Stroke and Coronary Artery Disease

Authors: M. Kováčik 1,2,4;  Š. Madarász 1,2;  D. Bartko 1,2;  M. Pešta 3;  R. Herzig 4;  P. Kaňovský 4
Authors‘ workplace: Neurologická klinika, ÚVN SNP – FN Ružomberok 1;  Ústav medicínskych vied, neurovied a vojenského zdravotníctva, ÚVN SNP – FN Ružomberok 2;  Katedra pravděpodobnosti a matematické statistiky, MFF UK v Praze 3;  Iktové centrum, Neurologická klinika LF UP a FN Olomouc 4
Published in: Cesk Slov Neurol N 2010; 73/106(5): 497-502
Category: Review Article


Acute coronary syndrome as a manifestation of coronary heart disease is the main cause of long-term mortality in stroke patients, with an annual incidence of 2% in the Czech Republic. The occurrence of stroke alone doubles the risk of myocardial infarction. It follows that the presence of symptomatic coronary artery disease and screening for asymptomatic coronary artery disease are highly worthy of attention. Human, financial and logistical factors dictate that it is impossible to screen all stroke patients for the presence of asymptomatic coronary artery disease, so considerable effort should be devoted to the proper selection of high-risk patients, those who would benefit most from the detection of coronary artery disease.

Key words:
stroke – coronary artery disease – carotid endarterectomy


1. White H, Boden-Albala B, Wang C, Elkind MS, ­Rundek T, Wright CB at al. Ischemic stroke subtype incidence among whites, blacks, and Hispanics: the Northern Manhattan Study. Circulation 2005; 111(10): 1327–1331.

2. Adams RJ, Chimowitz MI, Alpert JS, Awad IA, Cerqueria MD, Fayad P et al. Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: a scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association. Stroke 2003; 34(9): 2310–2322.

3. Di Pasquale G, Pinelli G, Grazi P, Andreoli A, ­Corbelli C, Manini GL et al. Incidence of silent myocardial ischaemia in patients with cerebral ischaemia. Eur Heart J 1988; 9 (Suppl N): 104–107.

4. Gongora-Rivera F, Labreuche J, Jaramillo A, Steg PG, Hauw JJ, Amarenco P. Autopsy prevalence of coronary atherosclerosis in patients with fatal stroke. Stroke 2007; 38(4): 1203–1210.

5. Silver FL, Norris JW, Lewis AJ, Hachinski VC. Early mortality following stroke: a prospective review. Stroke 1984; 15(3): 492–496.

6. Elneihoum AM, Goransson M, Falke P, Janzon L. Three-year survival and recurrence after stroke in Malmö, Sweden: an analysis of stroke registry data. Stroke 1998; 29(10): 2114–2117.

7. Hankey GJ, Jamrozik K, Broadhurst RJ, Forbes S, Burvill PW, Anderson CS et al. Long-term risk of first recurrent stroke in the Perth Community Stroke Study. Stroke 1998; 29(12): 2491–2500.

8. Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C. Long-term risk of recurrent stroke after a first-ever stroke: the Oxfordshire Community Stroke Project. Stroke 1994; 25(2): 333–337.

9. Hillen T, Coshall C, Tilling K, Rudd AG, McGovern R, Wolfe CD. Cause of stroke recurrence is multifactorial patterns, risk factors, and outcomes of stroke recurrence in the South London Stroke Register. Stroke 2003; 34(6): 1457–1463.

10. Touzé E, Varenne O, Chatellier G, Peyrard S, ­Rothwell PM, Mas JL. Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and ­meta-analysis. Stroke 2005; 36(12): 2748–2755.

11. European Stroke Prevention Study. ESPS group. Stroke 1990; 21: 1122–1130.

12. Hass WK, Easton JD, Adams HP jr, Pryse-Phillips W, Molony BA, Anderson S et al. A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients: Ticlopidine Aspirin Stroke Study Group. N Engl J Med 1989; 321(8): 501–507.

13. Diener HC, Cunha L, Forbes C, Sivenius J, Smets P, Lowenthal A. European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci 1996; 143(1–2): 1–13.

14. CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996; 348(9038): 1329–1339.

15. Ovbiagele B, Liebeskind DS, Kim D, Ali LK, Pineda S, Saver JL. Optimizing screening and management of asymptomatic coronary artery disease in patients with stroke and patients with transient ischemic attack. Stroke 2009; 40(10): 3407–3409.

16. Barakova A. Epidemiologická situácia v SR – choroby obehovej sústavy a ich rizikové faktory. Via practica 2009; 6(1): 17–21.

17. Adams HP jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al. Classification of subtype of acute ischemic stroke: definitions for use in a multicenter clinical trial. TOAST: Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24(1): 35–41.

18. Chimowitz MI, Poole RM, Starling MR, Schwaiger M, Gross MD. Frequency and severity of asymptomatic coronary disease in patients with different causes of stroke. Stroke 1997; 28(5): 941–945.

19. Petty GW, Brown RD jr, Whisnant JP, Sicks JD, O’Fallon WM, Wiebers DO. Ischemic stroke subtypes: a population-based study of functional outcome, survival, and recurrence. Stroke 2000; 31(5): ­1062–1068.

20. Bamford J, Sandercock P, Jones L, Warlow C. The natural history of lacunar infarction: the ­Oxfordshire Community Stroke Project. Stroke 1987; 18(3): ­545–551.

21. Salgado AV, Ferro JM, Gouveia-Oliveira A. Long-term prognosis of first-ever lacunar strokes. A ­hospital-based study. Stroke 1996; 27(4): ­661–666.

22. Longstreth WT jr, Bernick C, Fitzpatrick A, ­Cushman M, Knepper L, Lima J et al. Frequency and predictors of stroke death in 5,888 participants in the Cardiovascular Health Study. Neurology 2001; 56(3): 368–375.

23. Hartmann A, Rundek T, Mast H, Paik MC, ­Boden-Albala B, Mohr JP et al. Mortality and causes of death after first ischemic stroke: the Northern Manhattan Stroke Study. Neurology 2001; 57(11): ­2000–2005.

24. Grau AJ, Weimar C, Buggle F, Heinrich A, ­Goertler M, Neumaier S et al. Risk factors, outcome, and treatment in subtypes of ischemic stroke: the German stroke data bank. Stroke 2001; 32(11): 2559–2566.

25. Urbinati S, Di Pasquale G, Andreoli A, Lusa AM, Ruffini M, Lanzino G et al. Frequency and prognostic significance of silent coronary artery disease in patients with cerebral ischemia undergoing caro­tid endarterectomy. Am J Cardiol 1992; 69(14): ­1166–1170.

26. Sconocchini C, Racco F, Pratillo G, Alesi C, ­Zappelli L. Patients with carotid stenosis and clinical history negative for coronary disease: usefulness of the ergometric test for the identification of ischemic myocardial disease. Minerva Med 1997; 88(5): ­173–181.

27. Okin PM, Roman MJ, Schwartz JE, Pickering TG, Devereux RB. Relation of exercise-induced myocardial ischemia to cardiac and carotid structure. Hypertension 1997; 30(6): 1382–1388.

28. Hertzer NR, Young JR, Beven EG, Graor RA, O’Hara PJ, Ruschhaupt WF jr et al. Coronary angiography in 506 patients with extracranial cerebrovascular disease. Arch Intern Med 1985; 145(5): 849–852.

29. Schulz UG, Rothwell P M. Differences in vascular risk factors between etiological subtypes of ichemic stroke: importance of population-based studies. Stroke 2003; 34(8): 2050–2059.

30. Bártková A, Šaňák D, Herzig R, Vlachová I, ­Zapletalová J, Král M et al. Prospektivní analýza subtypů a rizikových faktorů ischemické cévní mozkové příhody u dospělých do 50 let. Cesk Slov Neurol N 2010; 73/106(2): 143–149.

31. Grundy SM, Pasternak R, Greenland P, Smith S jr, Fuster V. Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cardio­logy. Circulation 1999; 100(13): 1481–1492.

32. Salonen T, Salonen R. Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. Arterioscler Thromb 1991; 11(5): 1245–1249.

33. Bots ML, Hoes AW, Koudstaal PJ, Hofman A, Grobbee DE. Common carotid intima-media thickness and risk of stroke and myocardial infarction: the ­Rotterdam Study. Circulation 1997; 96(5): ­1432–1437.

34. O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med 1999; 340(1): 14–22.

35. Rosvall M, Janzon L, Berglund G, Engstrôm G, Hedblad B. Incident coronary events and case fatality in relation to common carotid intima-media thickness. J Intern Med 2005; 257(5): 430–437.

36. Lorenz MW, von Kegler S, Steinmetz H, Markus HS, Sitzer M. Carotid intima-media thickening indicates a higher vascular risk across a wide age range: prospective data from the Carotid Atherosclerosis Progression Study (CAPS). Stroke 2006; 37(1): 87–92.

37. Rosvall M, Janzon L, Berglund G, Engstrôm G, Hedblad B. Incidence of stroke is related to carotid IMT even in the absence of plaque. Atherosclerosis 2005; 179(2): 325–331.

38. Kitamura A, Iso H, Imano H, Ohira T, Okada T, Sato S et al. Carotid intima-media thickness and plaque characteristics as a risk factor for stroke in Japanese elderly men. Stroke 2004; 35(12): 2788–2794.

39. Folsom AR, Kronmal RA, Detrano RC, O’Leary DH, Bild DE, Bluemke DA et al. Coronary artery calcification compared with carotid intima-media thickness in the prediction of cardiovascular disease incidence: the Multi-Ethnic Study of Atherosclerosis (MESA). Arch Intern Med 2008; 168(12): 1333–1339.

40. Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987–1993. Am J Epidemiol 1997; 146(6): 483–494.

41. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007; 115(4): 459–467.

42. Lau KK, Chan YH, Yiu KH, Tam S, Li SW, Lau CP et al. Incremental predictive value of vascular assessments combined with the Framingham Risk Score for prediction of coronary events in subjects of ­low/­intermediate risk. Postgrad Med J 2008; 84(989): ­153–157.

43. Simon A, Megnien JL, Chironi G. The value of carotid intima-media thickness for predicting cardiovascular risk. Arterioscler Thromb Vasc Biol 2010; 30(2): 182–185.

44. O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. N Engl J Med 1999; 340(1): 14–22.

45. Chan SY, Mancini GB, Kuramoto L, Schulzer M, Frohlich J, Ignaszewski A. The prognostic importance of endothelial dysfunction and carotid atheroma burden in patients with coronary artery disease. J Am Coll Cardiol 2003; 42(6): 1037–1043.

46. Johnsen SH, Mathiesen EB, Joakimsen O, ­Stensland E, Wilsgaard T, Løchen ML et al. Carotid atherosclerosis is a stronger predictor of myocardial infarction in women than in men: a 6-year follow-up study of 6226 persons: the Tromsø Study. Stroke 2007; 38(11): 2873–2880.

47. Spence ID, Eliasziw M, Di Cicco M, Hackam DG, Galil R, Lohmann T. Carotid plaque area: a tool for targeting and evaluating vascular preventive therapy. Stroke 2002; 33(12): 2916–2922.

48. Tzivoni D, Gavish A, Zin D, Gottlieb S, Moriel M, Keren A et al. Prognostic significance of ischemic episodes in patients with previous myocardial infarction. Am J Cardiol 1988; 62(10): 661–664.

49. Killip T. Silent myocardial ischemia: some good news. Circulation 1997; 95(8): 1992–1993.

50. Marcassa C, Galli M, Baroffio C, Campini R, ­Giannuzzi P. Ischemic burden in silent and painful myocardial ischemia: a quantitative exercise sestamibi tomographic study. J Am Coll Cardiol 1997; 29(5): 948–954.

51. Deedwania PC, Carbajal EV. Silent ischemia during daily life is an independent predictor of mortality in stable angina. Circulation 1990; 81(3): 748–756.

52. Deedwania PC, Carbajal EV. Usefulness of ambulatory silent myocardial ischemia added to the prognostic value of exercise test parameters in predicting risk of cardiac death in patients with stable angina pectoris and exercise-induced myocardial ischemia. Am J Cardiol 1991; 68(13): 1279–1286.

53. Yeung AC, Barry J, Orav J, Bonassin E, Raby KE, Selwyn AP. Effects of asymptomatic ischemia on long-term prognosis in chronic stable coronary disease. Circulation 1991; 83(5): 1598–1604.

54. Mraček J, Holečková I, Mork J, Choc M. Timing karotické endarterektomie. Cesk Slov Neurol N 2008; 71/104(4): 414–421.

55. Alamowitch S, Eliasziw M, Barnett HJ. The risk and benefit of endarterectomy in women with symptomatic internal carotid artery disease. Stroke 2005; 36(1): 27–31.

56. Estes JM, Guadagnoli E, Wolf R, LoGerfo FW, Whittemore AD. The impact of cardiac comorbidity after carotid endarterectomy. J Vasc Surg 1998; 28(4): 577–584.

57. Chimowitz MI, Weiss DG, Cohen SL, Starling MR, Hobson RW jr. Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease: Veterans Affairs Cooperative Study Group 167. Stroke 1994; 25(4): 759–765.

58. McCrory DC, Goldstein LB, Samsa GP, Oddone EZ, Landsman PB, Moore WS et al. Predicting complications of carotid endarterectomy. Stroke 1993; 24(9): 1285–1291.

59. Rihal CS, Gersh BJ, Whisnant JP, Rooke TW, Sundt TM jr, O’Fallon WM et al. Influence of coronary heart disease on morbidity and mortality after carotid endarterectomy: a population-based study in Olmsted County, Minnesota (1970–1988). J Am Coll Cardiol 1992; 19(6): 1254–1260.

60. Nawaz I, Lord RS, Kelly RP. Myocardial ischaemia, infarction and cardiac-related death following carotid endarterectomy: risk assessment by thallium myocardial perfusion scan compared with clinical examination. Cardiovasc Surg 1996; 4(5): 596–601.

61. Liapis CD, Bell PR, Mikhailidis D, Sivenius J, ­Nicolaides A, Fernandes e Fernandes J et a. ESVS Guidelines Collaborators. ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg 2009; 37 (4 Suppl): 1–19.

62. Moore WS, Barnett HJ, Beebe HG, Bernstein EF, Brener BJ, Brott T et al. Guidelines for carotid endarterectomy. A multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association. Stroke 1995; 26(1): 188–201.

63. Ferguson GG, Eliasziw M, Barr HW, Clagett GP, Barnes RW, Wallace MC et al. The North American Symptomatic Carotid Endarterectomy Trial: surgical results in 1415 patients. Stroke 1999; 30(9): ­1751–1758.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 5

2010 Issue 5

Most read in this issue
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account