Abstract 4362533: Burden of coronary artery disease in cryptogenic ischemic stroke patients aged ≥50 years: A multimodality-imaging study

Background/Purpose: Cryptogenic stroke (CS) is defined as an ischemic stroke with no identifiable cause. We investigate the burden of obstructive and non-obstructive coronary artery disease (CAD) in patients with CS and the impact of CAD on new vascular events and mortality during a 6-year follow up. Methods: A total of 103 patients were enrolled in the present prospective observational NORSTROKE (Norwegian Stroke Research Registry) sub-study of patients ≥50 years with a documented CS (Figure). Clinical characteristics, echocardiographic, coronary imaging, vascular ultrasound, and 24-hour Holter-monitoring data were analysed. Results: The mean age was 67.9 (±8.2) years, with 70.9% (n=73) males. CAD was present in 81.5% (n=84), (non-obstructive 56.3% (n=58) and obstructive 25.2% (n=26)). New-onset atrial fibrillation was detected in 15.5% (n=16), two had thrombus in left atrial appendage (LAA) on cardiac CT. During a mean follow-up of 6.2 (±2.3) years, 14 (13.6%) died, and 29 (28.2%) experienced a composite endpoint of new stroke and/or death. In the multivariate Cox regression model CAD was an independent predictor of the composite endpoint of death or recurrent ischemic stroke (HR 2.70; 95% CI 1.13-6.21, p=0.024) adjusted for age, gender, smoking, new-onset atrial fibrillation, hypertension, and cardiac Troponin T. Conclusion: In patients with CS, CAD was highly prevalent and an independent predictor of recurrent stroke and mortality. While new-onset atrial fibrillation was observed in nearly every sixth patient, the incidence of LAA thrombus was very low, suggesting other mechanisms may contribute to stroke in these patients. Cardiovascular assessment is important in patients with CS to identify high-risk individuals to potentially reduce stroke recurrence and mortality.