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Multicenter Study
. 2022 Jul;269(7):3745-3751.
doi: 10.1007/s00415-022-11001-5. Epub 2022 Feb 19.

Coronary angiography in acute ischemic stroke patients: frequency and determinants of pathological findings in a multicenter cohort study

Simon Litmeier  1   2   3 , Thomas R Meinel  4 , Regina von Rennenberg  5   6   7 , Joachim U Kniepert  4 , Heinrich J Audebert  5   7 , Matthias Endres  5   6   7   8   9   10 , Simon Jung  4 , Jan F Scheitz  5   7   8   9 , Christian H Nolte  5   7   8   9
Affiliations
Multicenter Study

Coronary angiography in acute ischemic stroke patients: frequency and determinants of pathological findings in a multicenter cohort study

Simon Litmeier et al. J Neurol. 2022 Jul.

Abstract

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: 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: 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: Several variables suggest absence of CAD in AIS patients and may help in clinical decision making in stroke patients with myocardial injury.

Keywords: Acute ischemic stroke; Heart and brain axis; Myocardial injury; Stroke-heart-syndrome.

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Conflict of interest statement

TM was supported by the Swiss Heart Foundation (Grant FF19014). ME reports grants from Bayer and fees paid to the Charité from AstraZeneca, Bayer, Boehringer Ingelheim, BMS, Daiichi Sankyo, Amgen, GSK, Sanofi, Covidien, Novartis, Pfizer, all outside the submitted work. CHN received research grants from German Ministry of Research and Education, German Center for Neurodegenerative Diseases, German Center for cardiovascular Research. He received speaker and/or consultation fees from Bayer, Boehringer Ingelheim, BMS, Daiichi Sankyo, Pfizer Pharma, Alexion, Abbott and W.L. Gore and Associates, all outside the submitted work. JFS reports speaker fees from AstraZeneca outside the submitted work. No relevant conflicts of interest. Outside the submitted work: HJA reports receiving personal fees from Bayer Vital, Boehringer Ingelheim, Bristol Myers Squibb, Novo Nordisk, Pfizer, Daiichi Sankyo and Sanofi. On behalf of the other authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Indication for coronary angiogram and prevalence of CAD in 139 AIS patients. CAD coronary artery disease, ACS suspected acute coronary syndrome, pre-OP pre (cardiac) operation
See this image and copyright information in PMC

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