Incidence of subclinical coronary atherosclerosis in patients with suspected embolic stroke using cardiac computed tomography

Yeonyee E. Yoon, Hyuk Jae Chang, Iksung Cho, Ki Hyun Jeon, Eun Ju Chun, Sang Il Choi, Hee Jun Bae, Juan J. Rivera, Khurram Nasir, Roger S. Blumenthal, Tae Hwan Lim

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

The purpose of this study was to investigate the incidence of subclinical coronary artery disease (CAD) in patients with suspected acute embolic stroke or transient ischemic attack (TIA) using 64-row multi-slice computed tomography (MSCT) and to examine its association with conventional risk stratification. We consecutively enrolled 175 patients (66 ± 13 years, 50% men) suspected to have had embolic stroke/TIA clinically or radiologically, and underwent 64-row MSCT to evaluate for a possible cardiac source of embolism. Both coronary artery calcium scoring (CACS) and coronary CT angiography (CCTA) were concurrently performed based on standard scanning protocols. Patients with a history of angina or documented CAD, and those with significant carotid stenosis were excluded. Atherosclerotic plaques were indentified in 105 (60%) individuals; 37 (21%) had occult CAD of ≥50% diameter stenosis on CCTA. Subjects with and without ≥50% occult CAD on CCTA had similar prevalence of cardiovascular risk factors. Thirty out of 175 (17%) individuals with ≥50% occult CAD would have missed further cardiac testing based on the American Heart association and the American Stroke Association guideline. However, these numbers would be reduced to 2% (4/175) using CACS. In logistic regression analysis, only CACS independently predicted the presence ≥50% occult CAD evidenced by CCTA. Subclinical CAD, including ≥50% stenotic disease, is highly prevalent in patients who had suffered a suspected embolic stroke. The current guideline for further cardiac testing may have limited value to identify patients with ≥50% CAD in this patient population, which can be improved by adopting CACS.

Original languageEnglish
Pages (from-to)1035-1044
Number of pages10
JournalInternational Journal of Cardiovascular Imaging
Volume27
Issue number7
DOIs
Publication statusPublished - 2011 Oct 1

Fingerprint

Coronary Artery Disease
Stroke
Tomography
Incidence
Coronary Angiography
Coronary Vessels
Calcium
Transient Ischemic Attack
Guidelines
American Heart Association
Carotid Stenosis
Atherosclerotic Plaques
Embolism
Pathologic Constriction
Logistic Models
Regression Analysis
Computed Tomography Angiography
Population

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Yoon, Yeonyee E. ; Chang, Hyuk Jae ; Cho, Iksung ; Jeon, Ki Hyun ; Chun, Eun Ju ; Choi, Sang Il ; Bae, Hee Jun ; Rivera, Juan J. ; Nasir, Khurram ; Blumenthal, Roger S. ; Lim, Tae Hwan. / Incidence of subclinical coronary atherosclerosis in patients with suspected embolic stroke using cardiac computed tomography. In: International Journal of Cardiovascular Imaging. 2011 ; Vol. 27, No. 7. pp. 1035-1044.
@article{c8d17b8a4202459fb4d70646e08a0f6f,
title = "Incidence of subclinical coronary atherosclerosis in patients with suspected embolic stroke using cardiac computed tomography",
abstract = "The purpose of this study was to investigate the incidence of subclinical coronary artery disease (CAD) in patients with suspected acute embolic stroke or transient ischemic attack (TIA) using 64-row multi-slice computed tomography (MSCT) and to examine its association with conventional risk stratification. We consecutively enrolled 175 patients (66 ± 13 years, 50{\%} men) suspected to have had embolic stroke/TIA clinically or radiologically, and underwent 64-row MSCT to evaluate for a possible cardiac source of embolism. Both coronary artery calcium scoring (CACS) and coronary CT angiography (CCTA) were concurrently performed based on standard scanning protocols. Patients with a history of angina or documented CAD, and those with significant carotid stenosis were excluded. Atherosclerotic plaques were indentified in 105 (60{\%}) individuals; 37 (21{\%}) had occult CAD of ≥50{\%} diameter stenosis on CCTA. Subjects with and without ≥50{\%} occult CAD on CCTA had similar prevalence of cardiovascular risk factors. Thirty out of 175 (17{\%}) individuals with ≥50{\%} occult CAD would have missed further cardiac testing based on the American Heart association and the American Stroke Association guideline. However, these numbers would be reduced to 2{\%} (4/175) using CACS. In logistic regression analysis, only CACS independently predicted the presence ≥50{\%} occult CAD evidenced by CCTA. Subclinical CAD, including ≥50{\%} stenotic disease, is highly prevalent in patients who had suffered a suspected embolic stroke. The current guideline for further cardiac testing may have limited value to identify patients with ≥50{\%} CAD in this patient population, which can be improved by adopting CACS.",
author = "Yoon, {Yeonyee E.} and Chang, {Hyuk Jae} and Iksung Cho and Jeon, {Ki Hyun} and Chun, {Eun Ju} and Choi, {Sang Il} and Bae, {Hee Jun} and Rivera, {Juan J.} and Khurram Nasir and Blumenthal, {Roger S.} and Lim, {Tae Hwan}",
year = "2011",
month = "10",
day = "1",
doi = "10.1007/s10554-010-9743-8",
language = "English",
volume = "27",
pages = "1035--1044",
journal = "International Journal of Cardiovascular Imaging",
issn = "1569-5794",
publisher = "Springer Netherlands",
number = "7",

}

Incidence of subclinical coronary atherosclerosis in patients with suspected embolic stroke using cardiac computed tomography. / Yoon, Yeonyee E.; Chang, Hyuk Jae; Cho, Iksung; Jeon, Ki Hyun; Chun, Eun Ju; Choi, Sang Il; Bae, Hee Jun; Rivera, Juan J.; Nasir, Khurram; Blumenthal, Roger S.; Lim, Tae Hwan.

In: International Journal of Cardiovascular Imaging, Vol. 27, No. 7, 01.10.2011, p. 1035-1044.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Incidence of subclinical coronary atherosclerosis in patients with suspected embolic stroke using cardiac computed tomography

AU - Yoon, Yeonyee E.

AU - Chang, Hyuk Jae

AU - Cho, Iksung

AU - Jeon, Ki Hyun

AU - Chun, Eun Ju

AU - Choi, Sang Il

AU - Bae, Hee Jun

AU - Rivera, Juan J.

AU - Nasir, Khurram

AU - Blumenthal, Roger S.

AU - Lim, Tae Hwan

PY - 2011/10/1

Y1 - 2011/10/1

N2 - The purpose of this study was to investigate the incidence of subclinical coronary artery disease (CAD) in patients with suspected acute embolic stroke or transient ischemic attack (TIA) using 64-row multi-slice computed tomography (MSCT) and to examine its association with conventional risk stratification. We consecutively enrolled 175 patients (66 ± 13 years, 50% men) suspected to have had embolic stroke/TIA clinically or radiologically, and underwent 64-row MSCT to evaluate for a possible cardiac source of embolism. Both coronary artery calcium scoring (CACS) and coronary CT angiography (CCTA) were concurrently performed based on standard scanning protocols. Patients with a history of angina or documented CAD, and those with significant carotid stenosis were excluded. Atherosclerotic plaques were indentified in 105 (60%) individuals; 37 (21%) had occult CAD of ≥50% diameter stenosis on CCTA. Subjects with and without ≥50% occult CAD on CCTA had similar prevalence of cardiovascular risk factors. Thirty out of 175 (17%) individuals with ≥50% occult CAD would have missed further cardiac testing based on the American Heart association and the American Stroke Association guideline. However, these numbers would be reduced to 2% (4/175) using CACS. In logistic regression analysis, only CACS independently predicted the presence ≥50% occult CAD evidenced by CCTA. Subclinical CAD, including ≥50% stenotic disease, is highly prevalent in patients who had suffered a suspected embolic stroke. The current guideline for further cardiac testing may have limited value to identify patients with ≥50% CAD in this patient population, which can be improved by adopting CACS.

AB - The purpose of this study was to investigate the incidence of subclinical coronary artery disease (CAD) in patients with suspected acute embolic stroke or transient ischemic attack (TIA) using 64-row multi-slice computed tomography (MSCT) and to examine its association with conventional risk stratification. We consecutively enrolled 175 patients (66 ± 13 years, 50% men) suspected to have had embolic stroke/TIA clinically or radiologically, and underwent 64-row MSCT to evaluate for a possible cardiac source of embolism. Both coronary artery calcium scoring (CACS) and coronary CT angiography (CCTA) were concurrently performed based on standard scanning protocols. Patients with a history of angina or documented CAD, and those with significant carotid stenosis were excluded. Atherosclerotic plaques were indentified in 105 (60%) individuals; 37 (21%) had occult CAD of ≥50% diameter stenosis on CCTA. Subjects with and without ≥50% occult CAD on CCTA had similar prevalence of cardiovascular risk factors. Thirty out of 175 (17%) individuals with ≥50% occult CAD would have missed further cardiac testing based on the American Heart association and the American Stroke Association guideline. However, these numbers would be reduced to 2% (4/175) using CACS. In logistic regression analysis, only CACS independently predicted the presence ≥50% occult CAD evidenced by CCTA. Subclinical CAD, including ≥50% stenotic disease, is highly prevalent in patients who had suffered a suspected embolic stroke. The current guideline for further cardiac testing may have limited value to identify patients with ≥50% CAD in this patient population, which can be improved by adopting CACS.

UR - http://www.scopus.com/inward/record.url?scp=80054990182&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80054990182&partnerID=8YFLogxK

U2 - 10.1007/s10554-010-9743-8

DO - 10.1007/s10554-010-9743-8

M3 - Article

C2 - 21063781

AN - SCOPUS:80054990182

VL - 27

SP - 1035

EP - 1044

JO - International Journal of Cardiovascular Imaging

JF - International Journal of Cardiovascular Imaging

SN - 1569-5794

IS - 7

ER -