Coronary Calcium Score. Is There a Difference among Ischemic Stroke Subtypes?

Ischemic heart disease is an important cause of death in stroke patients during a long-term follow-up. ^, Ischemic stroke survivors have a high prevalence of asymptomatic coronary artery disease (CAD). Indeed, half of those with no cardiac history have some degree of coronary atherosclerotic plaques and one-third have more than 50% of coronary stenosis. For the assessment of CAD risk, a non-invasive stratification score based on the extent and density of computed tomography coronary artery calcium (CAC) was proposed by Agatston et al. The measurement of CAC to improve clinical risk prediction for cardiovascular events in selected asymptomatic adults is the recommendation of worldwide guidelines. ^– Although there is a strong association between atherosclerosis and subclinical CAD, it is remains uncertain for non-atherosclerotic stroke patients. ^,

In this issue of ABC Cardiol, Negrão et al. conducted a cross-sectional study to compare the coronary calcium score (CCS) between atherosclerotic and non-atherosclerotic ischemic stroke patients who were admitted at Rehabilitation Hospital. Of 244 evaluated patients, 80 (33%) were included in the atherosclerotic etiology group. The non-atherosclerotic group was represented by the remaining etiologies, such as cardioembolism (30%), small artery occlusion (15%), other causes (6%), and undetermined cause (16%). Although there was no difference in CAD risk between those groups, age ≥60 years was an independent predictor for high CAD risk (OR 3.52; 95%CI 1.72-7.18).

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