Ischemic stroke caused by large-artery atherosclerosis: a red flag for subclinical coronary artery disease

BACKGROUND: The coronary calcium score (CAC) measured on chest computerized tomography is a risk marker of cardiac events and mortality. We compared CAC scores in two multiethnic groups without symptomatic coronary artery disease: subjects in the chronic phase after stroke or transient ischemic attack and at least one symptomatic stenosis ≥50% in the carotid or vertebrobasilar territories (Group(athero)) and a control group (Group(control)). METHODS: In this cross-sectional study, Group(athero) included two subgroups: Group(ExtraorIntra), with stenoses in either cervical or intracranial arteries, and Group(Extra&Intra), with stenoses in at least one cervical and one intracranial artery. Group(control) had no history of prior stroke/transient ischemic attacks and no stenoses ≥50% in cervical or intracranial arteries. Age and sex were comparable in all groups. Frequencies of CAC ≥100 and CAC > 0 were compared between Group(athero) and Group(control), as well as between Group(ExtraorIntr), Group(Extra&Intra), and Group(control), with bivariate logistic regressions. Multivariate analyses were also performed. RESULTS: A total of 120 patients were included: 80 in Group(athero) and 40 in Group(control.) CAC >0 was significantly more frequent in Group(athero) (85%) than Group(control) (OR, 4.19; 1.74–10.07; p = 0.001). Rates of CAC ≥100 were not significantly different between Group(athero) and Group(control) but were significantly greater in Group(Extra&Intra) (n = 13) when compared to Group(control) (OR 4.67; 1.21–18.04; p = 0.025). In multivariate-adjusted analyses, “Group(athero)” and “Group(Extra&Intra)” were significantly associated with CAC. CONCLUSION: The frequency of coronary calcification was higher in subjects with stroke caused by large-artery atherosclerosis than in controls.