Charlotte Cordonnier1, Gilles Lemesle2, Barbara Casolla1, Matthieu Bic3, François Caparros1, Nicolas Lamblin4, Christophe Bauters4. 1. Université de Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Lille, France. 2. Université de Lille, Inserm U1011, Institut Pasteur, CHU Lille, Department of Cardiology, Lille, France. 3. Department of Cardiology, Centre Hospitalier, Lens, France. 4. Université de Lille, Inserm U1167, Institut Pasteur, CHU Lille, Department of Cardiology, Lille, France.
Abstract
INTRODUCTION: There are limited data on cerebrovascular events in patients with stable coronary artery disease. To study the risk of cerebrovascular event, the relative proportion of ischaemic stroke and intracranial haemorrhage, and their prognostic factors in stable coronary artery disease are investigated. PATIENTS AND METHODS: The CORONOR registry prospectively recruited, between February 2010 and April 2011, 4184 unselected stable coronary artery disease outpatients. All events occurring during a five-year follow-up were adjudicated. RESULTS: Ninety-six patients had an ischaemic stroke and 34 had an intracranial haemorrhage, reaching a cumulative incidence after five years of 3.2 (2.7-3.8)%. During the same period, 677 deaths and 170 myocardial infarctions (ST-elevation MI, n = 55; non-ST-elevation MI, n = 115) occurred. In elderly individuals, the number of cerebrovascular events was higher than that of myocardial infarctions and largely exceeded that of ST-elevation myocardial infarctions. Predictors of ischaemic stroke were: previous history of stroke (subhazard ratio (SHR)=3.16(1.95-5.14)), absence of statin therapy at inclusion (SHR = 2.45(1.47-4.10), increasing age (SHR = 1.45(1.16-1.82) per 10-year increase) and diabetes mellitus (SHR = 1.65(1.10-2.49)). Predictors of intracranial haemorrhage were: combination of vitamin K antagonists with an antiplatelet agent at inclusion (SHR = 5.41(2.49-11.75), single antiplatelet therapy as reference), and increasing age (SHR = 1.47(1.12-1.93) per 10-year increase). DISCUSSION: In stable coronary artery disease patients, the brain deserves attention. In patients at high risk of ischaemic stroke, secondary prevention could be intensified. Our results raise awareness of the hazard of the association of antiplatelet drugs with oral anticoagulants in stable coronary artery disease patients. CONCLUSION: While improving the prevention of future vaso-occlusive events should be our ultimate goal in coronary artery disease patients, the net clinical benefit of our treatments should carefully be studied.
INTRODUCTION: There are limited data on cerebrovascular events in patients with stable coronary artery disease. To study the risk of cerebrovascular event, the relative proportion of ischaemic stroke and intracranial haemorrhage, and their prognostic factors in stable coronary artery disease are investigated. PATIENTS AND METHODS: The CORONOR registry prospectively recruited, between February 2010 and April 2011, 4184 unselected stable coronary artery disease outpatients. All events occurring during a five-year follow-up were adjudicated. RESULTS: Ninety-six patients had an ischaemic stroke and 34 had an intracranial haemorrhage, reaching a cumulative incidence after five years of 3.2 (2.7-3.8)%. During the same period, 677 deaths and 170 myocardial infarctions (ST-elevation MI, n = 55; non-ST-elevation MI, n = 115) occurred. In elderly individuals, the number of cerebrovascular events was higher than that of myocardial infarctions and largely exceeded that of ST-elevation myocardial infarctions. Predictors of ischaemic stroke were: previous history of stroke (subhazard ratio (SHR)=3.16(1.95-5.14)), absence of statin therapy at inclusion (SHR = 2.45(1.47-4.10), increasing age (SHR = 1.45(1.16-1.82) per 10-year increase) and diabetes mellitus (SHR = 1.65(1.10-2.49)). Predictors of intracranial haemorrhage were: combination of vitamin K antagonists with an antiplatelet agent at inclusion (SHR = 5.41(2.49-11.75), single antiplatelet therapy as reference), and increasing age (SHR = 1.47(1.12-1.93) per 10-year increase). DISCUSSION: In stable coronary artery disease patients, the brain deserves attention. In patients at high risk of ischaemic stroke, secondary prevention could be intensified. Our results raise awareness of the hazard of the association of antiplatelet drugs with oral anticoagulants in stable coronary artery disease patients. CONCLUSION: While improving the prevention of future vaso-occlusive events should be our ultimate goal in coronary artery disease patients, the net clinical benefit of our treatments should carefully be studied.
Authors: Valentin Fuster; Lars E Rydén; Davis S Cannom; Harry J Crijns; Anne B Curtis; Kenneth A Ellenbogen; Jonathan L Halperin; G Neal Kay; Jean-Yves Le Huezey; James E Lowe; S Bertil Olsson; Eric N Prystowsky; Juan Luis Tamargo; L Samuel Wann Journal: J Am Coll Cardiol Date: 2011-03-15 Impact factor: 24.094
Authors: Stephan D Fihn; Julius M Gardin; Jonathan Abrams; Kathleen Berra; James C Blankenship; Apostolos P Dallas; Pamela S Douglas; Joanne M Foody; Thomas C Gerber; Alan L Hinderliter; Spencer B King; Paul D Kligfield; Harlan M Krumholz; Raymond Y K Kwong; Michael J Lim; Jane A Linderbaum; Michael J Mack; Mark A Munger; Richard L Prager; Joseph F Sabik; Leslee J Shaw; Joanna D Sikkema; Craig R Smith; Sidney C Smith; John A Spertus; Sankey V Williams Journal: J Am Coll Cardiol Date: 2012-11-19 Impact factor: 24.094
Authors: Caroline E Lovelock; Charlotte Cordonnier; Hiromitsu Naka; Rustam Al-Shahi Salman; Cathie L M Sudlow; Takatoshi Sorimachi; David J Werring; Simone M Gregoire; Toshio Imaizumi; Seung-Hoon Lee; Dennis Briley; Peter M Rothwell Journal: Stroke Date: 2010-04-29 Impact factor: 7.914
Authors: Eugene Braunwald; Michael J Domanski; Sarah E Fowler; Nancy L Geller; Bernard J Gersh; Judith Hsia; Marc A Pfeffer; Madeline M Rice; Yves D Rosenberg; Jean L Rouleau Journal: N Engl J Med Date: 2004-11-07 Impact factor: 91.245
Authors: John C LaRosa; Scott M Grundy; David D Waters; Charles Shear; Philip Barter; Jean-Charles Fruchart; Antonio M Gotto; Heiner Greten; John J P Kastelein; James Shepherd; Nanette K Wenger Journal: N Engl J Med Date: 2005-03-08 Impact factor: 91.245
Authors: Philip A Poole-Wilson; Jacobus Lubsen; Bridget-Anne Kirwan; Fred J van Dalen; Gilbert Wagener; Nicolas Danchin; Hanjörg Just; Keith A A Fox; Stuart J Pocock; Tim C Clayton; Michael Motro; John D Parker; Martial G Bourassa; Anthony M Dart; Per Hildebrandt; Ake Hjalmarson; Johannes A Kragten; G Peter Molhoek; Jan-Erik Otterstad; Ricardo Seabra-Gomes; Jordi Soler-Soler; Simon Weber Journal: Lancet Date: 2004 Sep 4-10 Impact factor: 79.321