Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, Republic of Korea; Department of Neurology, Keimyung University College of Medicine, 56 Dalseong-ro, Jung-gu, Daegu, Republic of Korea.
Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, Republic of Korea.
Atherosclerosis. 2017 Oct;265:7-13. doi: 10.1016/j.atherosclerosis.2017.07.029. Epub 2017 Jul 29.
Although stroke patients have a high risk of ischemic heart disease, little information is available on the risk of coronary events in stroke patients with asymptomatic coronary artery disease (CAD). We investigated the long-term vascular outcomes in stroke patients with asymptomatic CAD diagnosed with multi-detector coronary computed tomography (MDCT).
This study was a retrospective analysis using a prospective cohort of ischemic stroke patients. We included consecutive stroke patients without history or symptoms of CAD who underwent MDCT. We investigated the long-term risk of major adverse cardiovascular events (MACE: cardiovascular mortality, ischemic stroke, myocardial infarction, unstable angina, and urgent coronary revascularization) and composite of MACE/all-cause mortality/elective coronary revascularization. We further investigated the value of MDCT for MACE prediction.
Among the 1893 included patients, 1349 (71.3%) patients had some degree of CAD and 654 patients (34.5%) had significant (≥50%) CAD. At follow-up (median, 4.4 years), MACE occurred in 230 patients (12.2%). Event rates of MACE increased with the increasing extent of CAD. After adjustment for age, sex, and risk factors, the hazard ratios for MACE in mild CAD, 1-VD, 2-VD, and 3-VD or left main coronary disease were 1.28 (95% confidence interval [CI]: 0.88-1.87), 1.39 (95% CI: 0.90-2.16), 2.22 (95% CI: 1.39-3.55), and 2.91 (95% CI: 1.82-4.65), respectively (no CAD as a reference). Diagnosis of asymptomatic CAD significantly improved the prediction of MACE.
Asymptomatic CAD detected on MDCT was associated with increased risks of vascular events or deaths in acute stroke patients.
尽管中风患者发生缺血性心脏病的风险较高，但关于无症状性冠状动脉疾病（CAD）的中风患者发生冠状动脉事件的风险信息较少。我们通过多排螺旋 CT（MDCT）研究了诊断为无症状 CAD 的中风患者的长期血管预后。
这是一项回顾性分析，使用缺血性中风患者的前瞻性队列。我们纳入了连续的无 CAD 病史或症状的中风患者，这些患者均接受 MDCT 检查。我们研究了主要不良心血管事件（MACE：心血管死亡率、缺血性中风、心肌梗死、不稳定型心绞痛和紧急冠状动脉血运重建）和 MACE/全因死亡率/择期冠状动脉血运重建的复合终点的长期风险。我们进一步研究了 MDCT 对 MACE 预测的价值。
在纳入的 1893 例患者中，1349 例（71.3%）患者存在一定程度的 CAD，654 例（34.5%）患者存在显著（≥50%）CAD。在随访（中位数为 4.4 年）期间，230 例患者发生了 MACE（12.2%）。MACE 的发生率随着 CAD 程度的增加而增加。在校正年龄、性别和危险因素后，轻度 CAD、1 支血管病变、2 支血管病变、3 支血管病变或左主干病变患者的 MACE 风险比分别为 1.28（95%置信区间：0.88-1.87）、1.39（95%置信区间：0.90-2.16）、2.22（95%置信区间：1.39-3.55）和 2.91（95%置信区间：1.82-4.65）（无 CAD 作为参考）。无症状 CAD 的诊断显著提高了 MACE 的预测能力。
MDCT 检测到的无症状 CAD 与急性中风患者发生血管事件或死亡的风险增加相关。
