Minoru Tagawa1, Shigekazu Takeuchi2, Yuichi Nakamura3, Makihiko Saeki4, Yoshinori Taniguchi5, Tsukasa Ohno6, Hiroyuki Watanabe7, Yukie Ochiai8, Kiminori Kato9, Masaomi Chinushi10, Yoshifusa Aizawa11. 1. Department of Cardiology, Nagaoka Chuo General Hospital, Nagaoka, Niigata, Japan. Electronic address: m-tagawa@dc5.so-net.ne.jp. 2. Department of Neurosurgery, Nagaoka Chuo General Hospital, Nagaoka, Niigata, Japan. Electronic address: takeuchi@niigata-nogeka.or.jp. 3. Department of Cardiology, Nagaoka Chuo General Hospital, Nagaoka, Niigata, Japan. Electronic address: nakamura-y@nagachu.jp. 4. Department of Cardiology, Nagaoka Chuo General Hospital, Nagaoka, Niigata, Japan. Electronic address: makihikosaeki@gmail.com. 5. Department of Neurosurgery, Nagaoka Chuo General Hospital, Nagaoka, Niigata, Japan. Electronic address: ytaniyan@mail.goo.ne.jp. 6. Department of Neurology, Nagaoka Chuo General Hospital, Nagaoka, Niigata, Japan. Electronic address: tsukasa-oh@pop17.odn.ne.jp. 7. Department of Neurology, Nagaoka Chuo General Hospital, Nagaoka, Niigata, Japan. Electronic address: h-watanabe@hokuriku.me. 8. Department of Cardiology, Nagaoka Chuo General Hospital, Nagaoka, Niigata, Japan. Electronic address: yochiai1224@icloud.com. 9. Department of Laboratory Medicine and Clinical Epidemiology for Prevention of Noncommunicable Diseases, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan. Electronic address: kkato48@med.niigata-u.ac.jp. 10. Graduate School of Health Science, Niigata University School of Medicine, Niigata, Japan. Electronic address: masaomi@clg.niigata-u.ac.jp. 11. Department of Cardiology, Tachikawa Medical Center, Niigata, Japan. Electronic address: aizaways@med.niigata-u.ac.jp.
Abstract
OBJECTIVE: To investigate the prevalence and outcomes of asymptomatic coronary artery disease (CAD) in patients with the first episode of ischemic stroke. METHODS: Patients admitted to our hospital between November 2001 and January 2009 for the episode of an acute ischemic stroke/transient ischemic attack were included. Stress-Tl-201 scintigraphy was performed and followed by coronary angiography (CAG). The prevalence and risks for asymptomatic CAD, and long-term outcomes were studied. RESULTS: Of 1309 patients, only 15 (1.1%) patients presented with a history of CAD. Excluding 406 patients because of severity, systemic infection, early transfer to another hospital, or a refusal to participate, myocardial scintigraphy was performed in 903 patients (mean age, 72 ± 10 years, male 63.9%), and myocardial ischemia was diagnosed in 214 patients (23.7%). Of these patients, 76 patients underwent CAG, and showed significant stenosis (>75%) of a coronary artery in 61 (80.3%) patients. The risk factors for positive scintigraphy findings and CAG were high-grade premature complexes via Holter monitoring (P < .0001), enlarged left ventricle (P = .0051) and wall motion abnormalities (P = .0014) observed on echocardiography, and carotid artery stenosis observed in magnetic resonance angiography imaging (P < .0001). During the follow-up periods of 83 ± 47 months and of 91 ± 47 months, 17.2% of scintigraphy-positive and 2.8% of scintigraphy-negative patients developed episodes of myocardial ischemia, respectively (P < .001). CONCLUSIONS: Symptomatic CAD was rare in Japanese patients with the first episode of ischemic stroke, but asymptomatic CAD was identified by stress Tl-201 myocardial scintigraphy in one-quarter of the patients. Positive scintigraphy was associated with asymptomatic CAD and future cardiac events.
OBJECTIVE: To investigate the prevalence and outcomes of asymptomatic coronary artery disease (CAD) in patients with the first episode of ischemic stroke. METHODS:Patients admitted to our hospital between November 2001 and January 2009 for the episode of an acute ischemic stroke/transient ischemic attack were included. Stress-Tl-201 scintigraphy was performed and followed by coronary angiography (CAG). The prevalence and risks for asymptomatic CAD, and long-term outcomes were studied. RESULTS: Of 1309 patients, only 15 (1.1%) patients presented with a history of CAD. Excluding 406 patients because of severity, systemic infection, early transfer to another hospital, or a refusal to participate, myocardial scintigraphy was performed in 903 patients (mean age, 72 ± 10 years, male 63.9%), and myocardial ischemia was diagnosed in 214 patients (23.7%). Of these patients, 76 patients underwent CAG, and showed significant stenosis (>75%) of a coronary artery in 61 (80.3%) patients. The risk factors for positive scintigraphy findings and CAG were high-grade premature complexes via Holter monitoring (P < .0001), enlarged left ventricle (P = .0051) and wall motion abnormalities (P = .0014) observed on echocardiography, and carotid artery stenosis observed in magnetic resonance angiography imaging (P < .0001). During the follow-up periods of 83 ± 47 months and of 91 ± 47 months, 17.2% of scintigraphy-positive and 2.8% of scintigraphy-negative patients developed episodes of myocardial ischemia, respectively (P < .001). CONCLUSIONS: Symptomatic CAD was rare in Japanese patients with the first episode of ischemic stroke, but asymptomatic CAD was identified by stress Tl-201 myocardial scintigraphy in one-quarter of the patients. Positive scintigraphy was associated with asymptomatic CAD and future cardiac events.