Document Type : Original Article
Authors
- Marzieh Tajmirriahi 1
- Mohammad Saadatnia 2
- Hassan Shemirani 3
- Masoumeh Sadeghi 4
- Alireza Chamasemani 4
- Ali Safaei 5
1 Hypertension Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2 Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
4 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
5 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute; Isfahan University of Medical Sciences; Isfahan; Iran
Abstract
INTRODUCTION: Cerebral ischemia and coronary artery disease (CAD), the major leading causes of mortality and morbidity worldwide, are pathophysiologically interrelated. Cerebral ischemic events are categorized as large or small vessels disease. The current study compares the factors related to CAD events incidence following ischemic large versus small disease CVA.
METHOD: The current cohort study was conducted on 225 patients with ischemic stroke in two groups of large (n=75) and small (n=150) vessel disease during 2018-19. The patients’ demographic, medical, and clinical characteristics were recruited. They were followed for three years regarding the incidence of CAD events, including ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), unstable angina (UA), and sudden cardiac death (SCD). Data about the coronary angiography, computed tomography angiography (CTA), Single Photon Emission Computed Tomography (SPECT), and the therapeutic approach were gathered.
RESULTS: There were insignificant differences between the patients with small versus large vessels CVA in terms of ACS incidence (P-value=0.105), type of the events (P-value=0.836), angiographic (P-value=0.671), SPECT (P-value=0.99) and CTA findings (P-value>0.99) and approached CAD (P-value=0.728). Cox regression assessments revealed an increased risk of CAD events due to large versus small vessels disease after adjustments for hypertension, diabetes mellitus, dyslipidemia, re-stroke, and the previous history of IHD (HR=2.005, 95%CI: 1.093-2.988, P-value=0.021).
CONCLUSION: According to the findings of this study, large-vessel involvement in an ischemic stroke was associated with more than a two-fold increase in the three-year probability of ischemic heart disease incidencet.
Keywords
2. Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45(7): 2160-236. https://doi.org/10.1161/STR.0000000000000024
3. Burns JD, Rabinstein AA, Roger VL, Stead LG, Christianson TJ, Killian JM, et al. Incidence and predictors of myocardial infarction after transient ischemic attack: a population-based study. Stroke 2011; 42(4): 935-40. https://doi.org/10.1161/STROKEAHA.110.593723
4. Sadeghi M, Heshmat-Ghahdarijani K, Talaei M, Safaei A, Sarrafzadegan N, Roohafza H. The predictive value of atherogenic index of plasma in the prediction of cardiovascular events; a fifteen-year cohort study. Adv Med Sci 2021; 66(2): 418-23. https://doi.org/10.1016/j.advms.2021.09.003
5. Calvet D, Touzé E, Varenne O, Sablayrolles J-L, Weber S, Mas J-L. Prevalence of asymptomatic coronary artery disease in ischemic stroke patients: the PRECORIS study. Circulation 2010; 121(14): 1623-9. https://doi.org/10.1161/CIRCULATIONAHA.109.906958
6. Lee KJ, Kim SE, Kim JY, Kang J, Kim BJ, Han MK, et al. Five‐Year Risk of Acute Myocardial Infarction After Acute Ischemic Stroke in Korea. J Am Heart Assoc 2021; 10(1): e018807. https://doi.org/10.1161/JAHA.120.018807
7. Powers WJ. Acute ischemic stroke. N Engl J Med 2020; 383(3): 252-60. https://doi.org/10.1056/NEJMcp1917030
8. Han F, Zhai F-F, Wang Q, Zhou L-X, Ni J, Yao M, et al. Prevalence and risk factors of cerebral small vessel disease in a Chinese population-based sample. J Stroke 2018; 20(2): 239. https://doi.org/10.5853/jos.2017.02110
9. Xin X-Y, Cheng L, Yang Z, Zhang Y, Zeng L-L, Liu J-R. Comparison study of ASCO and TOAST classification system in Chinese minor stroke patients. Cerebrovasc Dis 2019; 47(1-2): 95-100. https://doi.org/10.1159/000497478
10. Rennert RC, Wali AR, Steinberg JA, Santiago-Dieppa DR, Olson SE, Pannell JS, et al. Epidemiology, natural history, and clinical presentation of large vessel ischemic stroke. Neurosurgery 2019; 85(suppl_1): S4-S8. https://doi.org/10.1093/neuros/nyz042
11. Shi Y, Wardlaw JM. Update on cerebral small vessel disease: a dynamic whole-brain disease. Stroke Vasc Neurol 2016; 1(3). https://doi.org/10.1136/svn-2016-000035
12. Barati M, Taheri-Kharameh Z, Bandehelahi K, Yeh VM, Kripalani S. Validation of the Short Form of the Adherence to Refills and Medications Scale (ARMS-SF) in Iranian Elders with Chronic Disease. J Clin Diagn Res 2018; 12(11). https://doi.org/10.7860/JCDR/2018/37584.12305
13. Thygesen K, Alpert J, Jaffe A, Simoons M, Chaitman B, White H, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol 2012; 60(16): 1581-98. https://doi.org/10.1161/CIR.0b013e31826e1058
14. Gunnoo T, Hasan N, Khan MS, Slark J, Bentley P, Sharma P. Quantifying the risk of heart disease following acute ischaemic stroke: a meta-analysis of over 50 000 participants. BMJ Open 2016; 6(1): e009535. https://doi.org/10.1136/bmjopen-2015-009535
15. Boulanger M, Béjot Y, Rothwell PM, Touzé E. Long‐term risk of myocardial infarction compared to recurrent stroke after transient ischemic attack and ischemic stroke: systematic review and meta‐analysis. J Am Heart Assoc 2018; 7(2): e007267. https://doi.org/10.1161/JAHA.117.007267
16. Touzé E, Varenne O, Chatellier G, Peyrard Sv, Rothwell PM, Mas J-L. Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis. Stroke 2005; 36(12): 2748-55. https://doi.org/10.1161/01.STR.0000190118.02275.33
17. Komorovsky R, Desideri A, Coscarelli S, Cortigiani L, Celegon L. Impact of carotid arterial narrowing on outcomes of patients with acute coronary syndromes. Am J Cardiol 2004; 93(12): 1552-5. https://doi.org/10.1016/j.amjcard.2004.03.012
18. Ntaios G. Embolic stroke of undetermined source: JACC review topic of the week. J Am Coll Cardiol 2020; 75(3): 333-40. https://doi.org/10.1016/j.jacc.2019.11.024
19. Pierik R, Algra A, van Dijk E, Erasmus ME, Van Gelder IC, Koudstaal PJ, et al. Distribution of cardioembolic stroke: a cohort study. Cerebrovasc Dis 2020; 49(1): 97-104. https://doi.org/10.1159/000505616
20. Merkler AE, Diaz I, Wu X, Murthy SB, Gialdini G, Navi BB, et al. Duration of heightened ischemic stroke risk after acute myocardial infarction. J Am Heart Assoc 2018; 7(22): e010782. https://doi.org/10.1161/JAHA.118.010782
21. Vilanova M, Mauri‐Capdevila G, Sanahuja J, Quilez A, Pinol‐Ripoll G, Begue R, et al. Prediction of myocardial infarction in patients with transient ischaemic attack. Acta Neurol Scand 2015; 131(2): 111-9. https://doi.org/10.1111/ane.12291
22. Amarenco P, Lavallée PC, Labreuche J, Ducrocq G, Juliard J-M, Feldman L, et al. Prevalence of coronary atherosclerosis in patients with cerebral infarction. Stroke 2011; 42(1): 22-9. https://doi.org/10.1161/STROKEAHA.110.584086
)