Increased Risk of Cardiovascular Events in Stroke Patients Who had Not Undergone Evaluation for Coronary Artery Disease
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: Although asymptomatic coronary artery occlusive disease is common in stroke patients, the long-term advantages of undergoingevaluation for coronary arterial disease using multi-detector coronary computed tomography (MDCT) have not been well established in stroke patients. We compared long-term cardio-cerebrovascular outcomes between patients who underwent MDCT and those who did not. Materials and Methods: This was a retrospective study in a prospective cohort of consecutive ischemic stroke patients. Of the 3117 patients who were registered between July 2006 and December 2012, MDCT was performed in 1842 patients [MDCT (+) group] and not in 1275 patients [MDCT (-) group]. Occurrences of death, cardiovascular events, and recurrent stroke were comparedbetween the groups using Cox proportional hazards models and propensity score analyses. Results: During the mean follow-up of 38.0±24.8 months, 486 (15.6%) patients died, recurrent stroke occurred in 297 (9.5%), and cardiovascular events occurred in 60 patients (1.9%). Mean annual risks of death (9.34% vs. 2.47%), cardiovascular events (1.2% vs. 0.29%), and recurrent stroke (4.7% vs. 2.56%) were higher in the MDCT (-) group than in the MDCT (+) group. The Cox proportionalhazards model and the five propensity score-adjusted models consistently demonstrated that the MDCT (-) group was at a high risk of cardiovascular events (hazard ratios 3.200, 95% confidence interval 1.172–8.735 in 1:1 propensity matching analysis) as well as death. The MDCT (-) group seemed to also have a higher risk of recurrent stroke. Conclusion: Acute stroke patients who underwent MDCT experienced fewer deaths, cardiovascular events, and recurrent strokes during follow-up.
Abstract
Purpose: Although asymptomatic coronary artery occlusive disease is common in stroke patients, the long-term advantages of undergoingevaluation for coronary arterial disease using multi-detector coronary computed tomography (MDCT) have not been well established in stroke patients. We compared long-term cardio-cerebrovascular outcomes between patients who underwent MDCT and those who did not. Materials and Methods: This was a retrospective study in a prospective cohort of consecutive ischemic stroke patients. Of the 3117 patients who were registered between July 2006 and December 2012, MDCT was performed in 1842 patients [MDCT (+) group] and not in 1275 patients [MDCT (-) group]. Occurrences of death, cardiovascular events, and recurrent stroke were comparedbetween the groups using Cox proportional hazards models and propensity score analyses. Results: During the mean follow-up of 38.0±24.8 months, 486 (15.6%) patients died, recurrent stroke occurred in 297 (9.5%), and cardiovascular events occurred in 60 patients (1.9%). Mean annual risks of death (9.34% vs. 2.47%), cardiovascular events (1.2% vs. 0.29%), and recurrent stroke (4.7% vs. 2.56%) were higher in the MDCT (-) group than in the MDCT (+) group. The Cox proportionalhazards model and the five propensity score-adjusted models consistently demonstrated that the MDCT (-) group was at a high risk of cardiovascular events (hazard ratios 3.200, 95% confidence interval 1.172–8.735 in 1:1 propensity matching analysis) as well as death. The MDCT (-) group seemed to also have a higher risk of recurrent stroke. Conclusion: Acute stroke patients who underwent MDCT experienced fewer deaths, cardiovascular events, and recurrent strokes during follow-up.
참고문헌 (25)
- Amarenco P, "Coronary artery disease and risk of major vascular events after cerebral infarction", Stroke, 44, pp.1505~1511 (2013)
- Hankey GJ, "Five-year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study", Stroke, 31, pp.2080~2086 (2000)
- Touzé E, "Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis", Stroke, 36, pp.2748~2755 (2005)
- Kazunori Toyoda, "Epidemiology and Registry Studies of Stroke in Japan", 대한뇌졸중학회지, 15(1), pp.21~26 (2013), 대한뇌졸중학회[DOI]
- Amarenco P, "Prevalence of coronary atherosclerosis in patients with cerebral infarction", Stroke, 42, pp.22~29 (2011)
- Gongora-Rivera F, "Autopsy prevalence of coronary atherosclerosis in patients with fatal stroke", Stroke, 38, pp.1203~1210 (2007)
- Miller JM, "Diagnostic performance of coronary angiography by 64-row CT", N Engl J Med, 359, pp.2324~2336 (2008)
- Bamberg F, "Meta-analysis and systematic review of the longterm predictive value of assessment of coronary atherosclerosis by contrast-enhanced coronary computed tomography angiography", J Am Coll Cardiol, 57, pp.2426~2436 (2011)
- Hulten EA, "Prognostic value of cardiac computed tomography angiography: a systematic review and meta-analysis", J Am Coll Cardiol, 57, pp.1237~1247 (2011)
- Min JK, "Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease", J Am Coll Cardiol, 58, pp.849~860 (2011)
- Calvet D, "Prevalence of asymptomatic coronary artery disease in ischemic stroke patients: the PRECORIS study", Circulation, 121, pp.1623~1629 (2010)
- Yoo J, "The frequency and risk of preclinical coronary artery disease detected using multichannel cardiac computed tomography in patients with ischemic stroke", Cerebrovasc Dis, 33, pp.286~294 (2012)
- Hur J, "Cardiac computed tomographic angiography for detection of cardiac sources of embolism in stroke patients", Stroke, 40, pp.2073~2078 (2009)
- Lee BI, "Yonsei Stroke Registry. Analysis of 1,000 patients with acute cerebral infarctions", Cerebrovasc Dis, 12, pp.145~151 (2001)
- North American Symptomatic Carotid Endarterectomy Trial Collaborators, "Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis", N Engl J Med, 325, pp.445~453 (1991)
- Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Trial Investigators, "Design, progress and challenges of a double-blind trial of warfarin versus aspirin for symptomatic intracranial arterial stenosis", Neuroepidemiology, 22, pp.106~117 (2003)
- Authors, "Task Force members", 2014 ESC, Eur Heart J, pp.2014, 35[DOI]
- Hachamovitch R, "Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography", Circulation, 107, pp.2900~2907 (2003)
- Levine GN, "2011 ACCF", AHA, American Heart Association Task Force on practice guidelines and the society for cardiovascular angiography and interventions, pp.Circulation, 2011[DOI]
- 김범준, "Ischemic Stroke Subtype Classification: An Asian Viewpoint", 대한뇌졸중학회지, 16(1), pp.8~17 (2014), 대한뇌졸중학회[DOI]
- Nam HS, "Longterm mortality in patients with stroke of undetermined etiology", Stroke, 43, pp.2948~2956 (2012)
- Cho HJ, "Transoesophageal echocardiography in patients with acute stroke with sinus rhythm and no cardiac disease history", J Neurol Neurosurg Psychiatry, 81, pp.412~415 (2010)
- Adams RJ, "Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: a scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association", American Stroke Association, 2003, pp.108, 1278~1290
- Hur J, "Dual-enhanced cardiac CT for detection of left atrial appendage thrombus in patients with stroke: a prospective comparison study with transesophageal echocardiography", Stroke, 42, pp.2471~2477 (2011)
- Ueshima H, "Cardiovascular disease and risk factors in Asia: a selected review", Circulation, 118, pp.2702~2709 (2008)