Probability of obstructive coronary atherosclerosis in patients with acute ischemic stroke by the Coronary Artery Disease consortium models

Objective. To evaluate the validation of models based on the coronary calcium index and the pre-test probability as delineated by the Coronary Artery Disease Consortium for the prediction of obstructive coronary heart disease in patients experiencing acute ischemic stroke. Additionally, the study aims to assess the diagnostic value of high-sensitivity troponin in calculating the risk of obstructive coronary heart disease. Materials and methods. In this prospective registry study, 50 patients (median age 60 years, interquartile range 52 to 66 years) with a confirmed diagnosis of ischemic stroke (IS) underwent computed tomography coronary angiography to identify obstructive coronary artery disease (CAD) (defined as stenosis greater than 50%). A comprehensive assessment of clinical, laboratory, electrocardiographic, and echocardiographic parameters was conducted. The area under the ROC curve (AUC), sensitivity, specificity, predictive value, and calibration of the pre-test probability (PTP) models were analyzed. Results. Obstructive ischemic heart disease was identified in 24 patients (48%) with IS. The Coronary Artery Disease 2 (CAD2) Consortium calcium score (CS) model (CI-CAD2), demonstrated the best discrimination (AUC=0.818, p<0.001) and calibration (χ2=10.982; p=0.203). Compared with the CAD2 model, the CS-CAD2 model significantly reduced the number of patients classified as having moderate PTP (7 patients [29%] vs. 2 patients [8%]; p=0.006). Multivariate regression analysis identified a significant independent association of CS >117 with obstructive CAD, with an OR of 9.220 (95% CI 1.482—57.346, p=0.017). Conclusion. In patients presenting with acute ischemic stroke, incorporating the calcium index into the Coronary Artery Disease Consortium clinical model enhances its accuracy in estimating the pre-test probability of obstructive coronary artery disease. This enhancement is reflected in improved calibration, discrimination, and classification. The coronary calcium index surpasses clinical, laboratory, and echocardiographic parameters in predicting obstructive coronary disease.