机构：[1]Department of Neurology. Xuanwu Hospital, Capital Medical University, Beijing 100053, China神经内科首都医科大学宣武医院[2]Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China放射科首都医科大学宣武医院[3]Department of Neurosurgery, Wayne State University School of Medicine, Detroit 48201, USA[4]Department of Biostatistics, Yale University School of Public Health, New Haven 06520, USA
Background:Asymptomatic coronary artery stenosis (ACAS) ≥50％ is common in patients with acute ischemic cerebrovascular disease (AICVD),which portends a poor cardiovascular and cerebrovascular prognosis.Identifying ACAS ≥50％ early may optimize the clinical management and improve the outcomes of these high-risk AICVD patients.This study aimed to investigate whether aortic arch plaque (AAP),an early atherosclerotic manifestation of brain blood-supplying arteries,could be a predictor for ACAS ≥50％ in AICVD.Methods:In this cross-sectional study,atherosclerosis of the coronary and brain blood-supplying arteries was simultaneously evaluated using one-step computed tomography angiography (CTA) in AICVD patients without coronary artery disease history.The patients were divided into ACAS ≥50％ and non-ACAS ≥50％ groups according to whether CTA showed stenosis ≥50％ in at least one coronary arterial segment.The AAP characteristics of CTA were depicted from aspects of thickness,extent,and complexity.Results:Among 118 analyzed patients with AICVD,29/118 (24.6％) patients had ACAS ≥50％,while AAPs were observed in 86/118 (72.9 ％) patents.Increased AAP thickness per millimeter (adjusted odds ratio [OR]:1.56,95 ％ confidence interval [CI]:1.18-2.05),severe-extent AAP (adjusted OR:13.66,95％ CI:2.33-80.15),and presence of complex AAP (adjusted OR:7.27,95％ CI:2.30-23.03) were associated with ACAS ≥50％ among patents with AICVD,independently of clinical demographics and cervicocephalic atherosclerotic stenosis.The combination of AAP thickness,extent,and complexity predicted ACAS ≥50％ with an area under the receiver-operating characteristic curve of 0.78 (95％ CI:0.70-0.85,P ＜ 0.001).All three AAP characteristics provided additional predictive power beyond cervical and intracranial atherosclerotic stenosis for ACAS ≥50％ in AICVD (all P ＜ 0.05).Conclusions:Thicker,severe-extent,and complex AAP were significant markers of the concomitant ACAS ≥50％ in AICVD,possibly superior to the indicative value of cervical and intracranial atherosclerotic stenosis.As an integral part of atherosclerosis of brain blood-supplying arteries,AAP should not be overlooked in predicting ACAS ≥50％ for patients with AICVD.
基金：
Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support [ZYLX201706]; Beijing Municipal Natural Science Foundation [7172093]
第一作者机构：[1]Department of Neurology. Xuanwu Hospital, Capital Medical University, Beijing 100053, China[*1]Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing 100053, China
通讯作者：
通讯机构：[*1]Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Beijing 100053, China
推荐引用方式(GB/T 7714)：
Ma Xin,Kong Qi,Wang Chen,et al.Predicting asymptomatic coronary artery stenosis by aortic arch plaque in acute ischemic cerebrovascular disease: beyond the cervicocephalic atherosclerosis?[J].Chinese Medical Journal.2019,132(8):905-913.doi:10.1097/CM9.0000000000000174.
APA：
Ma Xin,Kong Qi,Wang Chen,Rajah Gary,Ding Yu-Chuan...&Du Xiang-Ying.(2019).Predicting asymptomatic coronary artery stenosis by aortic arch plaque in acute ischemic cerebrovascular disease: beyond the cervicocephalic atherosclerosis?.Chinese Medical Journal,132,(8)
MLA：
Ma Xin,et al."Predicting asymptomatic coronary artery stenosis by aortic arch plaque in acute ischemic cerebrovascular disease: beyond the cervicocephalic atherosclerosis?".Chinese Medical Journal 132..8(2019):905-913
