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Table of Contents    
COMMENTARY
Year : 2021  |  Volume : 69  |  Issue : 4  |  Page : 923-924

Clinical Relevance of Coronary Artery Disease in Acute Ischemic Stroke


1 Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Spain
2 Medical Library, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain

Date of Submission26-Mar-2020
Date of Decision08-Aug-2020
Date of Acceptance04-Aug-2021
Date of Web Publication2-Sep-2021

Correspondence Address:
Dr. AdriÓ Arboix
Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, C/Viladomat 288, E-08029 Barcelona, Catalonia
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.325337

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How to cite this article:
Arboix A, Sánchez-López MJ. Clinical Relevance of Coronary Artery Disease in Acute Ischemic Stroke. Neurol India 2021;69:923-4

How to cite this URL:
Arboix A, Sánchez-López MJ. Clinical Relevance of Coronary Artery Disease in Acute Ischemic Stroke. Neurol India [serial online] 2021 [cited 2021 Sep 27];69:923-4. Available from: https://www.neurologyindia.com/text.asp?2021/69/4/923/325337




Ischemic heart disease is an important modifiable cerebrovascular risk factor. It includes myocardial infarction, acute coronary syndrome, percutaneous coronary intervention, coronary artery bypass graft surgery, and incident coronary artery disease.[1]

Patients with acute myocardial infarction are at increased risk of ischemic stroke during initial hospitalization. A cohort study performed in Denmark by Olesen et al.[2] demonstrated that increased severity of coronary artery disease is associated with an incremental risk of not only cardiac events (cardiac death and myocardial infarction) but also ischemic stroke over a 7-year period.

Similarly, cardiovascular complications are common after stroke. Patients with ischemic stroke are at higher risk of ischemic heart disease and major adverse cardiovascular events, which may lead to death in both women and men without known preexisting heart disease.[3] Sposato et al.,[4] in a population-based retrospective cohort study in older adults with first-ever ischemic stroke without prior heart disease, reported the highest risk of major adverse cardiovascular events in the first 30 days, although it remained independently elevated during the 3 years of follow-up. In the Stroke Registry of the Sagrat Cor Hospital of Barcelona, ischemic heart disease was present only in 9.6% of cerebral infarctions in patients <65 years but increased to 18.8% in 65–74 years, 17.3% in 75–84 years, and 14.9% in 85 years or more.[1]

The ischemic stroke subtypes show a heterogeneous pattern in terms of the frequency of ischemic heart disease. It is more frequent in cardioembolic (21.4%) and atherothrombotic (19.5%) infarctions than in lacunar (14.2%), those of undetermined cause (4.3%), or those of unusual etiology (3.5%).[1]

The presence of ischemic heart disease, even if asymptomatic or subclinical, is associated with an increased risk of future major vascular adverse events or deaths.[5] One-third of the deaths that occur after an ischemic stroke are cardiovascular.[6]

Lacunar infarcts or small subcortical infarcts result from the occlusion of a single penetrating artery and account for a quarter of cerebral infarctions. Hypertension and diabetes mellitus, but not ischemic heart disease, are major risk factors for lacunar stroke.[7] In contrast, in nonlacunar ischemic infarcts, mainly cardioembolic and atherothrombotic infarctions, coronary artery disease is a major associated risk factor.[8] Blood biomarkers (e.g. high levels of cardiac troponin) have been observed in patients with ischemic heart disease and may be a feasible strategy for improving the diagnosis of myocardial injury in the absence of preexisting coronary artery disease in the acute phase of acute ischemic stroke.

In conclusion, ischemic heart disease is an important cerebrovascular risk factor. Patients with ischemic stroke are at increased risk of additional cardiovascular adverse events. The coexistence of ischemic stroke and coronary artery disease, even if asymptomatic, is clinically relevant and requires appropriate and rigorous management and monitoring, as it increases the risk of major adverse cardiac events and recurrent stroke. Screening for ischemic heart disease in all patients with nonlacunar ischemic stroke in the age group of 65 years or older may be appropriate in clinical practice.

Acknowledgements

The authors wish to thank Dr. J Alió for the critical revision of the manuscript for intellectual content.



 
 ╗ References Top

1.
Arboix A. Cardiovascular risk factors for acute stroke: Risk profiles in the diferent subtypes of ischemic stroke. World J Clin Cases 2015;3:418-29.  Back to cited text no. 1
    
2.
Olesen KK, Madsen M, Lip GY, Egholm G, Thim T, Jensen LO, et al. Coronary artery disease and risk of adverse cardiac events and stroke. Eur J Clin Invest 2017;47:819-28.  Back to cited text no. 2
    
3.
Sposato LA, Lam M, Allen B, Shariff SZ, Saposnik G; PARADISE Study Group. First-ever ischemic stroke and incident major adverse cardiovascular events in 93,627 older women and men. Stroke 2020;51:387-94.  Back to cited text no. 3
    
4.
Sposato LA, Lam M, Allen B, Richard L, Shariff SZ, Saposnik G. First-ever ischemic stroke and increased risk of incident heart disease in older adults. Neurology 2020;94:e1559-70.  Back to cited text no. 4
    
5.
Yoo J, Song D, Baek J-H, Kim K, Kim J, Song T-J, et al. Poor long-term outcomes in stroke patients with asymptomatic coronary artery disease in heart CT. Atherosclerosis 2017;265:7-13.  Back to cited text no. 5
    
6.
Johansen MC, Sheth KN. Is incident stroke associated with increased risk of major adverse cardiovascular events? Neurology 2020;94:644-5.  Back to cited text no. 6
    
7.
Arboix A, Blanco-Rojas L, Martí-Vilalta JL. Advancements in understanding the mechanisms of symptomatic lacunar ischemic stroke: Translation of knowledge to prevention strategies. Expert Rev Neurother 2014;14:261-76.  Back to cited text no. 7
    
8.
Arboix A, Alió J. Acute cardioembolic stroke: An update. Expert Rev Cardiovasc Ther 2011;9:367-79.  Back to cited text no. 8
    




 

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