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Magnitude of and risk factors for in-hospital and postdischarge stroke in patients with acute coronary syndromes: findings from a Global Registry of Acute Coronary Events.
Circulation. 2005 Jun 21; 111(24):3242-7.Circ

Abstract

BACKGROUND

Stroke is a recognized complication after acute myocardial infarction, but few studies have investigated the incidence and outcome of stroke in patients with acute coronary syndrome (ACS). This study examined the incidence and outcomes of hemorrhagic and nonhemorrhagic stroke and risk factors associated with stroke in patients with ACS.

METHODS AND RESULTS

Data were obtained from 35,233 patients enrolled in the Global Registry of Acute Coronary Events (GRACE) with an ACS. In-hospital strokes occurred in 310 patients (0.9%), of which 100 (32.6%) were fatal. The incidence of in-hospital stroke was significantly higher in patients with ST-segment-elevation myocardial infarction than in non-ST-segment myocardial infarction or unstable angina (1.3%, 0.9%, 0.5%, respectively; P<0.001). Overall, 35.5% of in-hospital strokes occurred within 6 days of hospitalization. The strongest risk factor for in-hospital nonhemorrhagic stroke was in-hospital CABG, followed by in-hospital atrial fibrillation, previous stroke, initial enzyme elevation, and advanced age. Prior statin use was a protective factor. After controlling for potential confounders, in-hospital mortality was significantly higher among patients who experienced an in-hospital stroke (adjusted odds ratio, 8.3; 95% CI, 6.0 to 11.4). A total of 269 additional strokes (1.1%) occurred within 6 months after discharge from hospital, of which 56 (20.9%) were fatal. The most important risk factor for postdischarge stroke was the occurrence of an in-hospital stroke.

CONCLUSIONS

Stroke is an uncommon event in patients with ACS but is associated with high mortality. Despite current therapy, the incidence of postdischarge stroke is not low. New approaches are warranted to reduce the risk of stroke in patients with ACS.

Authors+Show Affiliations

Postgraduate Medical School, Grochowski Hospital, Grenadierów 51/59, 04-073 Warsaw, Poland. abudaj@kkcmkp.pl.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

15956123

Citation

Budaj, Andrzej, et al. "Magnitude of and Risk Factors for In-hospital and Postdischarge Stroke in Patients With Acute Coronary Syndromes: Findings From a Global Registry of Acute Coronary Events." Circulation, vol. 111, no. 24, 2005, pp. 3242-7.
Budaj A, Flasinska K, Gore JM, et al. Magnitude of and risk factors for in-hospital and postdischarge stroke in patients with acute coronary syndromes: findings from a Global Registry of Acute Coronary Events. Circulation. 2005;111(24):3242-7.
Budaj, A., Flasinska, K., Gore, J. M., Anderson, F. A., Dabbous, O. H., Spencer, F. A., Goldberg, R. J., & Fox, K. A. (2005). Magnitude of and risk factors for in-hospital and postdischarge stroke in patients with acute coronary syndromes: findings from a Global Registry of Acute Coronary Events. Circulation, 111(24), 3242-7.
Budaj A, et al. Magnitude of and Risk Factors for In-hospital and Postdischarge Stroke in Patients With Acute Coronary Syndromes: Findings From a Global Registry of Acute Coronary Events. Circulation. 2005 Jun 21;111(24):3242-7. PubMed PMID: 15956123.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Magnitude of and risk factors for in-hospital and postdischarge stroke in patients with acute coronary syndromes: findings from a Global Registry of Acute Coronary Events. AU - Budaj,Andrzej, AU - Flasinska,Katarzyna, AU - Gore,Joel M, AU - Anderson,Frederick A,Jr AU - Dabbous,Omar H, AU - Spencer,Frederick A, AU - Goldberg,Robert J, AU - Fox,Keith A A, AU - ,, Y1 - 2005/06/13/ PY - 2005/6/16/pubmed PY - 2006/1/31/medline PY - 2005/6/16/entrez SP - 3242 EP - 7 JF - Circulation JO - Circulation VL - 111 IS - 24 N2 - BACKGROUND: Stroke is a recognized complication after acute myocardial infarction, but few studies have investigated the incidence and outcome of stroke in patients with acute coronary syndrome (ACS). This study examined the incidence and outcomes of hemorrhagic and nonhemorrhagic stroke and risk factors associated with stroke in patients with ACS. METHODS AND RESULTS: Data were obtained from 35,233 patients enrolled in the Global Registry of Acute Coronary Events (GRACE) with an ACS. In-hospital strokes occurred in 310 patients (0.9%), of which 100 (32.6%) were fatal. The incidence of in-hospital stroke was significantly higher in patients with ST-segment-elevation myocardial infarction than in non-ST-segment myocardial infarction or unstable angina (1.3%, 0.9%, 0.5%, respectively; P<0.001). Overall, 35.5% of in-hospital strokes occurred within 6 days of hospitalization. The strongest risk factor for in-hospital nonhemorrhagic stroke was in-hospital CABG, followed by in-hospital atrial fibrillation, previous stroke, initial enzyme elevation, and advanced age. Prior statin use was a protective factor. After controlling for potential confounders, in-hospital mortality was significantly higher among patients who experienced an in-hospital stroke (adjusted odds ratio, 8.3; 95% CI, 6.0 to 11.4). A total of 269 additional strokes (1.1%) occurred within 6 months after discharge from hospital, of which 56 (20.9%) were fatal. The most important risk factor for postdischarge stroke was the occurrence of an in-hospital stroke. CONCLUSIONS: Stroke is an uncommon event in patients with ACS but is associated with high mortality. Despite current therapy, the incidence of postdischarge stroke is not low. New approaches are warranted to reduce the risk of stroke in patients with ACS. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/15956123/Magnitude_of_and_risk_factors_for_in_hospital_and_postdischarge_stroke_in_patients_with_acute_coronary_syndromes:_findings_from_a_Global_Registry_of_Acute_Coronary_Events_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.104.512806?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -