Background: Aortic stiffness is an independent predictor of coronary events. We assessed the predictive value of aortic stiffness for ≥50% asymptomatic coronary artery disease (CAD) in a stroke population.

Methods: From January 2006 to February 2009, 300 consecutive patients aged between 45 and 75 years with non disabling, non cardioembolic ischemic stroke or TIA, and no prior history of CAD were enrolled in the study. CAD was assessed with 64-section CT coronary angiography and all patients had a detailed cervicocephalic arterial work-up. Aortic stiffness was determined from carotid-femoral pulse wave velocity (PWV) using 12m/s as cut-off value. The predictive value of aortic stiffness was assessed by logistic regression and reclassification tables method after adjustment for the Framingham Risk Score (FRS) and the presence of cervicocephalic stenosis, which were previously shown to be independent predictors of ≥50% asymptomatic CAD.

Results: Among the 274 included patients who had CT coronary angiography, 26% (95% CI, 21%-32%) had an increased stiffness (PWV>12m/s) and 18% (14%-23%) had ≥50% asymptomatic CAD. Increased aortic stiffness was associated with the presence of ≥50% asymptomatic CAD, both in univariate (OR=3.4 [1.8–6.4]) and multivariate analyses (OR=2.3 [1.2–4.7]) after adjustment for FRS and presence of cervicocephalic stenosis. After PWV was added to the standard model including FRS and the presence of cervicocephalic stenosis, net reclassification improvement was 12.6% (p<0.005) and integrated discrimination index was 2.51% (p=0.025) and model fit was improved (likelihood ratio=4.99, p=0.025).

Conclusion: In stroke/TIA patients, aortic PWV improves risk prediction for the presence of ≥50% asymptomatic CAD.