FREQUENCY AND SEVERITY OF ASYMPTOMATIC CORONARY-DISEASE IN PATIENTS WITH DIFFERENT CAUSES OF STROKE

Background and Purpose We sought (1) to compare the frequency and seve rity of asymptomatic coronary artery disease (CAD) in patients with di fferent causes of brain ischemia and (2) to determine profiles of pati ents with brain ischemia who are at highest risk of asymptomatic CAD. Methods Sixty-nine patients with transient ischemic attack or stroke a nd without overt CAD underwent a cardiac stress test and a diagnostic evaluation to determine the cause of brain ischemia. The frequency of abnormal cardiac stress tests was compared in patients with large-arte ry cerebrovascular disease versus other causes of brain ischemia (90% of whom had penetrating artery disease or cryptogenic stroke). Additio nally, the frequencies of vascular risk factors, resting electrocardio graphic abnormalities, and cause of stroke (large-artery disease versu s other causes) were compared in patients with abnormal stress tests v ersus patients with normal stress tests. Results The frequency of abno rmal stress tests was 50% (15 of 30) in patients with large-artery cer ebrovascular disease versus 23% (9 of 39) in patients with other cause s of brain ischemia (P=.04). Moreover, 60% of abnormal stress tests (9 of 15) in patients with large-artery cerebrovascular disease suggeste d severe underlying CAD that was confirmed in 7 of 7 patients who unde rwent coronary angiography. On the other hand, less than 25% of abnorm al stress tests (2 of 9) in patients with other causes of brain ischem ia suggested severe underlying CAD. Features that were more common in patients with abnormal stress tests were smoking (P=.006), large-arter y cerebrovascular disease (P=.02), veteran status (P=.02), and left ve ntricular hypertrophy (P=.07). Conclusions Patients with penetrating a rtery disease or cryptogenic stroke have a significantly lower frequen cy of asymptomatic CAD than patients with large-artery cerebrovascular disease. Large-artery cerebrovascular disease, smoking, veteran Statu s, and possibly left ventricular hypertrophy may be useful features fo r identifying patients with transient ischemic attack or stroke who ar e at highest risk of harboring asymptomatic CAD.