Quantifying the risk of heart disease following acute ischaemic stroke: a meta-analysis of over 50 000 participants

Abstract

ObjectiveFollowing an acute stroke, there is a high risk of recurrence. However, the leading cause of mortality following a stroke is due to coronary artery disease (CAD) and myocardial infarction (MI) but that risk has not been robustly quantified. We sought to reliably quantify the risk of ischaemic heart disease (IHD) in patients presenting with acute ischaemic stroke (AIS) in the absence of a known cardiac history.SettingA meta-analysis study. PubMed, MEDLINE, EMBASE and Google Scholar were searched for potential studies up to October 2015. Included studies reported an acute cerebral ischaemic event and followed for CAD or MI within 1 year in patients without known IHD. Using arcsine transformed proportions for meta-analysis, studies were combined using a generic inverse variance random-effects model to calculate the pooled standardised mean difference and 95% CIs. These were interpreted as the percentage prevalence of CAD or incidence of MI following AIS.Results17 studies with 4869 patients with AIS demonstrated a mean average of asymptomatic CAD in 52%. Anatomical methods of CAD detection revealed a prevalence of asymptomatic ≥50% coronary stenosis in 32% (95% CI 19% to 47%; p<0.00001). 8 studies with 47229 patients with ischaemic stroke revealed an overall risk of MI in the year following stroke of 3% (95% CI 1% to 5%; p<0.00001) despite the absence of any cardiac history.ConclusionsOne-third of patients with ischaemic stroke with no cardiac history have more than 50% coronary stenosis and 3% are at risk of developing MI within a year. Our findings provide a reliable quantitative measure of the risk of IHD following AIS in patients with no cardiac history.

Post‐stroke seizure—Do the locations, types and managements of stroke matter?

“…Although Gunnoo et al. reported that a third of patients with ischemic stroke demonstrated asymptomatic coronary artery diseases, the relationship between IHD and post‐stroke seizures remains unclear.…”

“…Of interest, our multivariate analysis also showed that underlying IHD is an independent risk factor for post-stroke seizures. Although Gunnoo et al reported that a third of patients with ischemic stroke demonstrated asymptomatic coronary artery diseases, 23 the relationship between IHD and post-stroke seizures remains unclear.…”

Myocardial infarction after acute ischaemic stroke: Incidence, mortality and risk factors

“…3 Nevertheless, real-world data suggest that the incidence of MI after AIS may not be as high as theoretically expected. 5 The most recent systematic review calculated that the yearly risk of post-stroke MI is 1.67%. 4 Another meta-analysis showed similar results: ischaemic stroke was shown to be associated with an overall risk of MI in the year following stroke of 3% (1.0-5.0).…”

“…4 Another meta-analysis showed similar results: ischaemic stroke was shown to be associated with an overall risk of MI in the year following stroke of 3% (1.0-5.0). 5 The most recent systematic review calculated that the yearly risk of post-stroke MI is 1.67%. 6 Given that there is significant overlap between stroke secondary preventative therapies and acute coronary syndrome (ACS) primary prevention, it may not seem surprising that the annual incidence of post-stroke MI is not as high expected in such a highly co-morbid population.…”

“…We have also calculated the annual post-AIS MI incidence rate to be 0.54%, roughly half of previously reported values [4][5][6]. 30 Furthermore, most of these studies do not include in their analyses a full panel of potentially relevant co-morbid conditions or biochemical and haematological parameters.…”