Coronary Artery Calcium for the detection of CAD in stroke patients
Coronary disease exerts a significant toll in stroke patients, with studies showing a high prevalence of CAD in stroke patients, in addition to elevated myocardial infarction risks even in the absence of a cardiac history.39 Investigators have attempted to quantify the risk of coronary disease in stroke patients through the development of risk scores, such as the five-point PRECORIS score, which is adequate in the detection of severe (>50%) occult stenosis of the coronaries.40,41 Nevertheless, the application of the score still has some limitations, as more than half the patients with a score >4 have no occult coronary stenosis. The supplementation of the PRECORIS score with additional measures, namely CAC, can improve the predictive ability of the model in two ways: First, it can enhance the detection of severely stenosed patients in whom further investigations may be warranted. Second, it can improve the identification of those without severe stenosis, and therefore reduce additional unneeded investigations that would carry burdens of their own,42 table 1.