Ischemic heart disease in black South African stroke patients

Background and Purpose-Stroke patients in western countries frequently have coronary artery disease (CAD). In black Africans, CAD has been reported as being rare in both stroke patients and the general population. In this stu dy, an attempt has been made to determine the prevalence of CAD in a black South African stroke population. Methods-The prevalence of CAD was determined by indicators identified throu gh a series of 5 observational studies in black patients diagnosed with str oke. CAD indicators included (1) bedside diagnosis in 741 patients; (2) res ting ECG in 555 consecutively admitted patients; (3) a combination of clini cal examination cardiac ultrasound, radionuclide scintigraphy, and multigat ed blood pool studies in 102 consecutively admitted patients: (4) thallium scintigraphy in 60 patients; and (5) necropsy in 23 patients. Results-On bedside questioning, only 0.7% complained of previous angina. Th ere was no history given of myocardial infarction (MI), but documentation o f this was found in the clinical notes of 0.7% of the patients. In the rest ing ECG study, evidence of myocardial ischemia was present in 14.6% and MT in 2.1%. In the combined study, cardiac ischemia was documented on ECG in 1 2.7% of patients and evidence of previous MI in 5.8%. Cardiac scintigraphic studies revealed changes of myocardial ischemia in 31.7% and MI in 13.3% o f the 60 patients studied. Four (17.4%) of 23 patients in the necropsy stud y had histological evidence of previous MI, and 50% of all patients had evi dence of >50% atherosclerotic stenosis in 1, 2, or 3 coronary arteries. Conclusions-The prevalence of CAD in black African stroke patients is signi ficantly higher than has been documented in the general nonstroke black pop ulation as well as in stroke patients. Black stroke patients may have a ris k for CAD similar to that of their white counterparts.