Asymptomatic coronary artery disease in patients with stroke. Prevalence, prognosis, diagnosis, and treatment.

Abstract:

:The frequency of angiographically defined asymptomatic CAD in patients with carotid disease is 40%. Although the prognosis of patients with asymptomatic 1-vessel or 2-vessel CAD is good (annual cardiac mortality rate less than 2%), the prognosis of asymptomatic 3-vessel disease or left main CAD is substantially less favorable (annual cardiac mortality 5-8%). Preliminary data from nonrandomized studies suggest that coronary artery bypass surgery significantly lowers cardiac mortality in patients with asymptomatic 3-vessel or left main CAD. Further studies are needed to determine 1) vascular risk factor profiles that are predictive of asymptomatic CAD in patients with cerebrovascular disease and 2) the prevalence of asymptomatic CAD, especially 3-vessel and left main CAD, in patients with a variety of subtypes of cerebrovascular disease (e.g., carotid disease, atherosclerotic vertebrobasilar disease, cardioembolism, penetrating artery disease, stroke of undetermined cause). If the prevalence of asymptomatic 3-vessel or left main CAD is high in a subset of patients with cerebrovascular disease, a randomized study comparing coronary artery bypass surgery with best medical therapy (anti-ischemic agents, lipid-lowering therapy, and aspirin) may be warranted.

journal_name

Stroke

journal_title

Stroke

authors

Chimowitz MI,Mancini GB

doi

10.1161/01.str.23.3.433

subject

Has Abstract

pub_date

1992-03-01 00:00:00

pages

433-6

issue

3

eissn

0039-2499

issn

1524-4628

journal_volume

23

pub_type

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