Aortic Stiffness Measurement Improves the Prediction of Asymptomatic Coronary Artery Disease in Stroke/Transient Ischemic Attack Patients

Abstract

Background Aortic stiffness is an independent predictor of coronary events. Aims We assessed the predictive value of aortic stiffness for ⩾50% asymptomatic coronary artery disease in a stroke/transient ischemic attack population. Methods We enrolled 300 consecutive patients aged 45–75 years with nondisabling, noncardioembolic ischemic stroke or transient ischemic attack, and no prior history of coronary artery disease. Coronary artery disease was assessed with 64-section computed tomography coronary angiography and all patients had a detailed cervicocephalic arterial work-up. Aortic stiffness was determined from carotid-femoral pulse wave velocity with 9·6 m/s as cutoff value. The predictive value of aortic stiffness was assessed by logistic regression and reclassification tables method after adjustment for the Framingham Risk Score and the presence of cervicocephalic stenosis, which were previously shown to be independent predictor of ⩾50% asymptomatic coronary artery disease. Results Among the 274 included patients who had computed tomography coronary angiography, 26% (95% CI, 21%–32%) had an increased stiffness (pulse wave velocity > 9·6 m/s) and 18% (14%–23%) had ⩾50% asymptomatic coronary artery disease. Increased aortic stiffness was associated with the presence of ⩾50% asymptomatic coronary artery disease, both in univariate (odds ratio = 3·4 [1·8–6·4]) and multivariate analyses (odds ratio = 2·3 [1·2–4·7]) after adjustment for Framingham Risk Score and presence of cervicocephalic stenosis. After carotid-femoral pulse wave velocity was added to the standard model including Framingham Risk Score and the presence of cervicocephalic stenosis, net reclassification improvement was 12·6% ( P < 0·005), integrated discrimination index was 2·51% ( P = 0·025), and model fit was improved (likelihood ratio = 4·99, P = 0·025). Conclusions In stroke/transient ischemic attack patients, aortic pulse wave velocity improves the prediction of ⩾50% asymptomatic coronary artery disease beyond classical risk factors.