(Stroke. 1997;28:941-945.)
© 1997 American Heart Association, Inc.
Articles |
Frequency and Severity of Asymptomatic Coronary Disease in Patients With Different Causes of Stroke
From the Departments of Neurology (M.I.C., R.M.P.) and Internal Medicine, Divisions of Cardiology (M.R.S.) and Nuclear Medicine (M.S., M.D.G.), University of Michigan Medical Center and Department of Veterans Affairs Medical Center, Ann Arbor, Mich.
Correspondence to Marc I. Chimowitz, MB, ChB, Department of Neurology, Emory University Hospital, Box M23, Suite C296H, 1364 Clifton Rd, Atlanta GA 30322. E-mail mchimo{at}neuro.emory.edu
Background and Purpose We sought (1) to compare the frequency and severity of asymptomatic coronary artery disease (CAD) in patients with different causes of brain ischemia and (2) to determine profiles of patients with brain ischemia who are at highest risk of asymptomatic CAD.
Methods Sixty-nine patients with transient ischemic attack or stroke and without overt CAD underwent a cardiac stress test and a diagnostic evaluation to determine the cause of brain ischemia. The frequency of abnormal cardiac stress tests was compared in patients with large-artery cerebrovascular disease versus other causes of brain ischemia (90% of whom had penetrating artery disease or cryptogenic stroke). Additionally, the frequencies of vascular risk factors, resting electrocardiographic abnormalities, and cause of stroke (large-artery disease versus other causes) were compared in patients with abnormal stress tests versus patients with normal stress tests.
Results The frequency of abnormal stress tests was 50% (15 of 30) in patients with large-artery cerebrovascular disease versus 23% (9 of 39) in patients with other causes of brain ischemia (P=.04). Moreover, 60% of abnormal stress tests (9 of 15) in patients with large-artery cerebrovascular disease suggested severe underlying CAD that was confirmed in 7 of 7 patients who underwent coronary angiography. On the other hand, less than 25% of abnormal stress tests (2 of 9) in patients with other causes of brain ischemia suggested severe underlying CAD. Features that were more common in patients with abnormal stress tests were smoking (P=.006), large-artery cerebrovascular disease (P=.02), veteran status (P=.02), and left ventricular hypertrophy (P=.07).
Conclusions Patients with penetrating artery disease or cryptogenic stroke have a significantly lower frequency of asymptomatic CAD than patients with large-artery cerebrovascular disease. Large-artery cerebrovascular disease, smoking, veteran status, and possibly left ventricular hypertrophy may be useful features for identifying patients with transient ischemic attack or stroke who are at highest risk of harboring asymptomatic CAD.
Key Words: cardiac catheterization • carotid artery diseases • cerebral ischemia • coronary artery disease
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