Risk of ischemic stroke in patients with suspected coronary artery disease, according to coronary computed tomographic angiography and myocardial single-photon emission computed tomography findings

Abstract

Background: Coronary artery disease (CAD) is considered an important cause of morbidity and mortality in patients with ischemic stroke. However, risk for ischemic stroke in patients with CAD remains unclear. We evaluated the risk of ischemic stroke according to the presence, severity, and extent of CAD evidenced by coronary computed tomographic angiography (CCTA) and single-photon emission computed tomography (SPECT) in patients with suspected CAD.

Methods: We studied 1137 patients with suspected CAD, but without a history of CAD or stroke, who underwent both CCTA and SPECT for the evaluation of CAD between 2004 and 2011.

Results: During a median follow-up period of 26 months, ischemic stroke was observed in 25 of 1137 patients (2.2%). The presence of coronary atherosclerotic plaque on CCTA was associated with a > 4-fold hazard increase for ischemic stroke (unadjusted hazard ration [HR] 4.38

95% confidence interval [CI] 1.03–18.64

p = 0.046). Plaque in ≥ 2 vessels was associated with a >3-fold further increase in the risk of ischemic stroke compared with plaque only in one vessel (unadjusted HR 3.68

95% CI 1.57–8.62

p = 0.003), whereas plaque of ≥ 50% diameter stenosis was not associated with increased risk compared with plaque of < 50% diameter stenosis (unadjusted HR 1.03

95% CI 0.43–2.46

p = 0.943). The presence and extent of perfusion defect, and summed stress score on SPECT were not associated with ischemic stroke.

Conclusions: The risk of ischemic stroke was associated with the presence and extent of coronary atherosclerosis evidenced by CCTA, but not with the presence and extent of myocardial ischemia evidenced by SPECT. CCTA may provide additional information with regard to the risk of ischemic stroke in patients with suspected CAD.