Predicting asymptomatic coronary artery stenosis by aortic arch plaque in acute ischemic cerebrovascular disease:beyond the cervicocephalic atherosclerosis?

查看全文 作　　者：Xin [1]Ma;Qi [1]Kong;Chen [2]Wang;Gary [3]Rajah;Yu-Chuan [3]Ding;Yu-Ren [4]Zhang;Xiang-Ying [2]Du

机构地区：[1]Department of Neurology. Xuanwu Hospital, Capital Medical University, Beijing 100053, China;[2]Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China;[3]Department of Neurosurgery, Wayne State University School of Medicine, Detroit 48201, USA;[4]Department of Biostatistics, Yale University School of Public Health, New Haven 06520, USA

出　　处：《Chinese Medical Journal》索引2019年第8期,共9页

基　　金：Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support(No.ZYLX201706);Beijing Municipal Natural Science Foundation(No.7172093). 摘　　要：Background:Asymptomatic coronary artery stenosis(ACAS)≥50%is common in patients with acute ischemic cerebrovascular disease(AICVD),which portends a poor cardiovascular and cerebrovascular prognosis.Identifying ACAS>50%early may optimize the clinical management and improve the outcomes of these high-risk AICVD patients.This study aimed to investigate whether aortic arch plaque(AAP),an early atherosclerotic manifestation of brain blood-supplying arteries,could be a predictor for ACAS>50%in AICVD.Methods:In this cross-sectional study,atherosclerosis of the coronary and brain blood-supplying arteries was simultaneously evaluated using one-step computed tomography angiography(CTA)in AICVD patients without coronary artery disease history.The patients were divided into ACAS≥50%and non-ACAS≥50%groups according to whether CTA showed stenosis≥50%in at least one coronary arterial segment.The AAP characteristics of CTA were depicted from aspects of thickness,extent,and complexity.Results:Among 118 analyzed patients with AICVD,29/118(24.6%)patients had ACAS≥50%,while AAPs were observed in 86/118(72.9%)patients.Increased AAP thickness per millimeter(adjusted odds ratio[OR]:1.56,95%confidence interval[CI]:1.18-2.05),severe-extent AAP(adjusted OR:13.66,95%CI:2.33-80.15),and presence of complex AAP(adjusted OR:7.27,95%CI:2.30-23.03)were associated with ACAS≥50%among patients with AICVD,independently of clinical demographics and cervicocephalic atherosclerotic stenosis.The combination of AAP thickness,extent,and complexity predicted ACAS≥50%with an area under the receiver-operating characteristic curve of 0.78(95%CI:0.70-0.85,P<0.001).All three AAP characteristics provided additional predictive power beyond cervical and intracranial atherosclerotic stenosis for ACAS≥50%in AICVD(all P<0.05).Conclusions:Thicker,severe-extent,and complex AAP were significant markers of the concomitant ACAS≥50%in AICVD,possibly superior to the indicative value of cervical and intracranial atherosclerotic stenosis.As an integral part of atherosclerosis of brain blood-supplying arteries,AAP should not be overlooked in predicting ACAS≥50%for patients with AICVD. 关键词：ASYMPTOMATIC coronary artery STENOSIS AORTIC arch PLAQUE Acute ischemic CEREBROVASCULAR disease ATHEROSCLEROSIS Prediction

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Predicting asymptomatic coronary artery stenosis by aortic arch plaque in acute ischemic cerebrovascular disease:beyond the cervicocephalic atherosclerosis?

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