Jibril Khuluud Abdi, Kuiper Kier Jan, Nawaz Beenish, Naess Halvor, Fromm Annette, Øygarden Halvor, Sand Kristin Modalsli, Meijer Rudy, Mohamed Ali Abukar, Larsen Terje H, Bleie Øyvind, Skaar Elisabeth, Waje-Andreassen Ulrike, Saeed Sahrai
Department of Heart Disease Haukeland University Hospital Bergen Norway.
Department of Neurology Haukeland University Hospital Bergen Norway.
J Am Heart Assoc. 2025 Mar 18;14(6):e038899. doi: 10.1161/JAHA.124.038899. Epub 2025 Mar 13.
Studies in young patients with stroke identified coronary artery disease (CAD) as a main contributor to mortality. In the present NOR-SYS (Norwegian Stroke in the Young Study), we aimed to investigate the prevalence of CAD, and the impact on new vascular events and mortality.
A total of 385 patients with ischemic stroke, aged ≤60 years, were included. CAD was defined as a history of CAD or positive coronary imaging (computed tomography or coronary angiography).
Mean age was 49.6 years, and 68.1% were men. The prevalence of CAD was 25.2% (n=97) (nonobstructive, 9.6% [n=37]; and obstructive, 15.6% [n=60]). In the subsample of patients without clinical CAD but with femoral plaque on ultrasound (n=58) who underwent cardiac computed tomography, 46% (n=27) had nonobstructive CAD and 28% (n=16) had obstructive CAD. During a median follow-up of 10.1 years, 36 patients (9.4%) died, 84 (21.8%) reached a composite end point of new stroke, myocardial infarction, or death, whereas 64 (16.6%) had a composite end point of new stroke or death. Event-free survival was significantly lower in patients with obstructive CAD versus no CAD or nonobstructive CAD (log-rank <0.001). In the multivariable Cox regression models, CAD was a strong and independent predictor of all-cause mortality (hazard ratio [HR], 2.20 [95% CI, 1.05-4.60]; =0.037) and the composite end point of death or recurrent ischemic stroke (HR, 3.24 [95% CI, 1.46-7.20]; =0.004).
In young and middle-aged ischemic stroke survivors, a quarter of patients had CAD. CAD was an independent predictor of recurrent stroke and mortality. In patients without previous CAD, but femoral plaque on ultrasound, nearly a half had nonobstructive and one-fourth had obstructive CAD. Systematic screening with cardiac computed tomography may identify high-risk patients after ischemic stroke.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT01597453.
针对年轻中风患者的研究表明，冠状动脉疾病（CAD）是导致死亡的主要因素。在当前的NOR-SYS（挪威青年中风研究）中，我们旨在调查CAD的患病率，以及其对新发血管事件和死亡率的影响。
共纳入385例年龄≤60岁的缺血性中风患者。CAD定义为有CAD病史或冠状动脉成像（计算机断层扫描或冠状动脉造影）阳性。
平均年龄为49.6岁，男性占68.1%。CAD的患病率为25.2%（n = 97）（非阻塞性，9.6% [n = 37]；阻塞性，15.6% [n = 60]）。在无临床CAD但超声显示有股动脉斑块的患者亚组（n = 58）中，接受心脏计算机断层扫描的患者中，46%（n = 27）有非阻塞性CAD，28%（n = 16）有阻塞性CAD。在中位随访10.1年期间，36例患者（9.4%）死亡，84例（21.8%）达到新发中风、心肌梗死或死亡的复合终点，而64例（16.6%）达到新发中风或死亡的复合终点。与无CAD或非阻塞性CAD的患者相比，阻塞性CAD患者的无事件生存率显著降低（对数秩检验P<0.001）。在多变量Cox回归模型中，CAD是全因死亡率（风险比[HR]，2.20 [95% CI，1.05 - 4.60]；P = 0.037）和死亡或复发性缺血性中风复合终点（HR，3.24 [95% CI，1.46 - 7.20]；P = 0.004）的强有力独立预测因素。
在中青年缺血性中风幸存者中，四分之一的患者患有CAD。CAD是复发性中风和死亡率的独立预测因素。在既往无CAD但超声显示有股动脉斑块的患者中，近一半有非阻塞性CAD，四分之一有阻塞性CAD。采用心脏计算机断层扫描进行系统筛查可能有助于识别缺血性中风后的高危患者。
