Burden of Coronary Artery Disease as a Predictor of New Vascular Events and Mortality in Patients With Ischemic Stroke: Insights From the Norwegian Stroke in the Young Study

Abstract

BACKGROUND: Studies in young patients with stroke identified coronary artery disease (CAD) as a main contributor to mortality. In the present NOR-SYS (Norwegian Stroke in the Young Study), we aimed to investigate the prevalence of CAD, and the impact on new vascular events and mortality. METHODS: A total of 385 patients with ischemic stroke, aged ≤60 years, were included. CAD was defined as a history of CAD or positive coronary imaging (computed tomography or coronary angiography). RESULTS: Mean age was 49.6 years, and 68.1% were men. The prevalence of CAD was 25.2% (n=97) (nonobstructive, 9.6% [n=37]; and obstructive, 15.6% [n=60]). In the subsample of patients without clinical CAD but with femoral plaque on ultrasound (n=58) who underwent cardiac computed tomography, 46% (n=27) had nonobstructive CAD and 28% (n=16) had obstructive CAD. During a median follow-up of 10.1 years, 36 patients (9.4%) died, 84 (21.8%) reached a composite end point of new stroke, myocardial infarction, or death, whereas 64 (16.6%) had a composite end point of new stroke or death. Event-free survival was significantly lower in patients with obstructive CAD versus no CAD or nonobstructive CAD (log-rank P<0.001). In the multivari-able Cox regression models, CAD was a strong and independent predictor of all-cause mortality (hazard ratio [HR], 2.20 [95% CI, 1.05–4.60]; P=0.037) and the composite end point of death or recurrent ischemic stroke (HR, 3.24 [95% CI, 1.46–7.20]; P=0.004). CONCLUSIONS: In young and middle-aged ischemic stroke survivors, a quarter of patients had CAD. CAD was an independent predictor of recurrent stroke and mortality. In patients without previous CAD, but femoral plaque on ultrasound, nearly a half had nonobstructive and one-fourth had obstructive CAD. Systematic screening with cardiac computed tomography may identify high-risk patients after ischemic stroke.