Incidence, Trends, and Predictors of Ischemic Stroke 1 Year After an Acute Myocardial Infarction

Ulvenstam, Anders; Kajermo, Ulf; Modica, Angelo; Jernberg, Tomas; Söderström, Lars; Mooe, Thomas

doi:10.1161/strokeaha.114.005770

Cited by 48 publications

(46 citation statements)

References 28 publications

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“…The long-term risk of IS after MI in our cohort was relatively low (2.7% at 2 years), which is likely related to the aggressive use of antiplatelet agents, reperfusion therapies, and statins after an acute coronary event. 4 This is consistent with what has been reported in prior studies. 1,4 This risk, however, is %4-fold higher in the presence of cardiac injury, such as STEMI and NSTEMI, as opposed to the absence of cardiac injury, such as in UA.…”

Section: Discussionsupporting

confidence: 93%

“…The early IS risk after ST‐segment elevation MI (STEMI) has been shown to be related to left ventricular thrombi, which tend to develop within the first 2 weeks, and has been reduced with reperfusion therapy . In addition, several factors, such as the use of antiplatelets, statins, and anticoagulants, have contributed to a reduction in the early risk of IS after MI. The presence of cardiac injury in acute coronary syndrome (ACS) may induce cardiac arrhythmias or cause cardiac dysfunction, which in turn may increase the long‐term stroke risk.…”

Section: Introductionmentioning

confidence: 99%

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Ischemic Stroke Risk After Acute Coronary Syndrome

Yaghi

Pilot

Song

et al. 2016

JAHA

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BackgroundPrior studies show an increased risk of ischemic stroke (IS) after myocardial infarction; however, there is limited evidence on long‐term risk and whether it is directly related to cardiac injury. We hypothesized that the risk of IS after acute coronary syndrome is significantly higher if there is evidence of cardiac injury, such as ST‐segment elevation myocardial infarction (STEMI) or non‐STEMI, than when there is no evidence of cardiac injury, such as in unstable angina.Methods and ResultsAdministrative claims data were obtained from all emergency department encounters and hospitalizations at California's nonfederal acute care hospitals between 2008 and 2011. Patients with STEMI, non‐STEMI, and unstable angina were identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. The primary outcome was IS during 2 years of follow‐up. Unadjusted and adjusted Cox proportional hazards models were used to determine the association between acute coronary syndrome subtype and IS risk. We identified 73 059 patients with a diagnosis of STEMI (n=26 427), non‐STEMI (n=39 833), or unstable angina (n=6819) during the study period. In the fully adjusted models that included potential confounders such as atrial fibrillation and congestive heart failure, the risk of IS was higher with STEMI (hazard ratio 4.17, 95% CI 3.00–5.83; P<0.001) and non‐STEMI (hazard ratio 3.73, 95% CI 2.68–5.19, P<0.001) compared with unstable angina.ConclusionsNon‐STEMI and STEMI confer an equally increased risk of IS. Studies exploring IS mechanisms in cardiac patients are needed to improve and tailor stroke prevention strategies.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Ischemic Stroke Risk After Acute Coronary Syndrome

Yaghi

Pilot

Song

et al. 2016

JAHA

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“…In our study, stroke was rare after AMI, occurring in only five patients, thus limiting the statistical interpretation of this finding. This low event rate is in agreement with those of the recent large population-based studies after MI 12 13. Reperfusion, and antiplatelet and lipid-lowering therapy were associated with a reduced risk of stroke.…”

Section: Prognosis In Silent Afsupporting

confidence: 91%

Prognosis of silent atrial fibrillation after acute myocardial infarction at 1-year follow-up

Stamboul

Zeller

Fauchier

et al. 2015

Heart

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“…4 The annualized thromboembolic risk according to the ratio between free fatty acid cases with or without each potential source of cardioembolism. The annualized risks of thromboembolism used in the graph were referenced from Mas et al for PFO [30], Meissner et al for complex aortic plaque [31], Benjamin et al for MAC [32], Dunkman et al for CHF with low EF [33], Andersen et al for SSS [34], Spencer et al and Ulvenstam et al for recent MI with low EF [35,36], Cicala et al for RWMA [37], Choi et al for AF [9], Stroke Prevention in Atrial Fibrillation-III for LA thrombus and LA smoke [38], and Stratton et al for LV thrombus [39]. AF, atrial fibrillation; CHF with low EF, congestive heart failure with low ejection fraction; LA, left atrial; LV, left ventricular; MAC, mitral annulus calcification; MI myocardial infarction; PFO, patent foramen ovale; RWMA, regional wall motion abnormality; SSS, sick sinus syndrome. …”

Section: Resultsmentioning

confidence: 99%

Free Fatty Acid Is Associated with Thrombogenicity in Cardioembolic Stroke

et al. 2017

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Background: Recently, the role of free fatty acids (FFAs) in thromboembolism has re-emerged in the context of cardioembolic stroke. Therefore, we attempted to determine the role of FFAs in embolic risk in various potential sources of cardioembolism (PSCE). We hypothesized that if elevated FFA levels in stroke patients are associated with thrombogenesis, then patients with a well-known high risk of embolic sources would have high FFA levels. Methods: Data collected from 2 hospital-based stroke registries were analyzed to investigate the association between FFA and PSCE. Results: A total of 2,770 acute stroke patients, including 539 with cardioembolic stroke, were selected for analysis. FFA was an independent predictor for cardioembolism (OR 2.755, 95% CI 2.221-3.417, p < 0.001). Among the PSCE, FFA levels were significantly associated with high risk of atrial fibrillation (AF), valvular heart disease, congestive heart failure with low ejection fraction, left atrial thrombus, left ventricular thrombus, left atrial smoke, and ventricular wall motion abnormality. FFA levels increased with the number of PSCE per patient without interaction with the presence of AF. Conclusions: Among acute stroke patients, FFA levels increased in groups with higher risk of cardioembolic stroke irrespective of the presence of AF. These results suggest that enhanced thrombogenicity could be the main mechanism to explain the elevated FFA levels in patients with cardioembolic stroke.

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Incidence, Trends, and Predictors of Ischemic Stroke 1 Year After an Acute Myocardial Infarction

Cited by 48 publications

References 28 publications

Ischemic Stroke Risk After Acute Coronary Syndrome

Ischemic Stroke Risk After Acute Coronary Syndrome

Prognosis of silent atrial fibrillation after acute myocardial infarction at 1-year follow-up

Free Fatty Acid Is Associated with Thrombogenicity in Cardioembolic Stroke

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