Coronary angiography in acute ischemic stroke patients: frequency and determinants of pathological findings in a multicenter cohort study.
Acute ischemic stroke
Heart and brain axis
Myocardial injury
Stroke-heart-syndrome
Journal
Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161
Informations de publication
Date de publication:
Jul 2022
Jul 2022
Historique:
received:
20
12
2021
accepted:
29
01
2022
revised:
28
01
2022
pubmed:
20
2
2022
medline:
25
6
2022
entrez:
19
2
2022
Statut:
ppublish
Résumé
Myocardial injury as indicated by cardiac troponin elevation is associated with poor prognosis in acute stroke patients. Coronary angiography (CAG) is the diagnostic gold-standard to rule-out underlying obstructive coronary artery disease (CAD) in these patients. However, weighing risks and benefits of coronary angiography (CAG) against each other is particularly challenging, because stroke patients undergoing CAG may have a higher risk for secondary intracranial bleeding. Current guidelines remain vague. Thus, the aim of this study was to analyze frequency of pathological findings of CAG and associated clinical factors. We analyzed indications and frequency of CAG performed in acute ischemic stroke patients in clinical routine in two European tertiary care hospitals from 2011 to 2018. All data were obtained retrospectively. Multiple logistic regression analyses were performed to identify variables associated with absence of obstructive coronary artery disease defined as presence of at least one coronary vessel stenosis ≥ 50%. A total of 139 AIS patients underwent CAG. Frequent indications for CAG were suspected acute coronary syndrome (N = 114) or scheduled cardiac surgery (N = 25). Acute coronary stenting was applied in 51/139 patients. Among patients with suspected acute coronary syndrome, no obstructive CAD was found in 27/114 patients. Absence of obstructive CAD was associated with insular cortex lesions, no clinical symptoms for ACS, less than three cardiovascular risk factors, younger age and normal wall motion. Several variables suggest absence of CAD in AIS patients and may help in clinical decision making in stroke patients with myocardial injury.
Sections du résumé
BACKGROUND
BACKGROUND
Myocardial injury as indicated by cardiac troponin elevation is associated with poor prognosis in acute stroke patients. Coronary angiography (CAG) is the diagnostic gold-standard to rule-out underlying obstructive coronary artery disease (CAD) in these patients. However, weighing risks and benefits of coronary angiography (CAG) against each other is particularly challenging, because stroke patients undergoing CAG may have a higher risk for secondary intracranial bleeding. Current guidelines remain vague. Thus, the aim of this study was to analyze frequency of pathological findings of CAG and associated clinical factors.
METHODS
METHODS
We analyzed indications and frequency of CAG performed in acute ischemic stroke patients in clinical routine in two European tertiary care hospitals from 2011 to 2018. All data were obtained retrospectively. Multiple logistic regression analyses were performed to identify variables associated with absence of obstructive coronary artery disease defined as presence of at least one coronary vessel stenosis ≥ 50%.
RESULTS
RESULTS
A total of 139 AIS patients underwent CAG. Frequent indications for CAG were suspected acute coronary syndrome (N = 114) or scheduled cardiac surgery (N = 25). Acute coronary stenting was applied in 51/139 patients. Among patients with suspected acute coronary syndrome, no obstructive CAD was found in 27/114 patients. Absence of obstructive CAD was associated with insular cortex lesions, no clinical symptoms for ACS, less than three cardiovascular risk factors, younger age and normal wall motion.
CONCLUSION
CONCLUSIONS
Several variables suggest absence of CAD in AIS patients and may help in clinical decision making in stroke patients with myocardial injury.
Identifiants
pubmed: 35182178
doi: 10.1007/s00415-022-11001-5
pii: 10.1007/s00415-022-11001-5
pmc: PMC9217821
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
3745-3751Subventions
Organisme : Schweizerische Herzstiftung
ID : Grant FF19014
Informations de copyright
© 2022. The Author(s).
Références
Amarenco P, Lavallée PC, Labreuche J et al (2011) Prevalence of coronary atherosclerosis in patients with cerebral infarction. Stroke 42:22–29. https://doi.org/10.1161/STROKEAHA.110.584086
doi: 10.1161/STROKEAHA.110.584086
pubmed: 21088246
Boulanger M, Béjot Y, Rothwell PM, Touzé E (2018) Long-term risk of myocardial infarction compared to recurrent stroke after transient ischemic attack and ischemic stroke: systematic review and meta-analysis. J Am Heart Assoc. https://doi.org/10.1161/JAHA.117.007267
doi: 10.1161/JAHA.117.007267
pubmed: 29348322
pmcid: 5850155
Jane P, Lachlan MacGregor, Lees KR et al (2007) Predictors of early cardiac morbidity and mortality after ischemic stroke. Stroke 38:2295–2302. https://doi.org/10.1161/STROKEAHA.106.471813
doi: 10.1161/STROKEAHA.106.471813
Jauch EC, Saver JL, Adams HP et al (2013) Guidelines for the early management of patients with acute ischemic stroke. Stroke 44:870–947. https://doi.org/10.1161/STR.0b013e318284056a
doi: 10.1161/STR.0b013e318284056a
pubmed: 23370205
Kerr G, Ray G, Wu O et al (2009) Elevated troponin after stroke: a systematic review. CED 28:220–226. https://doi.org/10.1159/000226773
doi: 10.1159/000226773
Scheitz JF, Nolte CH, Doehner W et al (2018) Stroke-heart syndrome: clinical presentation and underlying mechanisms. Lancet Neurol 17:1109–1120. https://doi.org/10.1016/S1474-4422(18)30336-3
doi: 10.1016/S1474-4422(18)30336-3
pubmed: 30509695
Thygesen K, Alpert JS, Jaffe AS et al (2018) Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol 72:2231–2264. https://doi.org/10.1016/j.jacc.2018.08.1038
doi: 10.1016/j.jacc.2018.08.1038
pubmed: 30153967
Wyman RM, Safian RD, Portway V et al (1988) Current complications of diagnostic and therapeutic cardiac catheterization. J Am Coll Cardiol 12:1400–1406. https://doi.org/10.1016/s0735-1097(88)80002-0
doi: 10.1016/s0735-1097(88)80002-0
pubmed: 2973480
Scheitz JF, Mochmann H-C, Nolte CH et al (2011) Troponin elevation in acute ischemic stroke (TRELAS)-protocol of a prospective observational trial. BMC Neurol 11:98. https://doi.org/10.1186/1471-2377-11-98
doi: 10.1186/1471-2377-11-98
pubmed: 21824425
pmcid: 3166899
Giannitsis E, Kurz K, Hallermayer K et al (2010) Analytical validation of a high-sensitivity cardiac troponin T assay. Clin Chem 56:254–261. https://doi.org/10.1373/clinchem.2009.132654
doi: 10.1373/clinchem.2009.132654
pubmed: 19959623
Genders TSS, Steyerberg EW, Alkadhi H et al (2011) A clinical prediction rule for the diagnosis of coronary artery disease: validation, updating, and extension. Eur Heart J 32:1316–1330. https://doi.org/10.1093/eurheartj/ehr014
doi: 10.1093/eurheartj/ehr014
pubmed: 21367834
Scheitz JF, Gensicke H, Zinkstok SM et al (2018) Cohort profile: thrombolysis in ischemic stroke patients (TRISP): a multicentre research collaboration. BMJ Open 8:e023265. https://doi.org/10.1136/bmjopen-2018-023265
doi: 10.1136/bmjopen-2018-023265
pubmed: 30224398
pmcid: 6150152
Eagle KA, Lim MJ, Dabbous OH et al (2004) A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA 291:2727–2733. https://doi.org/10.1001/jama.291.22.2727
doi: 10.1001/jama.291.22.2727
pubmed: 15187054
Killip T, Kimball JT (1967) Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 20:457–464. https://doi.org/10.1016/0002-9149(67)90023-9
doi: 10.1016/0002-9149(67)90023-9
pubmed: 6059183
Subherwal S, Bach RG, Chen AY et al (2009) Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) Bleeding Score. Circulation 119:1873–1882. https://doi.org/10.1161/CIRCULATIONAHA.108.828541
doi: 10.1161/CIRCULATIONAHA.108.828541
pubmed: 19332461
pmcid: 3767035
Six AJ, Backus BE, Kelder JC (2008) Chest pain in the emergency room: value of the HEART score. Neth Heart J 16:191–196
doi: 10.1007/BF03086144
Mochmann H-C, Scheitz JF, Petzold GC et al (2016) Coronary angiographic findings in acute ischemic stroke patients with elevated cardiac troponin: the troponin elevation in acute ischemic stroke (TRELAS) study. Circulation 133:1264–1271. https://doi.org/10.1161/CIRCULATIONAHA.115.018547
doi: 10.1161/CIRCULATIONAHA.115.018547
pubmed: 26933082
Selvin E, Lazo M, Chen Y et al (2014) Diabetes mellitus, prediabetes, and incidence of subclinical myocardial damage. Circulation 130:1374–1382. https://doi.org/10.1161/CIRCULATIONAHA.114.010815
doi: 10.1161/CIRCULATIONAHA.114.010815
pubmed: 25149362
pmcid: 4198442
Tresch DD (1998) Management of the older patient with acute myocardial infarction: difference in clinical presentations between older and younger patients. J Am Geriatr Soc 46:1157–1162
doi: 10.1111/j.1532-5415.1998.tb06658.x
Sposato LA, Hilz MJ, Aspberg S et al (2020) Post-stroke cardiovascular complications and neurogenic cardiac injury: JACC state-of-the-art review. J Am Coll Cardiol 76:2768–2785. https://doi.org/10.1016/j.jacc.2020.10.009
doi: 10.1016/j.jacc.2020.10.009
pubmed: 33272372
Krause T, Werner K, Fiebach JB et al (2017) Stroke in right dorsal anterior insular cortex is related to myocardial injury. Ann Neurol 81:502–511. https://doi.org/10.1002/ana.24906
doi: 10.1002/ana.24906
pubmed: 28253544
Stengl H, Ganeshan R, Hellwig S et al (2021) Cardiomyocyte injury following acute ischemic stroke: protocol for a prospective observational cohort study. JMIR Res Protoc 10:e24186. https://doi.org/10.2196/24186
doi: 10.2196/24186
pubmed: 33544087
pmcid: 7895641
Nolte CH, von Rennenberg R, Litmeier S et al (2020) PRediction of acute coronary syndrome in acute ischemic StrokE (PRAISE)—protocol of a prospective, multicenter trial with central reading and predefined endpoints. BMC Neurol 20:318. https://doi.org/10.1186/s12883-020-01903-0
doi: 10.1186/s12883-020-01903-0
pubmed: 32854663
pmcid: 7450553