Coronary artery disease and risk of adverse cardiac events and stroke

BACKGROUND: Patients with acute myocardial infarction are at increased risk of ischemic stroke. Previous myocardial infarction is an important part of risk assessment for ischemic stroke. However, there is a lack of information regarding the association between the severity and extent of coronary artery disease and long-term risk of ischemic stroke.

MATERIALS AND METHODS: A cohort study of coronary angiographies performed in Western Denmark from January 1, 2003 to December 31, 2012. Patients were stratified according to the number of vessels affected by obstructive coronary artery disease (lumen narrowing ≥50%) at the time of angiography: 0-, 1-, 2- or 3-vessel disease and diffuse vessel disease. We followed patients for a maximum of 7 years. Endpoints were all-cause death, cardiac death, myocardial infarction, and ischemic stroke. Cumulative risks and crude and adjusted rate ratios were estimated.

RESULTS: The study population included 78,195 patients. Of these, 32,061 (41.0%) had 0 vessel disease, 6,205 (7.9%) had diffuse vessel disease, 20,202 (25.8%) had 1 vessel disease, 10,675 (13.7%) had 2 vessel disease, and 9,038 (11.6%) had 3 vessel disease. Median follow up was 3.6 years (inter quartile range 1.7-6.0 years). Increasing severity of obstructive coronary artery disease was associated with an increasing risk of all-cause death, cardiac death, MI, and ischemic stroke during follow-up.

CONCLUSIONS: The presence and extent of coronary artery disease was associated with an incremental risk of not only death, cardiac death, myocardial infarction, but also ischemic stroke over a 7-year period. This article is protected by copyright. All rights reserved.