Hur Jin, Lee Kye Ho, Hong Sae Rom, Suh Young Joo, Hong Yoo Jin, Lee Hye-Jeong, Kim Young Jin, Lee Hye Sun, Chang Hyuk-Jae, Choi Byoung Wook
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.
Atherosclerosis. 2015 Feb;238(2):271-7. doi: 10.1016/j.atherosclerosis.2014.10.102. Epub 2014 Nov 4.
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.
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.
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).
In ischemic stroke patients without chest pain, CCTA findings of CAD provide additional risk-discrimination over CACS.
冠状动脉计算机断层扫描血管造影（CCTA）在卒中患者中的预测价值尚未明确。我们研究了CCTA检测冠状动脉疾病（CAD）的预后价值，并确定了与冠状动脉钙化积分（CACS）相比，CCTA结果在无胸痛的缺血性卒中患者中增加风险分层的益处。
在914例连续的缺血性卒中患者中，前瞻性纳入317例（68.5%为男性，平均年龄64岁）至少有一项CAD临床危险因素且无胸痛的患者，进行CCTA检查。对CT图像评估CACS、CAD的存在情况及CAD的范围。主要终点是主要不良心脏事件（MACE），定义为心脏死亡、非致死性心肌梗死、需要住院治疗的不稳定型心绞痛或自索引CCTA起90天后的血运重建。
CACS≥1的患病率为73.1%（232/317），平均CACS为346.6±693.5（阿加斯顿单位）。在409天的中位随访期内，共有26例MACE。CACS[CAC（101 - 400，及>400）]和CCTA结果[存在阻塞性CAD、单支血管病变（VD）、双支血管病变和三支血管病变]均独立地对未来MACE的风险进行分层（所有p<0.05）。时间依赖性受试者工作特征曲线分析显示，基于CCTA的CAD结果（存在阻塞性CAD和受累血管数量）在临床危险因素和CACS之外改善了风险分层（iAUC：0.863对0.752，p<0.05）。
在无胸痛的缺血性卒中患者中，CCTA的CAD结果比CACS提供了额外的风险鉴别。
