Mechanism of late stroke after myocardial infarct: the Lausanne Stroke Registry.

Martin, Robin; Bogousslavsky, Julien

doi:10.1136/jnnp.56.7.760

Cited by 29 publications

(15 citation statements)

References 34 publications

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“…24,25 Strokes occurring several weeks after myocardial infarction may result from chronic left ventricular thrombi, an akinetic left ventricular segment, or left ventricular dysfunction, due to atrial fibrillation or due to atherosclerotic disease. 26 For every decrease of 5% in the ejection fraction, an 18% increase in the risk of long-term stroke has been found. 27 In our study cohort, higher NYHA class was associated with higher risk of ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

Severity of Angina Pectoris and Risk of Ischemic Stroke

Tanné

Shotan

Goldbourt

et al. 2002

Stroke

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Background and Purpose-Ischemic stroke and coronary heart disease (CHD) share risk factors and pathogenic process, ie, atherosclerosis and thrombosis. We examined the relationship between severity of angina pectoris and its accompanying characteristics and the risk of incident ischemic stroke. Methods-We traced 3122 patients with stable CHD, included in a secondary prevention trial of lipid modification, the Bezafibrate Infarction Prevention trial. CHD was documented by a history of myocardial infarction Ն6 months and Ͻ5 years before enrollment and/or stable angina pectoris with evidence of ischemia confirmed by ancillary diagnostic testing. Severity of angina pectoris was assessed according to the Canadian Cardiovascular Society angina classification, and heart failure functional class according to the New York Heart Association (NYHA) classification. Patients with severe heart failure or unstable angina on enrollment were excluded. Results-During a mean follow-up period of 8.2 years, 186 patients developed an ischemic stroke. The cumulative rate of ischemic stroke increased in a dose-response manner from 4.7% in patients with no angina to 5.7%, 8.4%, and 12.9% in patients with angina classes 1, 2, and 3, respectively (PϽ0.001). Patients with NYHA functional class 1 had a 5.5% rate of ischemic stroke versus 7.3% and 9.6% in patients with classes 2 and 3, respectively (Pϭ0.05). In a Cox proportional-hazard model adjusting for conventional risk factors and potential confounders, the hazard ratio associated with angina class 1 was 1.20 (95% CI, 0.83 to 1.74); class 2, 1.66 (95% CI, 1.12 to 2.45); and class 3, 2.35 (95% CI, 1.08 to 5.13), as compared with patients with no angina. Hazard ratios of ischemic stroke associated with conventional risk factors were 1.55 for a 10-year age increment, 2.16 for diabetes mellitus, 1.81 for current smoking, and 1.29 for a 20 mm Hg increase in systolic blood pressure. Conclusions-Severity of angina pectoris in patients with stable CHD predicts an increased risk of subsequent ischemic stroke. The association between angina class and incident ischemic stroke is independent of traditional vascular risk factors. (Stroke. 2002;33:245-250.)

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Section: Discussionmentioning

confidence: 99%

Severity of Angina Pectoris and Risk of Ischemic Stroke

Tanné

Shotan

Goldbourt

et al. 2002

Stroke

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“…The mechanism of stroke after AMI may change with increased duration from the AMI, 20 and age may also account for some of these differences. 21 Risk factors for stroke after MI in the elderly may be different from those previously found for younger cohorts.…”

Section: Predictors Of Strokementioning

confidence: 99%

Risk and Predictors of Stroke After Myocardial Infarction Among the Elderly

et al. 2002

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Background-Stroke is an important outcome after acute myocardial infarction. Studies that have examined this relationship have largely excluded older patients, even though half of stroke admissions occur among patients 75 years of age and older. Methods and Results-Among 111 023 medicare patients discharged with a principal diagnosis of acute myocardial infarction during an 8-month period in 1994 to 1995, we identified hospital admissions for ischemic stroke within 6 months of discharge. The rate of admission was 2.5% within 6 months. Independent predictors of ischemic stroke were age Ն75 years, black race, no aspirin at discharge, frailty, prior stroke, atrial fibrillation, diabetes, hypertension, and history of peripheral vascular disease. To identify individuals at increased risk for stroke, a risk stratification score was constructed from identified factors. The 6-month stroke admission rate for patients with a score of 4 or higher (Ϸ20% of the total sample) was Ϸ4%. Conclusions-The risk of stroke after myocardial infarction is substantial, with about 1 in 40 patients suffering an ischemic stroke within 6 months of discharge. Simple clinical factors can predict the risk of stroke and, based on these factors, we identified 20% of older patients who have a 1 in 25 chance of being hospitalized for a stroke within 6 months of discharge.

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“…The most obvious reason by which the statins reduce the number of IS is the reduction in the risk of AMI brought about by a reduction in the number of secondary cardioembolic strokes in the acute phase of AMI [117], which is related to ventricular dyskinesia/akinesia, ventricular clots, low ejection fraction, congestive heart failure, and atrial fibrillation [118,119,120]. The number of atherothrombotic strokes is reduced due to regression/stabilization of atherosclerotic plaque related to carotid stenosis [108,109,110,111,112,113] with aortic arch atheroma [121, 122] and, probably, intracranial stenosis.…”

Section: Is and Statinsmentioning

confidence: 99%

Lipids and Stroke: The Opportunity of Lipid-Lowering Treatment

Vivancos-Mora

Gil‐Núñez

2005

Cerebrovasc Dis

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Dyslipemia is a clear risk factor (RF) for ischemic heart disease and peripheral artery disease, but its relation with ischemic stroke (IS) is not so clear. HMG-CoA reductase inhibitor drugs or statins (simvastatin, atorvastatin, pravastatin) reduce the relative risk of IS by between 18 and 51% in patients with IHD, in patients with high vascular disease risk and in hypertensive patients with other RFs, acute coronary syndrome, and type 2 diabetes mellitus. According to the guidelines for use, statins are indicated in the majority of patients with IS since the risk is equivalent to that of IHD or high vascular disease risk. In view of the existing clinical evidence of benefit, it would not seem unreasonable to proceed with treatment of patients using statins while awaiting specific studies justifying their use. The non-lipid-lowering mechanisms of the statins and results of studies, such as the Heart Protection Study, provide evidence for widening the indications of statins beyond the prevention of dyslipemia, as a new therapeutic approach in the prevention of IS in patients with plasma levels of total cholesterol or low density lipoproteins currently considered within the normal distribution. The neuroprotective role, which these drugs may play in the acute phase of cerebral ischemia, remains to be clarified, but very recent evidence suggests that such patients may also benefit.

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Mechanism of late stroke after myocardial infarct: the Lausanne Stroke Registry.

Abstract: To assess the potential mechanisms and patterns of late stroke after myocardial infarct, 94 consecutive patients with first ever stroke at least three months after myocardial infarction (anterior 67%; inferior 12%; widespread 12%) were studied.

Cited by 29 publications

References 34 publications

Severity of Angina Pectoris and Risk of Ischemic Stroke

Severity of Angina Pectoris and Risk of Ischemic Stroke

Risk and Predictors of Stroke After Myocardial Infarction Among the Elderly

Lipids and Stroke: The Opportunity of Lipid-Lowering Treatment

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