Highlights
- 1Cerebral microbleeds were frequently observed in patients with coronary artery disease (CAD).
- 2The factors associated with cerebral microbleeds in CAD were long-term DAPT.
- 3These findings may enable physicians to take appropriate preventive measures, including stringent regulation of antiplatelet therapy in patients at high risk.
Abstract
Objectives
Cerebral microbleeds (CMBs), which can be detected by gradient-echo T2*-weighted magnetic
resonance imaging (MRI), represent small chronic brain hemorrhages caused by structural
abnormalities in cerebral small vessels. CMBs are known to be a potential predictor
of future stroke, and are associated with age, various cardiovascular risk factors,
cognitive impairment, and the use of antithrombotic drugs. Patients with coronary
artery disease (CAD) are at potentially high risk of CMBs due to the presence of coexistent
conditions. However, little is known about CMBs in patients with CAD. We aimed to
identify the factors associated with the presence of CMBs among patients with CAD.
Methods
We evaluated 356 consecutive patients [mean age, 72 ± 10 years; men = 276 (78%)] with
angiographically proven CAD who underwent T2*-weighted brain MRI. The brain MRI was
assessed by researchers blinded to the patients’ clinical details.
Results
CMBs were found in 128 (36%) patients. Among 356 patients, 119 (33%) had previously
undergone percutaneous coronary intervention (PCI), and 26 (7%) coronary artery bypass
grafting (CABG). There was no significant relationship between CMBs and sex, hypertension,
dyslipidemia, diabetes mellitus, anticoagulation therapy, antiplatelet therapy, or
prior PCI. CMBs were significantly associated with advanced age, previous CABG, eGFR,
non-HDL cholesterol, carotid artery disease, long-term antiplatelet therapy, and long-term
dual antiplatelet therapy (DAPT) using univariate logistic regression analysis. The
multivariate logistic regression analysis showed that long-term antiplatelet therapy
(odds ratio, 1.73; 95% CI, 1.06 – 2.84; P = 0.03) or long-term DAPT (odds ratio, 2.92; 95% CI, 1.39 – 6.17; P = 0.004) was significantly associated with CMBs after adjustment for confounding
variables.
Conclusions
CMBs were frequently observed in patients with CAD and were significantly associated
with long-term antiplatelet therapy, especially long-term DAPT.
Abbreviations:
CMBs (Cerebral microbleeds), MRI (Magnetic resonance imaging), CAD (Coronary artery disease), PCI (Percutaneous coronary intervention), CABG (Coronary artery bypass grafting), DAPT (Dual antiplatelet therapy), SAPT (Single antiplatelet therapy), eGFR (Estimated glomerular filtration rate)Key Words
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Article info
Publication history
Published online: November 22, 2021
Accepted:
October 31,
2021
Received in revised form:
October 20,
2021
Received:
May 29,
2021
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106211
Copyright
© 2021 Elsevier Inc. All rights reserved.
