multi-detector coronary computed tomography; outcome

PMID:
27873503
PMCID:
PMC5122626
DOI:
10.3349/ymj.2017.58.1.114
[Indexed for MEDLINE]
Free PMC Article

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