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Acute coronary syndromes in patients with prior cerebrovascular events: lessons from the Euro-Heart Survey of Acute Coronary Syndromes.
Am Heart J 2003; 146(5):832-8AH

Abstract

BACKGROUND

The aim of this study was to determine the frequency of prior cerebrovascular events (CE) among patients with an acute coronary syndrome (ACS) and to compare the clinical characteristics, clinical course, treatment, and outcomes of patients with ACS with and without a prior CE.

METHODS AND RESULTS

We prospectively enrolled 10,484 patients with ACS in 103 hospitals in 25 countries across Europe and the Mediterranean basin. A prior CE was reported in 254 of 4338 patients (5.9%) with ST elevation, 420 of 5215 patients (8.1%) without ST elevation, and 92 of 663 patients (13.9%) with an undetermined electrocardiographic pattern. In general, patients with a prior CE were older, more likely to be females and nonsmokers, more commonly had prior myocardial infarction, heart failure, bypass surgery, and were more likely to have diabetes, hypertension, and renal failure. While in the hospital, they had more heart failure, and they were more likely to receive warfarin, digoxin, diuretics and calcium-channel blockers, and less likely to receive antiplatelet agents, beta-blockers, and statins. The inhospital mortality rates were 9.1% (with a prior CE) versus 6.4% (without a prior CE) for patients with ACS with ST elevation; 5.0% versus 2.0% for patients with ACS with non-ST elevation; and 14.1% versus 10.7% for patients with ACS with undetermined electrocardiographic results. The adjusted risk (95% CI) of inhospital death for patients with a prior CE was 1.12 (0.70, 1.81), 1.79 (1.06, 3.00), and 0.92 (0.44, 1.94) for ST-elevation ACS, non-ST-elevation ACS, and ACS with undetermined electrocardiogram, respectively. The P value for interaction between prior CE and the type of ACS on outcome was.10.

CONCLUSIONS

Patients with a prior CE constitute 7.5% of patients with ACS and have high-risk features. A prior CE is associated with increased inhospital mortality, particularly in patients with with non-ST-elevation ACS.

Authors+Show Affiliations

Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel. dhasdai@post.tau.ac.ilNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14597932

Citation

Hasdai, David, et al. "Acute Coronary Syndromes in Patients With Prior Cerebrovascular Events: Lessons From the Euro-Heart Survey of Acute Coronary Syndromes." American Heart Journal, vol. 146, no. 5, 2003, pp. 832-8.
Hasdai D, Haim M, Behar S, et al. Acute coronary syndromes in patients with prior cerebrovascular events: lessons from the Euro-Heart Survey of Acute Coronary Syndromes. Am Heart J. 2003;146(5):832-8.
Hasdai, D., Haim, M., Behar, S., Boyko, V., & Battler, A. (2003). Acute coronary syndromes in patients with prior cerebrovascular events: lessons from the Euro-Heart Survey of Acute Coronary Syndromes. American Heart Journal, 146(5), pp. 832-8.
Hasdai D, et al. Acute Coronary Syndromes in Patients With Prior Cerebrovascular Events: Lessons From the Euro-Heart Survey of Acute Coronary Syndromes. Am Heart J. 2003;146(5):832-8. PubMed PMID: 14597932.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute coronary syndromes in patients with prior cerebrovascular events: lessons from the Euro-Heart Survey of Acute Coronary Syndromes. AU - Hasdai,David, AU - Haim,Moti, AU - Behar,Solomon, AU - Boyko,Valentina, AU - Battler,Alexander, PY - 2003/11/5/pubmed PY - 2004/2/26/medline PY - 2003/11/5/entrez SP - 832 EP - 8 JF - American heart journal JO - Am. Heart J. VL - 146 IS - 5 N2 - BACKGROUND: The aim of this study was to determine the frequency of prior cerebrovascular events (CE) among patients with an acute coronary syndrome (ACS) and to compare the clinical characteristics, clinical course, treatment, and outcomes of patients with ACS with and without a prior CE. METHODS AND RESULTS: We prospectively enrolled 10,484 patients with ACS in 103 hospitals in 25 countries across Europe and the Mediterranean basin. A prior CE was reported in 254 of 4338 patients (5.9%) with ST elevation, 420 of 5215 patients (8.1%) without ST elevation, and 92 of 663 patients (13.9%) with an undetermined electrocardiographic pattern. In general, patients with a prior CE were older, more likely to be females and nonsmokers, more commonly had prior myocardial infarction, heart failure, bypass surgery, and were more likely to have diabetes, hypertension, and renal failure. While in the hospital, they had more heart failure, and they were more likely to receive warfarin, digoxin, diuretics and calcium-channel blockers, and less likely to receive antiplatelet agents, beta-blockers, and statins. The inhospital mortality rates were 9.1% (with a prior CE) versus 6.4% (without a prior CE) for patients with ACS with ST elevation; 5.0% versus 2.0% for patients with ACS with non-ST elevation; and 14.1% versus 10.7% for patients with ACS with undetermined electrocardiographic results. The adjusted risk (95% CI) of inhospital death for patients with a prior CE was 1.12 (0.70, 1.81), 1.79 (1.06, 3.00), and 0.92 (0.44, 1.94) for ST-elevation ACS, non-ST-elevation ACS, and ACS with undetermined electrocardiogram, respectively. The P value for interaction between prior CE and the type of ACS on outcome was.10. CONCLUSIONS: Patients with a prior CE constitute 7.5% of patients with ACS and have high-risk features. A prior CE is associated with increased inhospital mortality, particularly in patients with with non-ST-elevation ACS. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/14597932/Acute_coronary_syndromes_in_patients_with_prior_cerebrovascular_events:_lessons_from_the_Euro_Heart_Survey_of_Acute_Coronary_Syndromes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002870303004149 DB - PRIME DP - Unbound Medicine ER -