Association of Aortic Arch Atherosclerosis on Chest Radiography with Ischemic Stroke on Non-Contrast Head CT Scan at Royal Prima General Hospital, Medan
DOI:
https://doi.org/10.54832/phj.v8i2.1595Keywords:
aortic arch atherosclerosis, aortic arch calcification, chest radiograph, infarct stroke, non-contrast head CT scanAbstract
Background: Aortic arch calcification (AAC) visible on chest radiography is a surrogate marker of atherosclerotic burden; it is not equivalent to complex aortic arch plaque, the established embolic source of ischemic stroke. Data on the association between radiographic AAC and ischemic stroke in Indonesian patients are limited.
Methods: This single-center retrospective cross-sectional study included 100 adults (≥18 years) who underwent non-contrast head CT for suspected stroke and a posteroanterior chest radiograph during the same hospital visit at Royal Prima General Hospital, Medan; all eligible records in the study period were included (total sampling). AAC was graded 0–3 using the Iijima criteria. Ischemic stroke was defined as a hypodense lesion in an arterial territory on CT without intracranial hemorrhage. Crude prevalence ratios (PR) with 95% confidence intervals (CI), chi-square and Cochran–Armitage trend tests, and Spearman correlation were used.
Results: Mean age was 63.7 ± 9.1 years and 60% were male. AAC was present in 70% (grades 2–3 in 40%) and ischemic stroke in 68% of this selected sample. The crude proportion with ischemic stroke increased across AAC grades: 33.3% (grade 0), 66.7% (grade 1), 90.0% (grade 2), and 100% (grade 3) (p < 0.001 for trend). Any AAC was associated with a higher crude prevalence of ischemic stroke (PR 2.49, 95% CI 1.48–4.17); the corresponding odds ratio (9.67, 95% CI 3.62–25.79) overstates this relative prevalence because the outcome was common and should not be read as a risk ratio. AAC grade correlated strongly with age (Spearman ρ = 0.807, 95% CI 0.71–0.87), and age ≥60 years was strongly associated with ischemic stroke (PR 3.69, 95% CI 2.08–6.52), whereas sex was not (p = 0.93). Because AAC grade and age were strongly correlated, the crude association may be substantially confounded by age.
Conclusion: In this selected hospital imaging cohort, radiographic AAC showed a graded, unadjusted association with ischemic stroke that was closely intertwined with age. Because no age-adjusted analysis was performed and major vascular risk factors were unavailable, whether AAC grading on clinically indicated chest radiographs adds information beyond age and conventional risk factors requires validation in prospective studies with comprehensive confounder adjustment and reliability assessment.
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