Choi Hye-Yeon, Shin Soo Jeong, Yoo Joonsang, Lee Kijeong, Song Dongbeom, Kim Young Dae, Nam Hyo Suk, Lee Kyung Yul, Lee Hye Sun, Kim Dong Joon, Heo Ji Hoe
Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea.
Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
Front Neurol. 2020 Mar 27;11:206. doi: 10.3389/fneur.2020.00206. eCollection 2020.
Many patients with ischemic stroke have concomitant coronary artery disease (CAD). However, it remains unclear which stroke patients should undergo evaluation for asymptomatic CAD, and which screening tools are appropriate. We investigated the role of coronary artery calcium (CAC) score as a screening tool for asymptomatic but severe CAD in acute stroke patients. We determined the selection criteria for CAC screening based on risk factors and cerebral atherosclerosis. The present study included consecutive patients with acute stroke who had undergone cerebral angiography and multi-detector computed tomography coronary angiography. Severe CAD was defined as left main artery disease or three-vessel disease. Enrolled patients were randomly assigned to two sets; a set for developing selection criteria and a set for validation. To develop selection criteria, we identified associated factors with severe CAD regarding clinical factors and cerebral atherosclerosis. CAD predictability of selection criteria with the CAC score was calculated. Overall, 2,658 patients were included. Severe CAD was present in 360 patients (13.5%). CAC score was associated with CAD severity ( < 0.001). In the development set ( = 1,860), severe CAD was associated with age >65 years [odds ratio (95% confidence interval), 2.62 (1.93-3.55)], male sex (1.81 [1.33-2.46]), dyslipidemia (1.77 [1.25-2.61]), peripheral artery disease (2.64 [1.37-5.06]) and stenosis in the cervicocephalic branches, including the internal carotid (2.79 [2.06-3.78]) and vertebrobasilar arteries (2.08 [1.57-2.76]). We determined the combination of clinical and arterial factors as the selection criteria for CAC evaluation. The cut-off criterion was two or more elements of the selection criteria. The area under the curve (AUC) of the selection criteria was 0.701. The AUC significantly improved to 0.836 when the CAC score was added ( < 0.001). In the validation set ( = 798), the AUC of the selection criteria only was 0.661, and that of the CAC score was 0.833. The AUC of the selection criteria + CAC score significantly improved to 0.861( < 0.001). The necessity for CAC evaluation could be determined based on the presence of risk factors and significant stenosis of the cervicocephalic arteries. CAC evaluation may be useful for screening for severe CAD in stroke patients.
许多缺血性中风患者同时患有冠状动脉疾病（CAD）。然而，尚不清楚哪些中风患者应接受无症状CAD的评估，以及哪些筛查工具是合适的。我们研究了冠状动脉钙化（CAC）评分作为急性中风患者无症状但严重CAD筛查工具的作用。我们根据危险因素和脑动脉粥样硬化确定了CAC筛查的选择标准。本研究纳入了连续接受脑血管造影和多排螺旋CT冠状动脉造影的急性中风患者。严重CAD定义为左主干动脉疾病或三支血管疾病。入选患者被随机分为两组；一组用于制定选择标准和一组用于验证。为了制定选择标准，我们确定了与严重CAD相关的临床因素和脑动脉粥样硬化的相关因素。计算了选择标准与CAC评分对CAD的预测性。总体而言，共纳入2658例患者。360例患者（13.5%）存在严重CAD。CAC评分与CAD严重程度相关（<0.001）。在开发组（n = 1860）中，严重CAD与年龄>65岁[比值比（95%置信区间），2.62（1.93 - 3.55）]、男性（1.81[1.33 - 2.46]）、血脂异常（1.77[1.25 - 2.61]）、外周动脉疾病（2.64[1.37 - 5.06]）以及包括颈内动脉（2.79[2.06 - 3.78]）和椎基底动脉（2.08[1.57 - 2.76]）在内的颈脑分支狭窄有关。我们确定了临床和动脉因素的组合作为CAC评估的选择标准。截断标准是选择标准中的两个或更多要素。选择标准的曲线下面积（AUC）为0.701。加入CAC评分后，AUC显著提高至0.836（<0.001）。在验证组（n = 798）中，仅选择标准的AUC为0.661，CAC评分的AUC为0.833。选择标准 + CAC评分的AUC显著提高至0.861（<0.001）。可以根据危险因素的存在和颈脑动脉的显著狭窄来确定进行CAC评估的必要性。CAC评估可能有助于筛查中风患者的严重CAD。
