Risk of Myocardial Infarction or Vascular Death After First Ischemic Stroke

Abstract

Background and Purpose-In national guidelines, absolute long-term risk of myocardial infarction (MI) or coronary death determines target low-density lipoprotein levels, but stroke patients are not explicitly addressed. We determined the absolute 5-year risk of cardiovascular outcomes and their predictors after first ischemic stroke in a multiethnic cohort. Methods-A population-based cohort of first ischemic stroke patients Ն40 years old was prospectively followed annually for recurrent stroke, MI and cause-specific mortality. Kaplan-Meier 5-year risks for MI or vascular death (primary outcome), and other cardiovascular events, were calculated. Univariate and multivariate Cox proportional hazards models were used to calculate hazard ratios and 95% CI for predictors of cardiovascular outcomes. Results-Mean age (nϭ655) was 69.7Ϯ12.7 years; 55.4% of participants were women, and 51.3% Hispanic. The 5-year risk of MI or vascular death was 17.4% (95% CI, 14.2% to 20.6%). Independent historical predictors of MI or vascular death were age Ͼ70 years (hazard ratio 1.62, 1.07 to 2.44), history of coronary artery disease (hazard ratio 1.76, 1.13 to 2.74), and atrial fibrillation (hazard ratio 1.76, 1.05 to 2.94). In the lowest risk group, those Յ70 years old without coronary artery disease, 5-year risk of MI or vascular death was 9.7%. Conclusions-The absolute risk of MI or vascular death after ischemic stroke, even in those without high-risk features, approximates levels used by national organizations to designate groups of patients at high risk of vascular events. The comparability of levels of absolute risk among stroke and cardiac patients may have treatment implications. (Stroke.

Lifestyle Factors and Early Clinical Outcome in Patients With Acute Stroke

“…[3][4][5][6][7][8][9][10] In addition, most of the existing studies have not been population based and have often been conducted in specialized units which raise concerns about the generalizability of the findings. There is consequently a need for large-scale studies on unselected patients in order better to comprehend the impact of lifestyle on stroke outcomes, including stroke severity, the risk of important medical complications, and mortality in acute stroke care settings.…”

Prognostic factors of recurrent acute cerebrovascular incidents in patients with ischemic stroke

“…Клинические проявления ИБС свидетельствуют не только о наличии коронарного атеросклероза, но и служат маркером генерализации атеросклеротиче-ского процесса в целом, включая вовлечение брахио-цефальных и интракраниальных артерий [13,14]. Так, пациенты со стабильными проявлениями ИБС даже при кажущемся клиническом благополучии представляют собой группу высокого риска атеро-тромбоза не только в коронарном, но и церебраль-ном и периферическом сосудистых бассейнах [15].…”

Cost‐effectiveness of Quantitative Pretest Probability Intended to Reduce Unnecessary Medical Radiation Exposure in Emergency Department Patients With Chest Pain and Dyspnea

“…The Consumer Price Index was used to adjust all costs to 2013 dollars. 39 [16][17][18] 0.083 NA Probability of death from recurrent PE 19,20 0.34 0.3-0.44 Probability of improved health after PE 0.2 NA Probability of ICH for those with PE 8,21,22 0.004 NA Probability of death from ICH for those with PE in year 1 8,21,23 0.45 0.21-0.72 Probability of death from ICH experienced after year 1 21,24 0.23 NA Probability of ICH in the general population 24 0.000292 0.000274-0.00031 MI and ischemic stroke Probability of MI in the medium risk population 25 0.015 0.012-0.018 Probability of MI recurrence (based on high risk population) 25 0.032 0.026-0.038 Probability that MI is nonfatal 26 0.55 0.44-0.66 Probability of improved health after MI 0.2 NA Probability of ischemic stroke 27 0.0027 NA Probability of death from first stroke within a year 28 0.0375 0.0302-0.0461 Probability of stroke recurrence 29 0.111 0.09-0.133 Probability of complete recovery within 1 year of stroke 30 0 Data Supplement S3 (available as supporting information in the online version of this paper) details other assumptions of the model. Five assumptions warrant specific consideration.…”