Background: Atherosclerosis is a systemic disease. Many ischemic stroke patients may have concomitant coronary artery disease (CAD). Detection and treatment of preclinical CAD in stroke patients may improve long-term outcome and survival because CAD is a major cause of death during follow-up in stroke patients. However, association between coronary and cerebral artery atherosclerosis in stroke patients has not fully been investigated. This study aimed at examining the frequency and high-risk groups of CAD in ischemic stroke patients. Methods: Consecutive patients who were admitted due to acute ischemic stroke between July 2006 and June 2010 were prospectively enrolled in this study. A total of 1,304 patients who underwent MSCT coronary angiography and cerebral angiography were included in this study. By using 64-multislice computed tomography coronary angiography, we investigated the frequency of CAD and association between coronary and cerebral artery atherosclerosis in terms of location and burden (severity and extent) in stroke patients. We also sought to identify high-risk groups for CAD among stroke patients. Results: The frequency of significant (≧50%) CAD was 32.3% and the frequency of any degree of CAD was 70.1%. Diabetes mellitus, serum levels of total cholesterol, high-density lipoprotein cholesterol and triglyceride, and significant stenosis of the extracranial carotid, intracranial vertebral and basilar arteries were independently associated with CAD. However, no association was found between CAD and significant stenosis of the anterior, middle and posterior cerebral arteries. The association between CAD and cerebral atherosclerosis was stronger with increased severity and extent of cerebral atherosclerosis. When compared to patients with <2 risk factors and without significant cerebral atherosclerosis, those with multiple (≧2) risk factors and atherosclerosis in both the carotid and the vertebrobasilar arteries had very high risks of CAD [odds ratio (OR) 8.36; 95% confidence interval (CI) 4.15–16.87]. The risk was also high in patients with multiple risk factors and atherosclerosis in either the carotid or the vertebrobasilar artery (OR 4.13; 95% CI 2.62–6.51), and in those with <2 risk factors but atherosclerosis in both the carotid and the vertebrobasilar arteries (OR 3.40; 95% CI 1.22–9.47). Conclusions: A substantial portion of stroke patients had preclinical CAD, and there was a clear relationship between coronary and cerebral artery atherosclerosis in terms of location and burden. The risk of CAD was particularly high in stroke patients with multiple risk factors and atherosclerosis of the carotid and/or vertebrobasilar arteries.

1.
Alberts MJ, Bhatt DL, Mas JL, Ohman EM, Hirsch AT, Rother J, Salette G, Goto S, Smith SC Jr, Liau CS, Wilson PW, Steg PG: Three-year follow-up and event rates in the international reduction of atherothrombosis for continued health registry. Eur Heart J 2009;30:2318–2326.
2.
Rothwell PM, Coull AJ, Silver LE, Fairhead JF, Giles MF, Lovelock CE, Redgrave JNE, Bull LM, Welch SJV, Cuthbertson FC, Binney LE, Gutnikov SA, Anslow P, Banning AP, Mant D, Mehta Z: Population-based study of event-rate, incidence, case fatality, and mortality for all acute vascular events in all arterial territories (Oxford Vascular Study). Lancet 2005;366:1773–1783.
3.
Touze E, Varenne O, Chatellier G, Peyrard S, Rothwell PM, Mas JL: Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis. Stroke 2005;36:2748–2755.
4.
Man BL, Fu YP, Chan YY, Lam W, Hui CF, Leung WH, Mok V, Wong KS: Long-term outcomes of ischemic stroke patients with concurrent intracranial and extracranial stenoses and ischemic heart disease. Cerebrovascular Diseases 2010;29:236–241.
5.
Rokey R, Rolak LA, Harati Y, Kutka N, Verani MS: Coronary artery disease in patients with cerebrovascular disease: A prospective study. Ann Neurol 1984;16:50–53.
6.
Wofford JL, Kahl FR, Howard GR, McKinney WM, Toole JF, Crouse JR 3rd: Relation of extent of extracranial carotid artery atherosclerosis as measured by B-mode ultrasound to the extent of coronary atherosclerosis. Arterioscler Thromb 1991;11:1786–1794.
7.
Di Pasquale G, Andreoli A, Pinelli G, Grazi P, Manini G, Tognetti F, Testa C: Cerebral ischemia and asymptomatic coronary artery disease: A prospective study of 83 patients. Stroke 1986;17:1098–1101.
8.
Gongora-Rivera F, Labreuche J, Jaramillo A, Steg PG, Hauw JJ, Amarenco P: Autopsy prevalence of coronary atherosclerosis in patients with fatal stroke. Stroke 2007;38:1203–1210.
9.
Hertzer NR, Young JR, Beven EG, Graor RA, O’Hara PJ, Ruschhaupt WF 3rd, deWolfe VG, Maljovec LC: Coronary angiography in 506 patients with extracranial cerebrovascular disease. Arch Intern Med 1985;145:849–852.
10.
Wilterdink JL, Furie KL, Easton JD: Cardiac evaluation of stroke patients. Neurology 1998;51:S23–S26.
11.
Adams RJ, Chimowitz MI, Alpert JS, Awad IA, Cerqueria MD, Fayad P, Taubert KA: 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. Circulation 2003;108:1278–1290.
12.
Craven T, Ryu J, Espeland M, Kahl F, McKinney W, Toole J, McMahan M, Thompson C, Heiss G, Crouse J 3d: Evaluation of the associations between carotid artery atherosclerosis and coronary artery stenosis. A case-control study. Circulation 1990;82:1230–1242.
13.
Kaden JJ, Eckert JP, Poerner T, Haghi D, Borggrefe M, Pillich M, Harrar-Haag J, Kosinski C, Ortlepp JR: Prevalence of atherosclerosis of the coronary and extracranial cerebral arteries in patients undergoing aortic valve replacement for calcified stenosis. J Heart Valve Dis 2006;15:165–168.
14.
Bae HJ, Yoon BW, Kang DW, Koo JS, Lee SH, Kim KB, Lee J, Roh JK: Correlation of coronary and cerebral atherosclerosis: Difference between extracranial and intracranial arteries. Cerebrovasc Dis 2006;21:112–119.
15.
Ropers D, Baum U, Pohle K, Anders K, Ulzheimer S, Ohnesorge B, Schlundt C, Bautz W, Daniel WG, Achenbach S: Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation 2003;107:664–666.
16.
Martuscelli E, Romagnoli A, D’Eliseo A, Razzini C, Tomassini M, Sperandio M, Simonetti G, Romeo F: Accuracy of thin-slice computed tomography in the detection of coronary stenoses. Eur Heart J 2004;25:1043–1048.
17.
Hamon M, Morello R, Riddell JW, Hamon M: Coronary arteries: Diagnostic performance of 16- versus 64-section spiral CT compared with invasive coronary angiography-meta-analysis. Radiology 2007;245:720–731.
18.
Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, Paul N, Clouse ME, Shapiro EP, Hoe J, Lardo AC, Bush DE, de Roos A, Cox C, Brinker J, Lima JAC: Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 2008;359:2324–2336.
19.
Seo WK, Yong HS, Koh SB, Suh S, Kim JH, Yu SW, Lee JY: Correlation of coronary artery atherosclerosis with atherosclerosis of the intracranial cerebral artery and the extracranial carotid artery. European Neurology 2008;59:292–298.
20.
Calvet D, Touze E, Varenne O, Sablayrolles JL, Weber S, Mas JL: Prevalence of asymptomatic coronary artery disease in ischemic stroke patients: the PRECORIS study. Circulation 2010;121:1623–1629.
21.
Cho HJ, Lee JH, Kim YJ, Moon Y, Ko SM, Kim HY: Comprehensive evaluation of coronary artery disease and aortic atherosclerosis in acute ischemic stroke patients: usefulness based on Framingham risk score and stroke subtype. Cerebrovascular Diseases 2011;31:592–600.
22.
Adams HP, Jr., Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE, 3rd: Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35–41.
23.
Expert Panel on Detection Evaluation Treatment of High Blood Cholesterol in Adults: Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 2001;285:2486–2497.
24.
The North American Symptomatic Carotid Endarterectomy Trial Collaborators: Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med 1991;325:445–453.
25.
Chimowitz MI, Kokkinos J, Strong J, Brown MB, Levine SR, Silliman S, Pessin MS, Weichel E, Sila CA, Furlan AJ, et al: The warfarin-aspirin symptomatic intracranial disease study. Neurology 1995;45:1488–1493.
26.
Kim YD, Choi HY, Jung YH, Nam CM, Yang JH, Cho HJ, Nam HS, Lee KY, Heo JH: Mirror pattern of cerebral artery atherosclerosis in patients with ischaemic stroke. Eur J Neurol 2009;16:1159–1164.
27.
Love BB, Grover-McKay M, Biller J, Rezai K, McKay CR: Coronary artery disease and cardiac events with asymptomatic and symptomatic cerebrovascular disease. Stroke 1992;23:939–945.
28.
Urbinati S, Di Pasquale G, Andreoli A, Lusa AM, Ruffini M, Lanzino G, Pinelli G: Frequency and prognostic significance of silent coronary artery disease in patients with cerebral ischemia undergoing carotid endarterectomy. Am J Cardiol 1992;69:1166–1170.
29.
Amarenco P, Lavallee PC, Labreuche J, Ducrocq G, Juliard JM, Feldman L, Cabrejo L, Meseguer E, Guidoux C, Adrai V, Ratani S, Kusmierek J, Lapergue B, Klein IF, Gongora-Rivera F, Jaramillo A, Mazighi M, Touboul PJ, Steg PG: Prevalence of coronary atherosclerosis in patients with cerebral infarction. Stroke 2011;42:22–29.
30.
Hoshino A, Nakamura T, Enomoto S, Kawahito H, Kurata H, Nakahara Y, Ijichi T: Prevalence of coronary artery disease in Japanese patients with cerebral infarction: impact of metabolic syndrome and intracranial large artery atherosclerosis. Circ J 2008;72:404–408.
31.
Gibbons RJ, Balady GJ, Timothy Bricker J, Chaitman BR, Fletcher GF, Froelicher VF, Mark DB, McCallister BD, Mooss AN, O’Reilly MG, Winters WL Jr, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Hiratzka LF, Jacobs AK, Russell RO, Smith SC Jr, Committee Members, Task Force Members: ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation 2002;106:1883–1892.
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