Abstract 17428: Impact of Asymptomatic Cerebral Microbleeds or Lacunar Infarction on Clinical Outcome in Patients With Coronary Artery Disease (CAD) Requiring Percutaneous Coronary Intervention
Background: Patients with coronary artery disease (CAD) are often complicated with cerebrovascular disease (CVD). Although there are many reports on the relation between stoke with symptomatic signs and CAD, there are few studies on cerebral microbleeds or lacunar infarction without symptomatic signs. The aim was to examine the prevalence of cerebral microbleeds or lacunar infarction without symptoms and clinical outcome in CAD patients.
Methods: Among 1,091 consecutive CAD patients who required percutaneous coronary intervention (PCI), patients with non-lacunar infarction more severe than lacunar infarction or old cerebral hemorrhage by computed tomography (CT) or magnetic resonance imaging (MRI) were excluded. We analyzed CAD patients with cerebral microbleeds or lacunar infarction without overt neurological signs (ML group; n=98, 71males) compared with patients without cerebral findings of CT or MRI and stroke history as control (N group; n=762, 525males). Clinical endpoints were cardiovascular death, myocardial infarction (MI), stroke, unstable angina and urgent revascularization.
Results: ML group had a high age (72.9±9.6 vs. 69.2±10.8ys; P=0.001), high incidence of diabetes mellitus (58.2 vs. 47.2%; P=0.042), peripheral artery disease (21.4 vs. 11.5%; P=0.005), and renal dysfunction (49.0 vs. 37.3%; P=0.025), and high levels of fibrinogen (435 vs. 402mg/dl; P=0.005), and high brachial-ankle pulse wave velocity (1975 vs. 1786cm/sec; P=0.001) compared with N group. Cardiovascular event rate was significantly higher in ML group than in N group (11.2 vs. 4.7%, P=0.008). Details in clinical outcome were as follows: cardiovascular death (ML group vs. N group, 0 vs. 0.9%; P=0.341), MI (1.0 vs. 0.5%; P=0.544), stroke (4.1 vs.0.7%; P=0.002), unstable angina (5.1 vs. 2.5%; P=0.140), revascularization (2.0 vs. 0.7%; P=0.498), respectively. Multiple regression analysis identified findings of microbleeds or lacunar infarction as a predictor of clinical events (OR, 2.830; 95%CI, 1.328-6.031; P=0.007).
Conclusions: There was high incidence of brain MRI or CT findings without symptom in CAD patients. We should pay attention to the asymptomatic patients with microbleeds or lacunar infarction irrespective of overt previous stroke.
Author Disclosures: S. Hokimoto: None. N. Tabata: None. T. Akasaka: None. K. Sakamoto: None. K. Tsujita: None. E. Yamamoto: None. M. Yamamuro: None. D. Sueta: None. K. Kaikita: None. S. Kojima: None. H. Ogawa: Other Research Support; Modest; Astellas Pharma Inc,, Bristol-Myers Squibb Company. Other Research Support; Significant; Novartis Pharma K.K, Sanofi K.K. Honoraria; Modest; AstraZeneca K.K. Honoraria; Significant; Bayer Yakuhin, Ltd., Daiichi Sankyo Co., Ltd..
- © 2015 by American Heart Association, Inc.