Long-Term Outcomes of Ischemic Stroke Patients with Concurrent Intracranial and Extracranial Stenoses and Ischemic Heart Disease

Abstract

Background and Purpose: Coexisting ischemic heart disease (IHD) and concurrent atherosclerosis of intracranial and extracranial vessels is common in Asians. This study aims to investigate the long-term outcomes of ischemic stroke patients with concurrent stenoses and IHD. Methods: This was a prospective cohort study in Hong Kong. Consecutive Chinese patients with acute ischemic stroke underwent MRI, magnetic resonance angiography and carotid duplex sonography. Results: A total of 428 patients were included. The mean follow-up period was 65 months (up to 87 months). Ninety-three patients (22%) died of any cause and 104 patients (22%) suffered from nonfatal vascular events. Fifty-four patients (13%) had IHD. Among them, 27 patients (50%) had concurrent stenoses. In patients with concurrent stenoses and IHD, only 3 (11%) were free of death and recurrent vascular events. Eight (30%) had recurrent nonfatal stroke, 7 (26%) had nonfatal myocardial infarct (MI) and 11 (41%) died, 6 (22%) of them due to fatal MI. The overall 5-year cumulative rates of mortality, recurrent vascular events and combined poor outcomes were 21, 23 and 43%, respectively. In patients with concurrent stenoses and IHD, these rates were 40, 50 and 83%, respectively. More deaths (log rank: 6.56; p = 0.01), recurrent vascular events (log rank: 25.24; p < 0.001) and poor outcomes (log rank: 27.50; p < 0.001) were found among patients with concurrent stenoses and IHD. Conclusions: Ischemic stroke patients with concurrent stenoses and IHD had high risks of death and recurrent vascular events. Future studies on aggressive medical therapy and early cardiac interventions in this high-risk group of stroke patients are warranted.