The risk of ischemic stroke is associated with coronary atherosclerotic burden, but not with myocardial ischemia in patients with suspected coronary artery disease

Purpose: We sought to evaluate whether coronary artery disease (CAD) evaluated by coronary computed tomographic angiography (CCTA) and photon emission computed tomography (SPECT) are related to the risk of future ischemic stroke in patients with suspected CAD. Methods: From 1874 consecutive patients undergoing both 64-slice CCTA and SPECT for the evaluation of CAD between 2004 and 2011, 516 patients with history of CAD, 148 patients with history of ischemic stroke, and 56 patients with lack of clinical information were excluded. Among them (n=1154), follow-up information was obtained for the occurrence of ischemic stroke in 1137 subjects (98.5%). Kaplan-Meier survival model and cox proportional hazards model were used for the analysis. Results: During a median follow-up of 26 months (interquartile range 14 to 43 months), ischemic stroke occurred in 25 of 1137 patients (2.2%). The presence of CAD on CCTA was associated with a >4-fold hazard increase for ischemic stroke (unadjusted HR 4.38, 95% CI 1.03-18.64, p = 0.029). Furthermore, CAD involving two or more vessels on CCTA demonstrated a >3-fold hazard increase for ischemic stroke compared to 1-vessel involvement (unadjusted HR 3.68, 95% CI 1.57-8.62, p = 0.003). In contrast, the presence of perfusion defect (PD) on SPECT was not associated with ischemic stroke (unadjusted HR 0.87, 95% CI 0.36-2.09, p = 0.747). PD with summed stress score (SSS) ≥8 did not show the hazard increase for ischemic stroke compared to that with SSS <8 (unadjusted HR 0.49, 95% CI 0.07-3.69, p = 0.493). ![Figure][1] Kaplan-Meier event-free survival by CCTA Conclusions: The risk of ischemic stroke is associated with coronary atherosclerotic burden but not with myocardial ischemic burden. It seems that CCTA can provide additional information with regard to the risk of future ischemic stroke in patients with suspected CAD. [1]: pending:yes