David Calvet1, Dongbeom Song, Joonsang Yoo, Guillaume Turc, Jean-Louis Sablayrolles, Byoung Wook Choi, Ji Hoe Heo, Jean-Louis Mas. 1. From Paris Descartes University, Centre de Psychiatrie et Neurosciences INSERM UMR 894, Paris, France (D.C., G.T., J.-L.M.); Department of Neurology, Centre Hospitalier Sainte-Anne, Paris, France (D.C., G.T., J.-L.M.); Departments of Neurology (D.S., J.Y., J.H.H.) and Radiology (B.W.C.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology, Centre Cardiolique du Nord, Saint-Denis, France (J.-L.S.).
Abstract
BACKGROUND AND PURPOSE: Identifying occult coronary artery stenosis may improve secondary prevention of stroke patients. The aim of this study was to derive and validate a simple score to predict severe occult coronary artery stenosis in stroke patients. METHODS: We derived a score from a French hospital-based cohort of consecutive patients (n=300) who had an ischemic stroke or a transient ischemic attack and no previous history of coronary heart disease (Predicting Asymptomatic Coronary Artery Disease in Patients With Ischemic Stroke and Transient Ischemic Attack [PRECORIS] score) and validated the score in a similar Korean cohort (n=1602). In both cohorts, severe coronary artery stenosis was defined by the presence of at least 1≥50% coronary artery stenosis as detected by 64-section CT coronary angiography. RESULTS: A 5-point score (Framingham Risk Score-predicted 10-year coronary heart disease risk [≥20%=3; 10-19%=1; <10%=0] and cervicocephalic artery stenosis [≥50%=2; <50%=1; none=0]) was predictive of occult≥50% coronary artery stenosis risk in the derivation cohort (C-statistic=0.77 [0.70-0.84]) and in the validation cohort (C-statistic=0.66 [0.63-0.68]). The predictive ability of the score was even stronger when only ≥50% left main trunk disease or 3-vessel disease were considered (C-statistic=0.83 [0.74-0.92] and 0.70 [0.66-0.74] in derivation and validation cohorts, respectively). The prevalence of occult≥50% coronary artery stenosis and ≥50% left main trunk or 3-vessel disease increased gradually with the PRECORIS score, reaching 44.2% and 13.5% in derivation cohort and 49.8% and 12.8% in validation cohort in patients with a PRECORIS score≥4. CONCLUSIONS: The PRECORIS score can identify a population of stroke or transient ischemic attack patients with a high prevalence of occult severe coronary artery stenosis.
BACKGROUND AND PURPOSE: Identifying occult coronary artery stenosis may improve secondary prevention of strokepatients. The aim of this study was to derive and validate a simple score to predict severe occult coronary artery stenosis in strokepatients. METHODS: We derived a score from a French hospital-based cohort of consecutive patients (n=300) who had an ischemic stroke or a transient ischemic attack and no previous history of coronary heart disease (Predicting Asymptomatic Coronary Artery Disease in Patients With Ischemic Stroke and Transient Ischemic Attack [PRECORIS] score) and validated the score in a similar Korean cohort (n=1602). In both cohorts, severe coronary artery stenosis was defined by the presence of at least 1≥50% coronary artery stenosis as detected by 64-section CT coronary angiography. RESULTS: A 5-point score (Framingham Risk Score-predicted 10-year coronary heart disease risk [≥20%=3; 10-19%=1; <10%=0] and cervicocephalic artery stenosis [≥50%=2; <50%=1; none=0]) was predictive of occult≥50% coronary artery stenosis risk in the derivation cohort (C-statistic=0.77 [0.70-0.84]) and in the validation cohort (C-statistic=0.66 [0.63-0.68]). The predictive ability of the score was even stronger when only ≥50% left main trunk disease or 3-vessel disease were considered (C-statistic=0.83 [0.74-0.92] and 0.70 [0.66-0.74] in derivation and validation cohorts, respectively). The prevalence of occult≥50% coronary artery stenosis and ≥50% left main trunk or 3-vessel disease increased gradually with the PRECORIS score, reaching 44.2% and 13.5% in derivation cohort and 49.8% and 12.8% in validation cohort in patients with a PRECORIS score≥4. CONCLUSIONS: The PRECORIS score can identify a population of stroke or transient ischemic attack patients with a high prevalence of occult severe coronary artery stenosis.
Authors: Kyoo Ho Cho; Dong Hyun Lee; Kyung Min Kim; Yun Ho Choi; Hyo Suk Nam; Ji Hoe Heo; Kyoung Heo; Young Dae Kim Journal: Front Neurol Date: 2019-07-31 Impact factor: 4.003
Authors: Sung Hyun Yoon; Eunhee Kim; Yongho Jeon; Sang Yoon Yi; Hee Joon Bae; Ik Kyung Jang; Joo Myung Lee; Seung Min Yoo; Charles S White; Eun Ju Chun Journal: Korean J Radiol Date: 2020-09 Impact factor: 3.500