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- W4313443947 abstract "One-third of ischemic strokes are “cryptogenic”, and in the absence of a clear etiology, managing secondary stroke prevention is challenging. Cardiovascular events constitute the main cause of death after stroke, but whether patients with prior cryptogenic stroke should be screened for coronary artery disease (CAD) remains controversial. To assess the incremental prognostic value of stress CMR beyond traditional risk factors in asymptomatic patients with prior cryptogenic ischemic stroke. Between 2008 and 2021, consecutive asymptomatic patients with prior cryptogenic strokes referred for a stress CMR were included. Inclusion criteria were no history of coronary artery disease and the presence of ≥ 2 cardiovascular risk factors. The patients were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction (MI). Univariable and multivariable Cox regressions were performed to determine the prognostic value of unrecognized MI and silent ischemia detected by stress CMR. Of 617 patients who successfully completed the stress CMR protocol, 542 patients (55.2% male, mean age 71.4 ± 8.8 years) completed the follow-up (median 5.9 [IQR 5.3–6.3] years), and 66 (12.2%) experienced MACE. Among the 542 patients, silent ischemia and unrecognized MI were detected in 18% and 17%, respectively, resulting in 30% of abnormal CMR. Using Kaplan-Meier analysis, silent ischemia and unrecognized MI were significantly associated with the occurrence of MACE (hazard ratio, HR: 8.43 [95%CI: 5.11–13.9]; HR: 7.87 [95%CI: 4.80–12.9]; respectively, P < 0.001). In multivariable analysis, silent ischemia and unrecognized MI were independent predictors of a higher incidence of MACE (HR: 8.08 [95%CI: 4.21–15.5]; HR: 6.65 [95%CI: 3.49–12.7]; respectively, P < 0.001). After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors (C statistic improvement: 0.13; NRI = 0.428; IDI = 0.048) (Fig. 1A–D). In asymptomatic patients with prior cryptogenic ischemic stroke, silent ischemia and unrecognized MI detected by stress CMR have an incremental prognostic value to predict MACE over traditional risk factors." @default.
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- W4313443947 date "2023-01-01" @default.
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- W4313443947 title "Prognostic value of unrecognized myocardial infarction and silent ischemia detected by stress CMR in asymptomatic patients with prior cryptogenic ischemic stroke" @default.
- W4313443947 doi "https://doi.org/10.1016/j.acvdsp.2022.10.112" @default.
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