Incidence and predictors of stroke in patients discharged with the diagnosis of acute coronary syndrome.
Int J Cardiol
; 276: 20-25, 2019 Feb 01.
Article
in En
| MEDLINE
| ID: mdl-30414748
ABSTRACT
BACKGROUND:
Stroke is one the most feared cardiovascular disease due to its high risk of disability and its incidence after an acute coronary syndrome (ACS) is not uncommon.METHODS:
Retrospective study of all consecutive patients admitted for an ACS in two hospitals. Competing risk regression, taking all-cause mortality as a competing event, was used for the assessment of stroke incidence.RESULTS:
We included 8771 patients, AF prevalence 12.4%. AF patients were older and presented higher prevalence of cardiovascular risk factors, previous cardiovascular disease, and lower glomerular filtration rate. Less than half of AF patients were receiving oral anticoagulation before admission. In-hospital mortality was 5.1% and it was more than two-fold higher in AF patients (10.2% vs. 4.4%; pâ¯<â¯0.01). Relevant differences on medical treatments were observed at discharge and oral anticoagulation was roughly <50% in AF patients. During a median follow-up was 58.7â¯months, 313 patients experienced at least one stroke (incidence 3.8%, 95% CI 3.4-4.2,) and it was 2-fold higher in patients with AF 7.8% vs. 3.3% (pâ¯<â¯0.01). Median time to first stroke was 33.0 (30.1) months and it was shorter for AF patients compared to non-AF patients (28.2⯱â¯22.3 vs. 34.6⯱â¯31.1; pâ¯<â¯0.01). The adjusted competing risk regression identified AF, previous stroke and CHA2DS2-VASc scoreâ¯=â¯2 or ≥3 as independent predictors of stroke; CHA2DS2-VASc scoreâ¯=â¯2 was associated to higher risk of stroke only in AF patients.CONCLUSIONS:
The long-term incidence of stroke after an ACS was 3.8%, 7.8% in AF-patients and 3.3% in patients without any diagnosis of AF.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Patient Discharge
/
Stroke
/
Acute Coronary Syndrome
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Int J Cardiol
Year:
2019
Document type:
Article