Sung Hyun Yoon MD, Presenter: Nothing to Disclose

Eun Ju Chun, Abstract Co-Author: Nothing to Disclose

Eunhee Kim MD, Abstract Co-Author: Nothing to Disclose

Yeo Goon Kim MD, Abstract Co-Author: Nothing to Disclose

Sang Il Choi MD, Abstract Co-Author: Nothing to Disclose

Dong Hoon Lee MD, Abstract Co-Author: Nothing to Disclose

Stroke and coronary heart disease (CHD) share common risk factors and pathologic mechanisms, so the likelihood of CHD is increased in stroke patients. However, little has been known about the prevalence or characteristics of subclinical coronary artherosclerosis (SCA) in patients with stroke. We aimed to assess the prevalence and characteristics of SCA in stroke patients using coronary CT angiography (CCTA), and also evaluated the predictors for CHD.

From January, 2006 to December, 2012, among 2,498 stroke patients without prior history of CHD, 2,433 patients (mean age 66.2±12.1 years, male 55.4%) who underwent CCTA were assessed for CHD (cardiac death, myocardial infarction (MI), unstable angina requiring hospitalization (UA), heart failure and coronary revascularization later than 90 days after CCTA). CT images were analyzed the plaque type (calcified, mixed, noncalcified and high-risk plaque) and the degree of stenosis (grade 0 to 3, 0%, 1-49%, 50-69%, >70%, respectively). High-risk plaque (HP) was defined as plaque density with <50HU with positive remodeling, napkin-ring sign or spotty calcification. The independent predictors for CHD were assessed using univariate and multivariate cox regression analysis .

During of 52±20 months of follow-up, CHD (cardiac death ,57; MI, 25; UA ,13; revascularization, 40; Heart failure, 10) occurred in 145 subjects (6.0%). In univariate analysis, age, sex, diabetes, hypertension, current smoker, and body mass index were significantly related with CHD (all p< 0.05). After adjustment of these risk factors, stenosis degree and plaque type were independent predictors for CHD (all p< 0.001). Increasing stenosis degree showed higher risk for CHD (hazard ratio [HR] of grade 1 to 3, 4.7 vs 17.9 vs 27.8, respectively). HP shows higher risk for CHD (HR, 33.82) than noncalcified plaque (HR, 12.5) or mixed/calcified plaque (HR 6.5). Importantly, the absence of plaque by CCTA was associated with a low rate of outcome (0.24%).

Assessment of stenosis degree and plaque type using CCTA will be helpful for the risk stratification in stoke patients without prior history of CHD.

CCTA might be clinically useful tool for improving risk stratification for CHD in stroke patients.

Yoon, S, Chun, E, Kim, E, Kim, Y, Choi, S, Lee, D, Risk Stratification for Coronary Heart Disease in Stroke Patients Using Coronary CT Angiography: ACADIS Study (Assessment of Coronary Artery Disease in Stroke Patients).  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018219.html