Asymptomatic coronary artery disease in ischaemic stroke survivors: A systematic review and meta-analysis.

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY European Stroke Journal Pub Date : 2024-09-01 Epub Date: 2024-02-15 DOI:10.1177/23969873241231702

Rahul G Muthalaly, Timothy B Abrahams, Nitesh Nerlekar, Adam J Nelson, Sean Tan, Jasmine Chan, Thanh Phan, Henry Ma, Stephen J Nicholls

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Abstract

Background: Ischaemic stroke and coronary artery disease share risk factors and stroke survivors experience a high rate of cardiac events. Recent work suggests a high burden of asymptomatic coronary artery disease (CAD) in ischaemic stroke survivors. Thus, we performed this systematic review and meta-analysis to A) estimate the prevalence of CAD in ischaemic stroke survivors without known CAD and B) evaluate the association between coronary atherosclerosis and future major adverse cardiovascular events (MACE) in stroke survivors.

Patients and methods: We conducted a systematic review and meta-analysis according to the PRISMA statement. We included studies investigating acute ischaemic stroke or transient ischaemic attack where participants underwent anatomical assessment of all coronary arteries. For objective B) we included studies that reported an association between coronary atherosclerosis and MACE. Two reviewers used the Newcastle-Ottawa Scale to assess risk of bias. We used random-effects modelling for our analyses.

Results: We identified 2983 studies of which 17 were included. These studies had a total of 6862 participants between 2008 and 2022. The pooled prevalence of any coronary atherosclerosis was 66.8% (95% CI 57.2%-75.1%) with substantial heterogeneity (I² = 95.2%). The pooled prevalence of obstructive (>50%) stenosis was 29.3% with substantial heterogeneity (I² = 91%). High-risk coronary anatomy (triple vessel disease or left main stenosis) was found in 7.0% (95% CI 4%-12%) with high heterogeneity I² = 72%. One study examined high-risk plaques and found a prevalence of 5.9%. Five studies reported the association of coronary atherosclerosis with future MACE. The presence of obstructive CAD confers a HR of 8.0 (95% CI 1.7-37.1, p = 0.007) for future MACE.

Discussion and conclusions: Asymptomatic CAD is common in ischaemic stroke survivors. The presence and severity of asymptomatic CAD strongly associates with the risk of future MACE. Further evaluation of the benefits of routine coronary assessment in ischaemic stroke is warranted.

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缺血性脑卒中幸存者中无症状的冠状动脉疾病：系统综述和荟萃分析。

背景：缺血性脑卒中和冠状动脉疾病具有共同的危险因素，脑卒中幸存者的心脏事件发生率很高。最近的研究表明，缺血性中风幸存者中无症状冠状动脉疾病（CAD）的负担很重。因此，我们进行了这项系统性回顾和荟萃分析，目的是：A）估计缺血性中风幸存者中无症状冠状动脉疾病（CAD）的患病率；B）评估冠状动脉粥样硬化与中风幸存者未来主要不良心血管事件（MACE）之间的关系：我们根据 PRISMA 声明进行了系统回顾和荟萃分析。我们纳入了调查急性缺血性脑卒中或短暂性脑缺血发作的研究，这些研究的参与者接受了所有冠状动脉的解剖学评估。对于目标 B)，我们纳入了报告冠状动脉粥样硬化与 MACE 之间存在关联的研究。两位审稿人使用纽卡斯尔-渥太华量表评估偏倚风险。我们采用随机效应模型进行分析：我们确定了 2983 项研究，其中 17 项被纳入。这些研究共有 6862 名参与者，时间跨度为 2008 年至 2022 年。任何冠状动脉粥样硬化的汇总患病率为 66.8%（95% CI 57.2%-75.1%），具有很大的异质性（I2 = 95.2%）。阻塞性（>50%）狭窄的汇总患病率为 29.3%，具有很大的异质性（I2 = 91%）。高危冠状动脉解剖（三重血管疾病或左主干狭窄）发现率为 7.0%（95% CI 4%-12%），异质性很高，I2 = 72%。一项研究检查了高风险斑块，发现发病率为 5.9%。五项研究报告了冠状动脉粥样硬化与未来 MACE 的关系。阻塞性 CAD 的存在使未来 MACE 的 HR 为 8.0（95% CI 1.7-37.1，p = 0.007）：讨论与结论：缺血性卒中幸存者中常见无症状的 CAD。无症状 CAD 的存在和严重程度与未来 MACE 风险密切相关。有必要进一步评估对缺血性卒中进行常规冠状动脉评估的益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.