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Association of Subclinical Coronary Artery Disease and Ischemic Stroke Caused by Cervical or Intracranial Atherosclerosis

Author(s): Ana Luíza Vieira de Araújo, Raul Dias dos Santos Filho, Marcio Sommer Bittencourt, Roberto Nery Dantas Junior, Carlos André Oshiro, Cesar Higa Nomura, Edson Bor-Seng Shu, Marce

Background: Coronary calcium score (CAC) is a marker of coronary atherosclerosis. We compared CAC scores in patients with ischemic stroke (IS) caused by large-artery atherosclerosis (Groupathero) to a control group (Groupcontrol), in multiethnic subjects without history of symptomatic coronary artery disease (CAD).

Methods: In this cross-sectional study, subjects in Groupathero (n=80) had at least one symptomatic stenosis ≥ 50% in the carotid or vertebrobasilar territories. Groupathero included two subgroups: stenosis in either cervical or intracranial arteries (GroupExtraorIntra), and in at least one cervical and one intracranial artery (GroupExtra&Intra). Subjects in Groupcontrol (n=40) had no history of stroke or stenosis ≥ 50% in cervical or intracranial arteries. Frequencies of CAC ≥ 100 and CAC > 0 were compared between the groups and subgroups by bivariate logistic regressions. Multivariate analyses were also performed.

Results: Rates of CAC ≥ 100 were not significantly different between Groupathero and Groupcontrol but were significantly greater in GroupExtra&Intra when compared to Groupcontrol (OR 4.67; 1.21-18.04; p = 0.025). CAC > 0 was significantly more frequent in Groupathero (85%) than Groupcontrol (OR, 4.19; 1.74-10.07; p = 0,001). In multivariate analyses, “Groupathero” and “GroupExtra&Intra” was significantly and independently associated with CAC.

Conclusions: The frequency of coronary calcification was higher in subjects with atherothrombotic stroke without symptoms of coronary disease than in controls with similar vascular risk factors. In patients with stroke, the burden of subclinical CAD was significantly higher in those with cervical and intracranial atherosclerosis.

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