London, United Kingdom 2013 8 Heart and brain 9:40 - 9:50 A score to PREdict asymptomatic COronary artery disease in patients with ISchemic stroke and TIA. The PRECORIS score D. Calvet1, D. Song2, J. Yoo3, G. Turc4, J. Hoe Heo5, J.L. Mas6 Paris Descartes University, INSERM UMR 894 and Departement of Nerology, Centre Hospitalier Sainte-Anne, Paris, FRANCE1,Department of Neurology, Yonsei University College of Medicine, Seoul, SOUTH KOREA2, Department of Neurology, Yonsei University College of Medicine, Seoul, SOUTH KOREA3, Paris Descartes University, INSERM UMR 894 and Departement of Nerology, Centre Hospitalier Sainte-Anne, Paris, FRANCE4, Depart-ment of Neurology, Yonsei University College of Medicine, Seoul, SOUTH KOREA5, Paris Descartes University, INSERM UMR 894 and Departement of Nerology, Centre Hospitalier Sainte-Anne, Paris, FRANCE6 Background Identifying stroke or TIA patients with severe asymptomatic coronary artery dis-ease (CAD) may help to improve secondary prevention of cardiac events in stroke/TIA pa-tients. The aim of this study was to derive and validate a simple score to predict the presence of severe asymptomatic CAD in stroke/TIA patients. Methods The score was derived from a French hospital-based cohort of consecutive patients (n=274) between 45 and 75 years of age who had an ischemic stroke or a TIA and no prior history of CAD. We validated the score in a similar Korean cohort (n=1850) of women older than 55 and men older than 45 years of age. In both cohorts, severe CAD was detected by with 64-section CT coronary angiography and defined by the presence of at least one ≥50% coronary artery stenosis. We also assessed the predictive ability of the score to detect patients with left main trunk disease or 3-vessel dis-ease. Results A five-point score (Framingham Risk Score-predicted 10-year coronary heart dis-ease risk ≥20%=3, 10-19%=1, <10%=0, cervicocephalic artery stenosis ≥50%=2, <50%=1, None=0) was predictive of severe CAD risk in the derivation cohort (c stat=0.77 0.70-0.84) with excellent cross-validation based in 1000 bootstrap replicates (c stat=0.77 0.70-0.83), and in validation cohort (c stat= 0.64 0.62-0.67). The predictive ability of the score was even stronger when left main trunk disease or 3-vessel disease were considered with c stat =0.83 (0.74-0.92) in derivation cohort and 0.69 (0.65-0.73) in validation cohort. The prevalence of severe asymptomatic CAD was 18% in the derivation cohort and 37 % in the validation cohort and increased to 44% and 51% respectively, in patients with a score of 4 or 5. With regards to left main trunk or 3-vessel disease, the prevalence was 4% in the derivation cohort and 8% in the validation cohort and increased to 14% in both cohorts in patients with a score of 4 or 5. Conclusion This score can identify a population of stroke/TIA patients with a high prevalence of asymptomatic CAD. Cerebrovasc Dis 2013; 35 (suppl 3)1-854 25 7 Heart and brain 9:30 - 9:40 Carotid Atherosclerosis and Risk of Subsequent Coronary Event in Outpatients with Ath-erothrombosis G. Sirimarco1, P. Amarenco2, J. Labreuche3, P.J. Touboul4, M. Alberts5, S. Goto6, J. Rother7, J.L. Mas8, D.L. Bhatt9, P.G. Steg10 Department of Neurology and Stroke Center,Bichat-Claude Bernard Hospital, Univer-sity of Paris Diderot, Paris, FRANCE1,Department of Neurology and Stroke Center,Bi-chat- Claude Bernard Hospital, University of Paris Diderot, Paris, FRANCE2, Department of Neurology and Stroke Center,Bichat-Claude Bernard Hospital, University of Paris Diderot, Paris, FRANCE3, Department of Neurology and Stroke Center,Bichat-Claude Bernard Hospital, University of Paris Diderot, Paris, FRANCE4, Department of Neurology, Northwestern Univer-sity Feinberg School of Medicine, Chicago, USA5, Department of Medicine (Cardiology), To-kai University School of Medicine, Isehara, JAPAN6, Department of Neurology, Klinikum Min-den, Hannover Medical School, Minden, GERMANY7, Stroke Unit, Neurology Department, Sainte-Anne Hospital, Paris Descartes University, Paris, FRANCE8, VA Boston Healthcare Sys-tem, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA9, Department of Cardiology, Bichat-Claude Bernard Hospital, University of Paris Diderot, Paris, FRANCE10 Background: The presence of carotid plaque reflects overall atherosclerotic burden and may predict coronary artery disease (CAD) events. We examined the association between carotid atherosclerosis, history of atherothrombotic events and risk of coronary events. Methods : Among 45227 patients enrolled in the REduction of Atherothrombosis for Contin-ued Health (REACH) Registry between 2003 and 2004 from 3647 centers in 29 countries and followed up for 4 years, 23364 patients with information on CP at baseline were analyzed. The primary outcome was the composite of first occurrence of cardiovascular death, myocardial in-farction (MI), or coronary hospitalisation. Results : At baseline, CPs were present in 46% (n=10725). The prevalence of CP increased with increasing conventional cardiovascular risk factor burden and the extent of symptomatic vascu-lar disease. During 4-year follow-up, 4304 patients experienced at least 1 coronary event. After adjustment for cardiovascular risk factors and geographic region, the risk of coronary events increased by 22% (95%CI, 14 to 30%) in patients with CPs relative to patients without. The in-creased risk (95%CI) was 18% (-7 to 51%) in patients enrolled with multiple risk factors only, 25% (16 to 35%) in patients with coronary artery disease, 46% (28 to 65%) in patients with cerebrovascular disease and 37% (17 to 60%) in patients with peripheral arterial disease. Carot-id atherosclerosis was associated with increased risk, even among patients with prior MI but no known stroke (P=0.001) or prior stroke but no known MI (P<0.001). Conclusions : Carotid atherosclerosis was an independent predictor of coronary events across all types of symptomatic vascular disease and had an incremental effect on risk regardless of risk factors or location of vessel disease.
Karger_ESC London_2013
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