Anders Ulvenstam1, Ulf Kajermo2, Angelo Modica2, Tomas Jernberg2, Lars Söderström2, Thomas Mooe2. 1. From the Östersund Hospital, Frösön, Sweden (A.U., A.M.); Skaraborg Hospital Skövde, Sweden (U.K.); Department of Medicine, Karolinska Institutet, Solna, Sweden (T.J.); Unit of Research, Education and Development, Östersund Hospital, Frösön, Sweden (L.S.); and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (A.U., A.M., U.K., T.M.). anders.ulvenstam@jll.se. 2. From the Östersund Hospital, Frösön, Sweden (A.U., A.M.); Skaraborg Hospital Skövde, Sweden (U.K.); Department of Medicine, Karolinska Institutet, Solna, Sweden (T.J.); Unit of Research, Education and Development, Östersund Hospital, Frösön, Sweden (L.S.); and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (A.U., A.M., U.K., T.M.).
Abstract
BACKGROUND AND PURPOSE: Ischemic stroke after acute myocardial infarction is an important complication. It is unknown whether the risk has changed because the treatment of acute myocardial infarction has improved during the past decade. There is also conflicting data about predictors of stroke risk. METHODS: To obtain the 1-year incidence of stroke after acute myocardial infarction, the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions database for the years 1998 to 2008 was merged with the Swedish National Patient Register (NPR). The time trend was studied by dividing the entire time period into 5 separate periods. Independent predictors were identified using a multivariable Cox proportional hazards regression model. RESULTS: Between 1998 and 2008, 7185 of 173 233 patients with acute myocardial infarction had an ischemic stroke within 1 year (4.1%). There was a 20% relative risk reduction during the study period (1998-2000 versus 2007-2008) relative risk 0.80 (95% confidence interval, 0.75-0.86; P<0.001. Independent predictors of stroke were age, female sex, ST-segment-elevation myocardial infarction, previous stroke, previous diabetes mellitus, heart failure at admission, angiotensin-converting enzyme inhibitor treatment and atrial fibrillation. Reperfusion treatment with fibrinolysis and percutaneous coronary intervention and treatment with aspirin, P2Y12-inhibitors, and statins predicted a reduced risk of stroke. CONCLUSIONS: The risk of ischemic stroke within a year after myocardial infarction is substantial but has clearly been reduced during the studied time period. The major predictive factors found to correlate well with previous investigations. Reperfusion treatment, thrombocyte aggregation inhibition, and lipid lowering are the main contributors to the observed risk reduction.
BACKGROUND AND PURPOSE:Ischemic stroke after acute myocardial infarction is an important complication. It is unknown whether the risk has changed because the treatment of acute myocardial infarction has improved during the past decade. There is also conflicting data about predictors of stroke risk. METHODS: To obtain the 1-year incidence of stroke after acute myocardial infarction, the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions database for the years 1998 to 2008 was merged with the Swedish National Patient Register (NPR). The time trend was studied by dividing the entire time period into 5 separate periods. Independent predictors were identified using a multivariable Cox proportional hazards regression model. RESULTS: Between 1998 and 2008, 7185 of 173 233 patients with acute myocardial infarction had an ischemic stroke within 1 year (4.1%). There was a 20% relative risk reduction during the study period (1998-2000 versus 2007-2008) relative risk 0.80 (95% confidence interval, 0.75-0.86; P<0.001. Independent predictors of stroke were age, female sex, ST-segment-elevation myocardial infarction, previous stroke, previous diabetes mellitus, heart failure at admission, angiotensin-converting enzyme inhibitor treatment and atrial fibrillation. Reperfusion treatment with fibrinolysis and percutaneous coronary intervention and treatment with aspirin, P2Y12-inhibitors, and statins predicted a reduced risk of stroke. CONCLUSIONS: The risk of ischemic stroke within a year after myocardial infarction is substantial but has clearly been reduced during the studied time period. The major predictive factors found to correlate well with previous investigations. Reperfusion treatment, thrombocyte aggregation inhibition, and lipid lowering are the main contributors to the observed risk reduction.
Authors: Shadi Yaghi; Markeith Pilot; Christopher Song; Christina A Blum; Aleksandra Yakhkind; Brian Silver; Karen L Furie; Mitchell S V Elkind; Dean Sherzai; Ayesha Z Sherzai Journal: J Am Heart Assoc Date: 2016-07-13 Impact factor: 5.501
Authors: Gaurav Aggarwal; Sri Harsha Patlolla; Saurabh Aggarwal; Wisit Cheungpasitporn; Rajkumar Doshi; Pranathi R Sundaragiri; Alejandro A Rabinstein; Allan S Jaffe; Gregory W Barsness; Marc Cohen; Saraschandra Vallabhajosyula Journal: J Am Heart Assoc Date: 2021-01-05 Impact factor: 5.501