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.