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Keller K, Schmitt VH, Hahad O, Hobohm L. Outcome of Pulmonary Embolism with and without Ischemic Stroke. J Clin Med 2024; 13:2730. [PMID: 38792272 PMCID: PMC11122224 DOI: 10.3390/jcm13102730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/10/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Ischemic stroke is the second, and pulmonary embolism (PE) is the third most common cardiovascular cause of death after myocardial infarction. Data regarding risk factors for ischemic stroke in patients with acute PE are limited. Methods: Patients were selected by screening the German nationwide in-patient sample for PE (ICD-code I26) and were stratified by ischemic stroke (ICD code I63) and compared. Results: The nationwide in-patient sample comprised 346,586 hospitalized PE patients (53.3% females) in Germany from 2011 to 2014; among these, 6704 (1.9%) patients had additionally an ischemic stroke. PE patients with ischemic stroke had a higher in-hospital mortality rate than those without (28.9% vs. 14.5%, p < 0.001). Ischemic stroke was independently associated with in-hospital death (OR 2.424, 95%CI 2.278-2.579, p < 0.001). Deep venous thrombosis and/or thrombophlebitis (DVT) combined with heart septal defect (OR 24.714 [95%CI 20.693-29.517], p < 0.001) as well as atrial fibrillation/flutter (OR 2.060 [95%CI 1.943-2.183], p < 0.001) were independent risk factors for stroke in PE patients. Systemic thrombolysis was associated with a better survival in PE patients with ischemic thrombolysis who underwent cardio-pulmonary resuscitation (CPR, OR 0.55 [95%CI 0.36-0.84], p = 0.006). Conclusions: Ischemic stroke did negatively affect the survival of PE. Combination of DVT and heart septal defect and atrial fibrillation/flutter were strong and independent risk factors for ischemic stroke in PE patients. In PE patients with ischemic stroke, who had to underwent CPR, systemic thrombolysis was associated with improved survival.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (V.H.S.); (O.H.); (L.H.)
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Volker H. Schmitt
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (V.H.S.); (O.H.); (L.H.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, 55131 Mainz, Germany
| | - Omar Hahad
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (V.H.S.); (O.H.); (L.H.)
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, 55131 Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany; (V.H.S.); (O.H.); (L.H.)
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
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Stulberg EL, Harris BRE, Zheutlin AR, Delic A, Sheibani N, Anadani M, Yaghi S, Petersen NH, de Havenon A. Association of Blood Pressure Variability With Death and Discharge Destination Among Critically Ill Patients With and Without Stroke. Neurology 2023; 101:e1145-e1157. [PMID: 37487742 PMCID: PMC10513881 DOI: 10.1212/wnl.0000000000207599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 05/15/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES It is unclear whether blood pressure variability's (BPV) association with worse outcomes is unique to patients with stroke or a risk factor among all critically ill patients. We (1) determined whether BPV differed between patients with stroke and nonstroke patients, (2) examined BPV's associations with in-hospital death and favorable discharge destination in patients with stroke and nonstroke patients, and (3) assessed how minimum mean arterial pressure (MAP)-a correlate of illness severity and cerebral perfusion-affects these associations. METHODS This is a retrospective analysis of adult intensive care unit patients hospitalized between 2001 and 2012 from the Medical Information Mart for Intensive Care III database. Confounder-adjusted logistic regressions determined associations between BPV, measured as SD and average real variability (ARV), and (1) in-hospital death and (2) favorable discharge, with testing of minimum MAP for effect modification. RESULTS BPV was higher in patients with stroke (N = 2,248) compared with nonstroke patients (N = 9,085) (SD mean difference 2.3, 95% CI 2.1-2.6, p < 0.01). After adjusting for minimum tertile of MAP and other confounders, higher SD remained significantly associated (p < 0.05) with higher odds of in-hospital death for patients with acute ischemic strokes (AISs, odds ratio [OR] 2.7, 95% CI 1.5-4.8), intracerebral hemorrhage (ICH, OR 2.6, 95% CI 1.6-4.3), subarachnoid hemorrhage (SAH, OR 3.4, 95% CI 1.2-9.3), and pneumonia (OR 1.9, 95% CI 1.1-3.3) and lower odds of favorable discharge destination in patients with ischemic stroke (OR 0.3, 95% CI 0.2-0.6) and ICH (OR 0.4, 95% CI 0.3-0.6). No interaction was found between minimum MAP tertile with SD (p > 0.05). Higher ARV was not significantly associated with increased risk of death in any condition when adjusting for illness severity but portended worse discharge destination in those with AIS (OR favorable discharge 0.4, 95% CI 0.3-0.7), ICH (OR favorable discharge 0.5, 95% CI 0.3-0.7), sepsis (OR favorable discharge 0.8, 95% CI 0.6-1.0), and pneumonia (OR favorable discharge 0.5, 95% CI 0.4-0.8). DISCUSSION BPV is higher and generally associated with worse outcomes among patients with stroke compared with nonstroke patients. BPV in patients with AIS and patients with ICH may be a marker of central autonomic network injury, although clinician-driven blood pressure goals likely contribute to the association between BPV and outcomes.
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Affiliation(s)
- Eric Lee Stulberg
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT.
| | - Benjamin Robert Edward Harris
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT
| | - Alexander Robert Zheutlin
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT
| | - Alen Delic
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT
| | - Nazanin Sheibani
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT
| | - Mohammad Anadani
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT
| | - Shadi Yaghi
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT
| | - Nils H Petersen
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT
| | - Adam de Havenon
- From the Department of Neurology (E.L.S., A.D., A.H.), and Department of Internal Medicine (B.R.E.H., A.R.Z.), University of Utah School of Medicine, Salt Lake City; Department of Neurology (N.S.), Tufts University Medical Center, Boston, MA; Department of Neurology (M.A.), Medical University of South Carolina, Charleston; Department of Neurology (S.Y.), Brown University Alpert School of Medicine, Providence, RI; and Department of Neurology (N.H.P., A.H.), Yale University School of Medicine, New Haven, CT
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Ulvenstam A, Graipe A, Irewall AL, Söderström L, Mooe T. Incidence and predictors of cardiovascular outcomes after acute coronary syndrome in a population-based cohort study. Sci Rep 2023; 13:3447. [PMID: 36859606 PMCID: PMC9977928 DOI: 10.1038/s41598-023-30597-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 02/27/2023] [Indexed: 03/03/2023] Open
Abstract
There is limited data on long-term outcomes after hospitalization for ACS. We aimed to estimate the rate of recurrent cardiovascular events in the long-term, in a population-based, unselected cohort of ACS patients. We included 1379 patients with ACS hospitalized at Östersund hospital 2010-2014 and followed them from the day after discharge to 31 December 2017. The primary endpoint was the unadjusted rate of the composite of CV death, AMI and ischemic stroke. Risk factors for the primary endpoint were assessed in a multivariable Cox proportional hazards regression model. During a median follow-up of 4.7 years, the unadjusted rate of the primary endpoint was 10.3% at 1 year and 28.6% at the end of follow-up. Predictors of increased risk for subsequent events were congestive heart failure, diabetes mellitus, angina pectoris, prior revascularization with PCI or CABG and treatment with diuretics at discharge. Lipid-lowering therapy at discharge and revascularization with PCI or CABG were associated with a lower risk of recurrent events. The risk of recurrent cardiovascular was high at 1 year and continued to be so during the following almost 3 years of median follow-up. Established predictors of cardiovascular risk were confirmed.
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Affiliation(s)
- Anders Ulvenstam
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Anna Graipe
- grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Anna-Lotta Irewall
- grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Söderström
- grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Thomas Mooe
- grid.12650.300000 0001 1034 3451Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Park D, Kim MC, Hong D, Jeong YS, Kim HS, Kim JH. Recurrence and Mortality Risks in Patients with First Incident Acute Stroke or Myocardial Infarction: A Longitudinal Study Using the Korean National Health Insurance Service Database. J Clin Med 2023; 12:jcm12020568. [PMID: 36675497 PMCID: PMC9865804 DOI: 10.3390/jcm12020568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 01/12/2023] Open
Abstract
Background: We aimed to identify the long-term risk of recurrence and mortality in patients who experienced acute ischemic stroke (AIS), acute myocardial infarction (AMI), or acute hemorrhagic stroke (AHS) using a population-level database. Methods: This retrospective cohort study included adults aged ≥55 years diagnosed with AIS, AMI, and AHS in the National Health Insurance Service Database between 2004 and 2007. The target outcomes were secondary AIS, AMI, AHS, and all-cause mortality. Predetermined covariates, such as age, sex, socioeconomic status, hypertension, diabetes, and dyslipidemia, were adjusted. Results: We included 151,181, 49,077, and 41,636 patients in the AIS, AHS, and AMI groups, respectively. The AMI (adjusted hazard ratio [aHR], 0.318; 95% confidence interval [CI], 0.306−0.330; p < 0.001) and AHS (aHR, 0.489; 95% CI, 0.472−0.506; p < 0.001) groups had a significantly lower risk of developing secondary AIS than the AIS group. The risk of developing secondary AMI was significantly lower in the AMI (aHR, 0.388; 95% CI, 0.348−0.433; p < 0.001) and AHS (aHR, 0.711; 95% CI, 0.640−0.790; p < 0.001) groups than in the AIS group. Initial AHS was a decisive risk factor for secondary AHS (aHR, 8.546; 95% CI, 8.218−8.887; p < 0.001). The AMI (aHR, 1.436; 95% CI, 1.412−1.461; p < 0.001) and AHS (aHR, 1.328; 95% CI, 1.309−1.348; p < 0.001) groups were associated with a significantly higher risk of long-term mortality than the AIS group. Conclusion: Our results elucidated that initial AIS was a significant risk factor for recurrent AIS and AMI; initial AHS was a decisive risk factor for developing secondary AHS. Further, AMI and AHS were more closely related to long-term mortality than AIS.
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Affiliation(s)
- Dougho Park
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang 37659, Republic of Korea
- Department of Medical Science and Engineering, School of Convergence Science and Technology, Pohang University of Science and Technology, Pohang 37673, Republic of Korea
| | - Mun-Chul Kim
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang 37659, Republic of Korea
| | - Daeyoung Hong
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang 37659, Republic of Korea
| | - Yong-Suk Jeong
- Department of Cardiology, Pohang Stroke and Spine Hospital, Pohang 37659, Republic of Korea
| | - Hyoung Seop Kim
- Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea
- Correspondence: (H.S.K.); (J.H.K.)
| | - Jong Hun Kim
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang 10444, Republic of Korea
- Correspondence: (H.S.K.); (J.H.K.)
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Hurskainen M, Tynkkynen J, Eskola M, Hernesniemi J. Incidence of stroke and mortality due to stroke after acute coronary syndrome. J Stroke Cerebrovasc Dis 2022; 31:106842. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/05/2022] [Accepted: 10/03/2022] [Indexed: 11/21/2022] Open
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Feng S, Li R, Zhou Q, Qu F, Hu W, Liu X. Bioinformatics analysis to identify potential biomarkers and therapeutic targets for ST-segment–elevation myocardial infarction-related ischemic stroke. Front Neurol 2022; 13:894289. [PMID: 36034287 PMCID: PMC9403764 DOI: 10.3389/fneur.2022.894289] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Acute myocardial infarction (AMI) is one of the major causes of mortality and disability worldwide, and ischemic stroke (IS) is a serious complication after AMI. In particular, patients with ST-segment–elevation myocardial infarction (STEMI) are more susceptible to IS. However, the interrelationship between the two disease mechanisms is not clear. Using bioinformatics tools, we investigated genes commonly expressed in patients with STEMI and IS to explore the relationship between these diseases, with the aim of uncovering the underlying biomarkers and therapeutic targets for STEMI-associated IS. Methods Differentially expressed genes (DEGs) related to STEMI and IS were identified through bioinformatics analysis of the Gene Expression Omnibus (GEO) datasets GSE60993 and GSE16561, respectively. Thereafter, we assessed protein-protein interaction networks, gene ontology term annotations, and pathway enrichment for DEGs using various prediction and network analysis methods. The predicted miRNAs targeting the co-expressed STEMI- and IS-related DEGs were also evaluated. Results We identified 210 and 29 DEGs in GSE60993 and GSE16561, respectively. CD8A, TLR2, TLR4, S100A12, and TREM1 were associated with STEMI, while the hubgenes, IL7R, CCR7, FCGR3B, CD79A, and ITK were implicated in IS. In addition, binding of the transcripts of the co-expressed DEGs MMP9, ARG1, CA4, CRISPLD2, S100A12, and GZMK to their corresponding predicted miRNAs, especially miR-654-5p, may be associated with STEMI-related IS. Conclusions STEMI and IS are related and MMP9, ARG1, CA4, CRISPLD2, S100A12, and GZMK genes may be underlying biomarkers involved in STEMI-related IS.
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Affiliation(s)
| | | | | | | | - Wei Hu
- *Correspondence: Xinfeng Liu
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Ng AKY, Ng PY, Ip A, Lau KK, Siu CW. Risk of ischaemic and haemorrhagic stroke in Chinese undergoing percutaneous coronary intervention treated with potent P2Y12 inhibitor versus clopidogrel. Stroke Vasc Neurol 2022; 7:310-318. [PMID: 35264399 PMCID: PMC9453842 DOI: 10.1136/svn-2021-001294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background Stroke after acute coronary syndrome (ACS) can be devastating. It is uncertain whether the risks of ischaemic stroke or intracranial haemorrhage (ICH) are associated with different choices of P2Y12 inhibitors (potent P2Y12 inhibitors such as ticagrelor and prasugrel vs clopidogrel). Even though East Asians are known to have different thrombotic and haemorrhagic profiles from Caucasians, data on Chinese patients are sparse. Method This was a retrospective cohort study conducting in Chinese patients with ACS who underwent first-ever percutaneous coronary intervention from 14 hospitals in Hong Kong between 2010 and 2017. The primary efficacy endpoint was ischaemic stroke. The secondary efficacy endpoint was a composite outcome of thrombotic events including all-cause mortality, non-fatal myocardial infarction and ischaemic stroke. The primary safety endpoint was ICH. The secondary safety endpoint was a composite of major bleeding events. Results After adjustment of baseline characteristics by 1:1 propensity score matching, a total of 6220 patients (3110 on each group) were analysed. Compared with clopidogrel, potent P2Y12 inhibitors were associated with a lower risk of ischaemic stroke (HR 0.57; 95% CI 0.37 to 0.87; p=0.008) and a lower risk of thrombotic events (HR 0.77; 95% CI 0.66 to 0.90; p=0.001). Potent P2Y12 inhibitor was associated with similar risk of ICH (HR 0.65; 95% CI 0.34 to 1.25, p=0.20) and major bleeding (HR 0.83; 95% CI 0.68 to 1.01, p=0.069). Conclusions Potent P2Y12 inhibitors were associated with a lower adjusted risk of ischaemic stroke and thrombotic events, compared with clopidogrel. The risks of ICH and major bleeding were similar.
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Affiliation(s)
| | - Pauline Yeung Ng
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, Hong Kong.,Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - April Ip
- Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Kui Kai Lau
- Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - Chung-Wah Siu
- Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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Kim D, Kim JH, Park SW, Han HW, An SJ, Kim YI, Ju HJ, Choi Y, Kim DY. Predictive value of the videofluoroscopic swallowing study for long-term mortality in patients with subacute stroke. Medicine (Baltimore) 2022; 101:e28623. [PMID: 35089200 PMCID: PMC8797482 DOI: 10.1097/md.0000000000028623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/29/2021] [Indexed: 01/05/2023] Open
Abstract
To investigate the usefulness of the videofluoroscopic swallowing study (VFSS) for subacute stroke in predicting long-term all-cause mortality, including not only simple parameters obtained from VFSS results, but also recommended dietary type as an integrated parameter.This was a retrospective study of patients with subacute (<1 month) stroke at a university hospital between February 2014 and September 2019. The independent risk factors were investigated using stepwise Cox regression analysis, which increased the all-cause mortality of patients with stroke among VFSS parameters.A total of 242 patients with subacute stroke were enrolled. The significant mortality-associated factors were age, history of cancer, recommended dietary type (modified dysphagia diet; adjusted hazard ratio [HR], 6.971; P = .014; tube diet, adjusted HR: 10.169; P = .019), and Modified Barthel Index. In the subgroup survival analysis of the modified dysphagia diet group (n = 173), the parameters for fluid penetration (adjusted HR: 1.911; 95% confidence interval, 1.086-3.363; P = .025) and fluid aspiration (adjusted HR: 2.236; 95% confidence interval, 1.274-3.927; P = .005) were significantly associated with mortality.The recommended dietary type determined after VFSS in subacute stroke was a significant risk factor for all-cause mortality as an integrated parameter for dysphagia. Among the VFSS parameters, fluid penetration and aspiration were important risk factors for all-cause mortality in patients with moderate dysphagia after stroke. Therefore, it is important to classify the degree of dysphagia by performing the VFSS test in the subacute period of stroke and to determine the appropriate diet and rehabilitation intervention for mortality-related prognosis.
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Affiliation(s)
- Daham Kim
- Department of Rehabilitation Medicine, College of Medicine, Catholic Kwandong University International St Mary's Hospital, Incheon, Korea
| | - Jae-Hyung Kim
- Department of Rehabilitation Medicine, College of Medicine, Catholic Kwandong University International St Mary's Hospital, Incheon, Korea
| | - Si-Woon Park
- Department of Rehabilitation Medicine, College of Medicine, Catholic Kwandong University International St Mary's Hospital, Incheon, Korea
| | - Hyung-Wook Han
- Department of Rehabilitation Medicine, College of Medicine, Catholic Kwandong University International St Mary's Hospital, Incheon, Korea
| | - Sang Joon An
- Department of Neurology, College of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, Korea
- The Convergence Institute of Healthcare and Medical Science, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Yeong In Kim
- Department of Neurology, College of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, Korea
- The Convergence Institute of Healthcare and Medical Science, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Hyo Jin Ju
- Department of Medical Humanities, College of Medicine, Catholic Kwandong University, Gangwon, Korea
- The Convergence Institute of Healthcare and Medical Science, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - YoonHee Choi
- The Convergence Institute of Healthcare and Medical Science, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Doo Young Kim
- Department of Rehabilitation Medicine, College of Medicine, Catholic Kwandong University International St Mary's Hospital, Incheon, Korea
- The Convergence Institute of Healthcare and Medical Science, College of Medicine, Catholic Kwandong University, Incheon, Korea
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Tang Y, Bai Y, Chen Y, Sun X, Shi Y, He T, Jiang M, Wang Y, Wu M, Peng Z, Liu S, Jiang W, Lu Y, Yuan H, Cai J. Development and validation of a novel risk score to predict 5-year mortality in patients with acute myocardial infarction in China: a retrospective study. PeerJ 2022; 9:e12652. [PMID: 35036143 PMCID: PMC8740514 DOI: 10.7717/peerj.12652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/28/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The disease burden from ischaemic heart disease remains heavy in the Chinese population. Traditional risk scores for estimating long-term mortality in patients with acute myocardial infarction (AMI) have been developed without sufficiently considering advances in interventional procedures and medication. The goal of this study was to develop a risk score comprising clinical parameters and intervention advances at hospital admission to assess 5-year mortality in AMI patients in a Chinese population. METHODS We performed a retrospective observational study on 2,722 AMI patients between January 2013 and December 2017. Of these patients, 1,471 patients from Changsha city, Hunan Province, China were assigned to the development cohort, and 1,251 patients from Xiangtan city, Hunan Province, China, were assigned to the validation cohort. Forty-five candidate variables assessed at admission were screened using least absolute shrinkage and selection operator, stepwise backward regression, and Cox regression methods to construct the C2ABS2-GLPK score, which was graded and stratified using a nomogram and X-tile. The score was internally and externally validated. The C-statistic and Hosmer-Lemeshow test were used to assess discrimination and calibration, respectively. RESULTS From the 45 candidate variables obtained at admission, 10 potential predictors, namely, including Creatinine, experience of Cardiac arrest, Age, N-terminal Pro-Brain Natriuretic Peptide, a history of Stroke, Statins therapy, fasting blood Glucose, Left ventricular end-diastolic diameter, Percutaneous coronary intervention and Killip classification were identified as having a close association with 5-year mortality in patients with AMI and collectively termed the C2ABS2-GLPK score. The score had good discrimination (C-statistic = 0.811, 95% confidence intervals (CI) [0.786-0.836]) and calibration (calibration slope = 0.988) in the development cohort. In the external validation cohort, the score performed well in both discrimination (C-statistic = 0.787, 95% CI [0.756-0.818]) and calibration (calibration slope = 0.976). The patients were stratified into low- (≤148), medium- (149 to 218) and high-risk (≥219) categories according to the C2ABS2-GLPK score. The predictive performance of the score was also validated in all subpopulations of both cohorts. CONCLUSION The C2ABS2-GLPK score is a Chinese population-based risk assessment tool to predict 5-year mortality in AMI patients based on 10 variables that are routinely assessed at admission. This score can assist physicians in stratifying high-risk patients and optimizing emergency medical interventions to improve long-term survival in patients with AMI.
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Affiliation(s)
- Yan Tang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuanyuan Bai
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuanyuan Chen
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuejing Sun
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yunmin Shi
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Tian He
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mengqing Jiang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yujie Wang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mingxing Wu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Zhiliu Peng
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China
| | - Suzhen Liu
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weihong Jiang
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yao Lu
- Center of Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Hong Yuan
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Center of Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jingjing Cai
- Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
- Center of Clinical Pharmacology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
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10
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Sun W, Zhang L, Liu W, Tian M, Wang X, Liang J, Wang Y, Ding L, Pei L, Lu J, Xu Y, Song B. Stroke and Myocardial Infarction: A Bidirectional Mendelian Randomization Study. Int J Gen Med 2021; 14:9537-9545. [PMID: 34916835 PMCID: PMC8670204 DOI: 10.2147/ijgm.s337681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Stroke and myocardial infarction (MI) are associated with each other, as demonstrated in observational studies. However, it is unclear whether this relationship is causal, and the purpose of this study was to explore the bidirectional causality between stroke and MI. Methods Causality between stroke and MI was assessed using two-sample Mendelian randomization (MR). All genetic instruments related to stroke (40,585 cases; 406,111 controls) and MI (43,676 cases; 128,199 controls) were derived from large published genome-wide association study. The MR analysis was calculated with inverse-variance weighting, MR-Egger, weighted mode, weighted median, and simple mode methods, and sensitivity analyses are used to detect the heterogeneity or pleiotropy. Results Genetically predicted large-artery stroke (LAS) was causally related to higher odds of MI (odds ratio [OR] = 1.13, 95% confidence interval [CI]: 1.06–1.20, p = 1.0×10−4), and the causal effect of LAS on MI was significantly weakened (OR = 1.09, 95% CI: 1.02–1.17, p = 0.017) after excluding the multipotent single-nucleotide polymorphisms (SNPs). MI phenotypes were genetically correlated with all ischemic strokes (OR = 1.15, 95% CI: 1.03–1.28, p = 0.013) and LAS (OR = 1.39, 95% CI: 1.14–1.71, p = 0.001); but a causal effect of MI on all ischemic strokes (OR = 1.00, 95% CI: 0.95–1.28, p = 0.219) and LAS (OR = 1.26, 95% CI: 0.93–1.69, p = 0.130) was not observed after excluding the multipotent SNPs. Conclusion This MR analysis provides evidence to support the causal effect of LAS subtype on MI, and some factors act as confiding factors whereas others may act as mediators.
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Affiliation(s)
- Wenxian Sun
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Luyang Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Weishi Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Mengke Tian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Xin Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Jing Liang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Yuying Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Lan Ding
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Lulu Pei
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Jie Lu
- Department of Epidemiology and Health Statistics College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
| | - Bo Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China
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11
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Gelosa P, Castiglioni L, Rzemieniec J, Muluhie M, Camera M, Sironi L. Cerebral derailment after myocardial infarct: mechanisms and effects of the signaling from the ischemic heart to brain. J Mol Med (Berl) 2021; 100:23-41. [PMID: 34674004 PMCID: PMC8724191 DOI: 10.1007/s00109-021-02154-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/07/2021] [Accepted: 10/14/2021] [Indexed: 12/04/2022]
Abstract
Myocardial infarction (MI) is the leading cause of death among ischemic heart diseases and is associated with several long-term cardiovascular complications, such as angina, re-infarction, arrhythmias, and heart failure. However, MI is frequently accompanied by non-cardiovascular multiple comorbidities, including brain disorders such as stroke, anxiety, depression, and cognitive impairment. Accumulating experimental and clinical evidence suggests a causal relationship between MI and stroke, but the precise underlying mechanisms have not yet been elucidated. Indeed, the risk of stroke remains a current challenge in patients with MI, in spite of the improvement of medical treatment among this patient population has reduced the risk of stroke. In this review, the effects of the signaling from the ischemic heart to the brain, such as neuroinflammation, neuronal apoptosis, and neurogenesis, and the possible actors mediating these effects, such as systemic inflammation, immunoresponse, extracellular vesicles, and microRNAs, are discussed.
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Affiliation(s)
- Paolo Gelosa
- Department of Pharmaceutical Sciences, University of Milan, 20133, Milan, Italy
| | - Laura Castiglioni
- Department of Pharmaceutical Sciences, University of Milan, 20133, Milan, Italy
| | - Joanna Rzemieniec
- Department of Pharmaceutical Sciences, University of Milan, 20133, Milan, Italy
| | - Majeda Muluhie
- Department of Pharmaceutical Sciences, University of Milan, 20133, Milan, Italy
| | - Marina Camera
- Department of Pharmaceutical Sciences, University of Milan, 20133, Milan, Italy.,Centro Cardiologico Monzino, 20138, Milan, Italy
| | - Luigi Sironi
- Department of Pharmaceutical Sciences, University of Milan, 20133, Milan, Italy.
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12
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Zhang Y, Li C, Pei Y, Zheng L, Sun X, Zhao Z, Wang S. Trelagliptin ameliorates oxygen-glucose deprivation/reperfusion (OGD/R)-induced mitochondrial dysfunction and metabolic disturbance of endothelial cells. Hum Cell 2021; 34:1717-1726. [PMID: 34435315 DOI: 10.1007/s13577-021-00594-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022]
Abstract
Acute myocardial infarction (AMI) is a severe cardiovascular disease with high mortality. It is reported to be closely related to the mitochondrial dysfunction and metabolic disturbance on endothelial cells under a chronic hypoxic state. Significant declined mitochondrial respiration, ATP production, and metabolic changes are the main characteristics of endothelial injury in the disease. Trelagliptin is a DPP-4 inhibitor applied for the treatment of type II diabetes and has been recently reported to exert various pharmacological properties. In this investigation, we examined whether Trelagliptin possessed a protective effect against mitochondrial dysfunction and metabolic disturbance in human aortic valvular endothelial cells (HAVECs) under oxygen-glucose deprivation/reperfusion (OGD/R) conditions. We found that both the cytotoxicity and mitochondrial oxidative stress in HAVECs induced by OGD/R stimulation were greatly alleviated by Trelagliptin. In addition, the declined mitochondrial respiration and ATP production decreased secretion of cystathionine and creatine, and the increased production of triglyceride and adiponectin in OGD/R-challenged HAVECs was dramatically reversed by Trelagliptin, accompanied by the upregulated expression level of PGC-1α and CPT-1. Lastly, the AMPK pathway was observed to be significantly activated in OGD/R-challenged HAVECs by Trelagliptin treatment. After co-administration of the inhibitor of the AMPK pathway, the effects of Trelagliptin on mitochondrial function and metabolic alterations were significantly abolished. Taken together, our data indicate that Trelagliptin ameliorated OGD/R-induced mitochondrial disturbance and metabolic changes by activating the AMPK pathway.
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Affiliation(s)
- Yatong Zhang
- Department of pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, 100730, China
| | - Chao Li
- Department of pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, 100730, China
| | - Yifang Pei
- Department of pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, 100730, China
| | - Li Zheng
- Department of Pharmacy, China Aerospace Science and Industry Corporation 731 Hospital, Beijing, 100074, China
| | - Xuelin Sun
- Department of pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, 100730, China
| | - Zinan Zhao
- Department of pharmacy, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Individual Application (Beijing Hospital), Beijing, 100730, China
| | - Shuanghu Wang
- The Laboratory of Clinical Pharmacy, The Sixth Affiliated Hospital of Wenzhou Medical University, The People's Hospital of Lishui, #15 Dazhong Street, Liandu District, Lishui City, 323000, Zhejiang, China.
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13
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Zhang PY, Becher H, Jeerakathil T, Graham MM, Shanks M. The incidence of stroke in patients with early echocardiography after acute myocardial infarction. Int J Cardiovasc Imaging 2021; 37:3423-3429. [PMID: 34251550 DOI: 10.1007/s10554-021-02333-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/25/2021] [Indexed: 01/03/2023]
Abstract
Left ventricular (LV) thrombus formation after ST-elevation myocardial infarction (STEMI) increases the risk of stroke. In our center, most echocardiograms are performed within 2 days post-STEMI. However, LV thrombi often become visible later. We assessed the 1-year incidence of stroke in patients without LV thrombus on echocardiography performed early (1-2 days) vs. later (day ≥ 3) post-STEMI. This retrospective observational study included 416 patients with acute STEMI. Patients with atrial fibrillation were excluded. All patients underwent echocardiography during admission. Patients with stroke within 12 months post-STEMI were identified from the hospital charts and administrative databases. Most echocardiograms (75%) were performed ≤ 2 days post-STEMI. LV thrombus was identified in 12 patients. One (8.3%) patient with LV thrombus and 10 (2.5%) patients without LV thrombus suffered stroke within 12 months post-STEMI. Most patients with stroke had apical akinesis. Most strokes occurred during the index admission or within 67 days of STEMI. There was no significant difference in the incidence of stroke between the patients with early vs. later echocardiography post-STEMI. The incidence of stroke after STEMI is low and similar between patients with echocardiography performed early vs. later post-STEMI which supports our current clinical practice. Importantly, most strokes occur in patients without LV thrombus on early echocardiography. High reported mortality rate associated with stroke following STEMI justifies the need for further validation in prospective studies to identify patients who may benefit from repeat imaging to detect later LV thrombus formation, and how this will impact patient outcomes and healthcare costs.
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Affiliation(s)
- Peter Yuan Zhang
- Division of Cardiology, Department of Medicine, 2C2 Walter Mackenzie Health Sciences Center, Mazankowski Alberta Heart Institute, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Harald Becher
- Division of Cardiology, Department of Medicine, 2C2 Walter Mackenzie Health Sciences Center, Mazankowski Alberta Heart Institute, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Thomas Jeerakathil
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Michelle M Graham
- Division of Cardiology, Department of Medicine, 2C2 Walter Mackenzie Health Sciences Center, Mazankowski Alberta Heart Institute, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Miriam Shanks
- Division of Cardiology, Department of Medicine, 2C2 Walter Mackenzie Health Sciences Center, Mazankowski Alberta Heart Institute, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.
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14
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Chen S, Che Q, Zheng Q, Zhang Y, Jia J, Wu Y, Huo Y, Chen D. Relationship Between Different Risk Factor Patterns and Follow-Up Outcomes in Patients With ST-Segment Elevation Myocardial Infarction. Front Cardiovasc Med 2021; 8:633992. [PMID: 34113659 PMCID: PMC8185218 DOI: 10.3389/fcvm.2021.633992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Few studies have been concerned with the combined influences of the presence of multiple risk factors on follow-up outcomes in AMI patients. Our study aimed to identify risk factor patterns that may be associated with 1-year survival in male patients with ST-segment elevation myocardial infarction (STEMI). Methods: Data were from the China STEMI Care Project Phase 2 (CSCAP-2) collected between 2015 and 2018. A total of 15,675 male STEMI patients were enrolled in this study. Risk factor patterns were characterized using latent class analysis (LCA) according to seven risk factors. Associations between risk factor patterns and follow-up outcomes, including the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause death, were investigated by Cox proportional hazard regression analysis. Results: We obtained four risk factor patterns as "young and middle-aged with low levels of multimorbidity," "middle-aged with overweight," "middle-aged and elderly with normal weight," and "elderly with high multimorbidity." Four patterns had significant differences in event-free survival (P < 0.001). As compared with the patients of "young and middle-aged with low levels of multimorbidity" pattern, the risk of incidence of MACCE and all-cause death were increased in patients of "middle-aged with overweight" pattern (All-cause death: HR = 1.70, 95% CI:1.29~2.23; MACCE: HR = 1.49, 95% CI:1.29~1.72), "middle-aged and elderly with normal weight" pattern (All-cause death: HR = 3.04, 95% CI: 2.33~3.98; MACCE: HR = 1.82, 95% CI: 1.56~2.12), and "elderly with high multimorbidity" pattern (All-cause death: HR = 5.78, 95% CI: 4.49~7.42; MACCE: HR = 2.67, 95% CI: 2.31~3.10). Conclusions: By adopting a Latent Class Analysis Approach, STEMI patients can be characterized into four risk factor patterns with significantly different prognosis. The data is useful for the improvement of community health management in each specific subgroup of patients, which indicates a particular risk factor pattern.
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Affiliation(s)
- Si Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Qianzi Che
- Department of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qiwen Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jia Jia
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yiqun Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Dafang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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15
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Boyanpally A, Cutting S, Furie K. Acute Ischemic Stroke Associated with Myocardial Infarction: Challenges and Management. Semin Neurol 2021; 41:331-339. [PMID: 33851390 DOI: 10.1055/s-0041-1726333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) may co-occur simultaneously or in close temporal succession, with occurrence of one ischemic vascular event increasing a patient's risk for the other. Both employ time-sensitive treatments, and both benefit from expert consultation. Patients are at increased risk of stroke for up to 3 months following AMI, and aggressive treatment of AMI, including use of reperfusion therapy, decreases the risk of AIS. For patients presenting with AIS in the setting of a recent MI, treatment with alteplase, an intravenous tissue plasminogen activator, can be given, provided anterior wall myocardial involvement has been carefully evaluated. It is important for clinicians to recognize that troponin elevations can occur in the setting of AIS as well as other clinical scenarios and that this may have implications for short- and long-term mortality.
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Affiliation(s)
- Anusha Boyanpally
- Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Shawna Cutting
- Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, Rhode Island
| | - Karen Furie
- Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, Rhode Island
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16
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Lopes S, Meincke HH, Lamotte M, Olivieri AV, Lean MEJ. A novel decision model to predict the impact of weight management interventions: The Core Obesity Model. Obes Sci Pract 2021; 7:269-280. [PMID: 34123394 PMCID: PMC8170577 DOI: 10.1002/osp4.495] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/13/2021] [Accepted: 02/14/2021] [Indexed: 11/07/2022] Open
Abstract
Aims Models are needed to quantify the economic implications of obesity in relation to health outcomes and health-related quality of life. This report presents the structure of the Core Obesity Model (COM) and compare its predictions with the UK clinical practice data. Materials and methods The COM is a Markov, closed-cohort model, which expands on earlier obesity models by including prediabetes as a risk factor for type 2 diabetes (T2D), and sleep apnea and cancer as health outcomes. Selected outcomes predicted by the COM were compared with observed event rates from the Clinical Practice Research Datalink-Hospital Episode Statistics (CPRD-HES) study. The importance of baseline prediabetes prevalence, a factor not taken into account in previous economic models of obesity, was tested in a scenario analysis using data from the 2011 Health Survey of England. Results Cardiovascular (CV) event rates predicted by the COM were well matched with those in the CPRD-HES study (7.8-8.5 per 1000 patient-years across BMI groups) in both base case and scenario analyses (8.0-9.4 and 8.6-9.9, respectively). Rates of T2D were underpredicted in the base case (1.0-7.6 vs. 2.1-22.7) but increased to match those observed in CPRD-HES for some BMI groups when a prospectively collected prediabetes prevalence was used (2.7-13.1). Mortality rates in the CPRD-HES were consistently higher than the COM predictions, especially in higher BMI groups. Conclusions The COM predicts the occurrence of CV events and T2D with a good degree of accuracy, particularly when prediabetes is included in the model, indicating the importance of considering this risk factor in economic models of obesity.
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Affiliation(s)
| | | | | | | | - Michael E J Lean
- Human Nutrition School of Medicine, Dentistry and Nursing Royal Infirmary University of Glasgow Glasgow UK
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17
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Zykov MV, Butsev VV, Suleymanov RR. Myocardial Infarction Complicated by Ischemic Stroke: Risk Factors, Prognosis, Unresolved Problems and Possible Methods of Prevention. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-02-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present work is devoted to the analysis of modern publications on various aspects of the development and course of ischemic stroke in the presence of acute myocardial infarction. A literature search was conducted on the websites of cardiological and neurological societies, as well as on the PubMed, EMBASE, eLibrary databases using the keywords: myocardial infarction, acute coronary syndrome, stroke, acute cerebrovascular accident, myocardial infarction, acute coronary syndrome, stroke. The authors of this review found that although stroke is a relatively rare complication of myocardial infarction, its prevention is an extremely significant task, since it is associated with high mortality, disability and a significant increase in the cost of treatment. So, it is extremely important to detect thrombosis of the left ventricular cavity in a timely manner, to register preexisting atrial fibrillation that occurs earlier or for the first time, followed by the appointment of anticoagulant therapy. Timely reperfusion treatment, the use of statins and modern dual antithrombotic therapy can reduce the risk of developing cerebrovascular accident in patients with myocardial infarction. It is likely that a decrease in the activity of subclinical inflammation after myocardial infarction will also reduce the risk of stroke, as was recently shown in the COLCOT study. Currently, it remains relevant to search for new knowledge about the risk factors for stroke, which complicated the course of myocardial infarction, which will allow developing more effective and personalized preventive measures in a patient with acute coronary syndrome.
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Affiliation(s)
- M. V. Zykov
- Research Institute for Complex Issues of Cardiovascular Diseases;
Sochi City Hospital №4
| | | | - R. R. Suleymanov
- District Cardiology Dispensary, Center for Diagnosis and Cardiovascular Surgery
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18
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Aggarwal G, Patlolla SH, Aggarwal S, Cheungpasitporn W, Doshi R, Sundaragiri PR, Rabinstein AA, Jaffe AS, Barsness GW, Cohen M, Vallabhajosyula S. Temporal Trends, Predictors, and Outcomes of Acute Ischemic Stroke in Acute Myocardial Infarction in the United States. J Am Heart Assoc 2021; 10:e017693. [PMID: 33399018 PMCID: PMC7955313 DOI: 10.1161/jaha.120.017693] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background There are limited contemporary data prevalence and outcomes of acute ischemic stroke (AIS) complicating acute myocardial infarction (AMI). Methods and Results Adult (>18 years) AMI admissions using the National Inpatient Sample database (2000–2017) were evaluated for in‐hospital AIS. Outcomes of interest included in‐hospital mortality, hospitalization costs, length of stay, discharge disposition, and use of tracheostomy and percutaneous endoscopic gastrostomy. The discharge destination was used to classify survivors into good and poor outcomes. Of a total 11 622 528 AMI admissions, 183 896 (1.6%) had concomitant AIS. As compared with 2000, in 2017, AIS rates increased slightly among ST‐segment–elevation AMI (adjusted odds ratio, 1.10 [95% CI, 1.04–1.15]) and decreased in non–ST‐segment–elevation AMI (adjusted odds ratio, 0.47 [95% CI, 0.46–0.49]) admissions (P<0.001). Compared with those without, the AIS cohort was on average older, female, of non‐White race, with greater comorbidities, and higher rates of arrhythmias. The AMI‐AIS admissions received less frequent coronary angiography (46.9% versus 63.8%) and percutaneous coronary intervention (22.7% versus 41.8%) (P<0.001). The AIS cohort had higher in‐hospital mortality (16.4% versus 6.0%; adjusted odds ratio, 1.75 [95% CI, 1.72–1.78]; P<0.001), longer hospital length of stay, higher hospitalization costs, greater use of tracheostomy and percutaneous endoscopic gastrostomy, and less frequent discharges to home (all P<0.001). Among AMI‐AIS survivors (N=153 318), 57.3% had a poor functional outcome at discharge with relatively stable temporal trends. Conclusions AIS is associated with significantly higher in‐hospital mortality and poor functional outcomes in AMI admissions.
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Affiliation(s)
- Gaurav Aggarwal
- Department of Medicine Jersey City Medical Center Jersey City NJ
| | | | - Saurabh Aggarwal
- Division of Cardiovascular Medicine Unity Point Clinic Des Moines IA
| | - Wisit Cheungpasitporn
- Division of Nephrology Department of Medicine University of Mississippi School of Medicine Jackson MS
| | - Rajkumar Doshi
- Department of Medicine University of Nevada Reno School of Medicine Reno NV
| | | | - Alejandro A Rabinstein
- Division of Neurocritical Care and Hospital Neurology Department of Neurology Mayo Clinic Rochester MN
| | - Allan S Jaffe
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | | - Marc Cohen
- Department of Cardiovascular Medicine Rutgers-New Jersey Medical School Newark NJ
| | - Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN.,Division of Pulmonary and Critical Care Medicine Department of Medicine Mayo Clinic Rochester MN.,Center for Clinical and Translational Science Mayo Clinic Graduate School of Biomedical Sciences Rochester MN.,Section of Interventional Cardiology Division of Cardiovascular Medicine Department of Medicine Emory University School of Medicine Atlanta GA
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19
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Albaeni A, Harris CM, Nasser H, Sifontes S, Hasan S, Guduru S, Abusaada K, Chatila K, Gilani S, Khalife WI. In-Hospital acute ischemic stroke following ST-elevation myocardial infarction. IJC HEART & VASCULATURE 2020; 31:100684. [PMID: 33344755 PMCID: PMC7736913 DOI: 10.1016/j.ijcha.2020.100684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/15/2020] [Accepted: 11/23/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND In-hospital ischemic stroke following acute ST-elevation myocardial infarction (STEMI) has not been evaluated on a national scale in the United States. METHODS We used 2003 to 2014 Nationwide Inpatient Sample data to identify adults with a principal diagnosis of STEMI. Patients were divided into two groups defined by presence or absence of ischemic stroke. Clinical characteristics and in-hospital outcomes were studied using relevant statistics. Multiple linear and logistic regression models identified factors associated with ischemic stroke, national trend of in-hospital stroke incidence and in-hospital mortality. RESULTS Of 1,842,529 STEMI patients hospitalized from 2003 to 2014, 22,268 (1.2%) developed acute in-hospital ischemic stroke. Those with acute strokes were older (age ≥ 65 years: 70% vs 46%), more likely female (51% vs 33%), and had higher rates of atrial fibrillation (28.9% vs 12.2%) and heart failure (40.5% vs 21.1%). Age and gender adjusted incidence of in-hospital ischemic stroke following STEMI remained stable; 1.4% in 2003 and 1.5% in 2014 (P trend = 0.50). However, age and gender adjusted in-hospital mortality declined in STEMI patients with and without in-hospital ischemic stroke [AOR 0.97 (0.95-0.99) P trend = 0.03, and AOR 0.98 (0.98-0.99) P trend < 0.001, respectively]. Patients with ischemic strokes had higher in-hospital mortality (25.7% Vs 7.2%, p < 0.001), [AOR 2.11, 95% CI (1.92-2.32)]. CONCLUSION In the United States, the incidence of acute in-hospital stroke remained stable from 2003 to 2014 following STEMI with significant decrease of in-hospital mortality trends. Despite slight improvement in mortality trends, in-hospital mortality rates remained elevated calling for interventions to optimize health care delivery.
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Affiliation(s)
- Aiham Albaeni
- Department of Medicine, Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Ché Matthew Harris
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Division of Hospital Medicine Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Hesham Nasser
- Department of Medicine, University of Central Florida, Ocala, FL, USA
| | - Sirhley Sifontes
- Department of Medicine, University of Central Florida, Ocala, FL, USA
| | - S.Mustajab Hasan
- Department of Medicine, University of Central Florida, Ocala, FL, USA
| | - Sai Guduru
- Department of Medicine, University of Central Florida, Ocala, FL, USA
| | - Khalid Abusaada
- Department of Medicine, University of Central Florida, Ocala, FL, USA
| | - Khaled Chatila
- Department of Medicine, Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Syed Gilani
- Department of Medicine, Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Wissam I. Khalife
- Department of Medicine, Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
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20
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Merkler AE, Diaz I, Wu X, Murthy SB, Gialdini G, Navi BB, Yaghi S, Weinsaft JW, Okin PM, Safford MM, Iadecola C, Kamel H. Duration of Heightened Ischemic Stroke Risk After Acute Myocardial Infarction. J Am Heart Assoc 2019; 7:e010782. [PMID: 30571491 PMCID: PMC6404432 DOI: 10.1161/jaha.118.010782] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background The duration of heightened stroke risk after acute myocardial infarction (MI) remains uncertain. Methods and Results We performed a retrospective cohort study using claims between 2008 and 2015 from a nationally representative 5% sample of Medicare beneficiaries aged ≥66 years. Both acute MI and ischemic stroke were ascertained using previously validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM), diagnosis codes. To exclude periprocedural strokes from percutaneous coronary intervention, we did not count strokes occurring during an acute MI hospitalization. Patients were censored at the time of ischemic stroke, death, end of Medicare coverage, or September 30, 2015. We fit Cox regression models separately for the groups with and without acute MI to examine its association with ischemic stroke after adjustment for demographics, stroke risk factors, and Charlson comorbidities. We used the corresponding survival probabilities to compute the hazard ratio in each 4‐week interval after discharge. Confidence intervals were computed using the nonparametric bootstrap method. Among 1 746 476 eligible beneficiaries, 46 182 were hospitalized for acute MI and 80 466 for ischemic stroke. After adjustment for demographics, stroke risk factors, and Charlson comorbidities, the risk of ischemic stroke was highest in the first 4 weeks after discharge from the MI hospitalization (hazard ratio: 2.7; 95% confidence interval, 2.3–3.2), remained elevated during weeks 5 to 8 (hazard ratio: 2.0; 95% confidence interval, 1.6–2.4) and weeks 9 to 12 (hazard ratio: 1.6; 95% confidence interval, 1.3–2.0), and was no longer significantly elevated afterward. Conclusions Acute MI is associated with an elevated risk of ischemic stroke that appears to extend beyond the 1‐month window that is currently considered the at‐risk period.
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Affiliation(s)
- Alexander E Merkler
- 1 Clinical and Translational Neuroscience Unit Feil Family Brain and Mind Research Institute Weill Cornell Medical College New York NY.,2 Department of Neurology Weill Cornell Medical College New York NY
| | - Ivan Diaz
- 2 Department of Neurology Weill Cornell Medical College New York NY.,3 Department of Healthcare Policy and Research Weill Cornell Medical College New York NY
| | - Xian Wu
- 2 Department of Neurology Weill Cornell Medical College New York NY.,3 Department of Healthcare Policy and Research Weill Cornell Medical College New York NY
| | - Santosh B Murthy
- 1 Clinical and Translational Neuroscience Unit Feil Family Brain and Mind Research Institute Weill Cornell Medical College New York NY.,2 Department of Neurology Weill Cornell Medical College New York NY
| | - Gino Gialdini
- 2 Department of Neurology Weill Cornell Medical College New York NY
| | - Babak B Navi
- 1 Clinical and Translational Neuroscience Unit Feil Family Brain and Mind Research Institute Weill Cornell Medical College New York NY.,2 Department of Neurology Weill Cornell Medical College New York NY
| | - Shadi Yaghi
- 4 Department of Neurology Warren Alpert Medical School of Brown University Providence RI
| | | | - Peter M Okin
- 5 Department of Medicine Weill Cornell Medical College New York NY
| | - Monika M Safford
- 5 Department of Medicine Weill Cornell Medical College New York NY
| | - Costantino Iadecola
- 1 Clinical and Translational Neuroscience Unit Feil Family Brain and Mind Research Institute Weill Cornell Medical College New York NY.,2 Department of Neurology Weill Cornell Medical College New York NY
| | - Hooman Kamel
- 1 Clinical and Translational Neuroscience Unit Feil Family Brain and Mind Research Institute Weill Cornell Medical College New York NY.,2 Department of Neurology Weill Cornell Medical College New York NY
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21
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Affiliation(s)
- Jukka Putaala
- 1 Department of Neurology Neurocenter Helsinki University Hospital Helsinki Finland.,2 Clinical Neurosciences University of Helsinki Finland
| | - Tuomo Nieminen
- 3 Internal Medicine University of Helsinki and Helsinki University Hospital and South Karelia Central Hospital Lappeenranta Finland
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22
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Bhandari M, Vishwakarma P, Sethi R, Pradhan A. Stroke Complicating Acute ST Elevation Myocardial Infarction-Current Concepts. Int J Angiol 2019; 28:226-230. [PMID: 31787820 PMCID: PMC6882668 DOI: 10.1055/s-0039-1695049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Myocardial infarction (MI) is one of the leading causes of mortality today both in developed and developing countries alike. Advancement in the pharmacotherapy and revascularization techniques has resulted in drastic improvement in survival. Most of the complications of MI can be managed adequately resulting in reduced mortality from MI in the recent years. However, mortality from stroke following acute MI remains high even today. Here, we discuss the incidence, risk factors, and management of stroke following acute ST elevation MI.
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Affiliation(s)
- Monika Bhandari
- Department of Cardiology, King George's Medical University, Lucknow, India
| | | | - Rishi Sethi
- Department of Cardiology, King George's Medical University, Lucknow, India
| | - Akshyaya Pradhan
- Department of Cardiology, King George's Medical University, Lucknow, India
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23
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Henriksson R, Björklund F, Mooe T. The introduction of ticagrelor is associated with lower rates of recurrent ischemic stroke after myocardial infarction. PLoS One 2019; 14:e0216404. [PMID: 31059535 PMCID: PMC6502343 DOI: 10.1371/journal.pone.0216404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/21/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Previous ischemic stroke is a predictor of recurrent ischemic stroke after an acute myocardial infarction (AMI). Dual antiplatelet therapy, including a P2Y12-inhibitor, is important in secondary prevention after AMI. Ticagrelor, a P2Y12-inhibitor, is more potent than the commonly used clopidogrel. Here, we evaluated the impact of ticagrelor on the risk of ischemic stroke following AMI in patients with previous ischemic stroke. METHODS Data for patients with AMI that had a previous ischemic stroke were obtained from the Swedish Registry of Information and Knowledge about Swedish Heart Intensive Care Admissions. Patients were assigned to early and late cohorts, each covering a two-year time period before and after, respectively, the introduction of ticagrelor prescriptions (20 Dec 2011). Patients in the early cohort (n = 1633) were treated with clopidogrel (100%); those in the late cohort (n = 1642) were treated with either clopidogrel (66.3%) or ticagrelor (33.7%). We assessed the risk of ischemic stroke and intracranial bleeding over time with Kaplan-Meier analyses. We identified predictors of ischemic stroke with multivariable Cox regression analyses. RESULTS Of 3275 patients, 311 experienced ischemic stroke after AMI. Cumulative Kaplan-Meier incidence estimates of ischemic stroke within one year after AMI were 12.1% versus 8.6% for the early and late cohorts, respectively (p<0.01). Intracranial bleeding incidences (1.2% versus 1.5%) were similar between the two cohorts. CONCLUSIONS Ticagrelor introduction was associated with a lower rate of ischemic stroke, with no increase in intracranial bleeding, in an AMI population with a history of ischemic stroke.
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Affiliation(s)
- Robin Henriksson
- Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden
| | - Fredrik Björklund
- Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden
| | - Thomas Mooe
- Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden
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24
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Lin CF, Chang YH, Chi NF, Chen IMI, Liu HY, Chien LN. Percutaneous coronary intervention in patients hospitalized for non-ST-elevation myocardial infarction and the risk of postdischarge ischemic stroke at 6-month, 1-year, and 3-year follow-ups. Heart Vessels 2019; 34:1132-1139. [PMID: 30830314 DOI: 10.1007/s00380-019-01367-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 01/11/2019] [Indexed: 11/26/2022]
Abstract
Percutaneous coronary intervention (PCI) is suggested for treating patients with non-ST-elevation myocardial infarction (NSTEMI) to reduce adverse cardiovascular events. However, the short- and long-term effects of PCI on the risk of postdischarge ischemic stroke (IS) in patients hospitalized for NSTEMI remain unclear. This study investigated the association of PCI on the risk of postdischarge IS in patients hospitalized for NSTEMI at different period follow-ups. A population-based cohort study was conducted using data from Taiwan's National Health Insurance Research Database. Propensity score matching (PSM) was used to select 6079 pairs of the patients with NSTEMI treated invasively by PCI (received PCI during hospitalization) and initial conservative strategy (did not receive PCI during hospitalization) with similar baseline characteristics for evaluation. After adjustment for patients' clinical variables and the duration of dual antiplatelet therapy, PCI was associated with a decreased risk of postdischarge IS at 6-month, 1-year, and 3-year follow-ups [adjusted hazard ratio (aHR) = 0.41, 95% confidence interval (CI) = 0.26-0.67, p < 0.001; aHR = 0.61, 95% CI 0.43-0.86, p = 0.004; and aHR = 0.69, 95% CI 0.54-0.89, p = 0.005respectively]. In the patients who had a CHA2DS2-VASc score of ≥2, PCI was also associated with a decreased risk of postdischarge IS at 6-month, 1-year, and 3-year follow-ups (aHR = 0.54, 95% CI 0.36-0.83, p = 0.005; aHR = 0.72, 95% CI 0.52-1.00, p = 0.048; and aHR =0.73, 95% CI 0.58-0.91, p = 0.005, respectively). These findings suggested that PCI might reduce the risk of postdischarge IS in patients hospitalized for NSTEMI.
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Affiliation(s)
- Chao-Feng Lin
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei, Taiwan
| | - Ya-Hui Chang
- Department of Pharmacy, MacKay Memorial Hospital, Taipei, Taiwan
| | - Nai-Fang Chi
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - I-M Ing Chen
- Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Hung-Yi Liu
- Health and Clinical Research Data Center, School of public health, Taipei Medical University, Taipei, Taiwan
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.
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25
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Henriksson R, Ulvenstam A, Söderström L, Mooe T. Increase in ticagrelor use over time is associated with lower rates of ischemic stroke following myocardial infarction. BMC Cardiovasc Disord 2019; 19:51. [PMID: 30832574 PMCID: PMC6399852 DOI: 10.1186/s12872-019-1030-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/21/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To evaluate the impact of a rapid change in preferred treatment from clopidogrel to ticagrelor on the risk of ischemic stroke following acute myocardial infarction (AMI). METHODS Data for AMI patients treated with either clopidogrel or ticagrelor were obtained from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA). Patients were divided into two cohorts, each covering a two-year time period; the initial prescription of ticagrelor (20 Dec 2011) was used as a cut-off point. Patients in the early cohort (n = 23,447) were treated with clopidogrel, while those in the later cohort (n = 24,227), were treated with either clopidogrel (47.9%) or ticagrelor (52.1%). Kaplan-Meier analyses were used to assess the risk of ischemic stroke over time, with multivariable Cox regression analyses used to identify predictors of ischemic stroke. RESULTS Of 47,674 patients, there were 1203 cases of ischemic stroke. Cumulative Kaplan-Meier incidence estimates of ischemic stroke after one year were 2.8% vs. 2.4% for the early and late cohorts, respectively (p = 0.001). Older age, hypertension, diabetes, previous stroke, congestive heart failure, atrial fibrillation, and ST-elevation myocardial infarction were associated with an increased risk of ischemic stroke. Percutaneous coronary intervention and statins at discharge were associated with a decreased risk of ischemic stroke, as was higher estimated glomerular filtration rate. Membership of the late cohort correlated with a 13% reduction in the relative risk of ischemic stroke. CONCLUSIONS The introduction of ticagrelor as well as an improved management of AMI was associated with a lower rate of ischemic stroke in a relatively unselected AMI population.
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Affiliation(s)
- Robin Henriksson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. .,Unit of Research, Education and Development, Region jämtland Härjedalen, Östersund, Sweden.
| | - Anders Ulvenstam
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Unit of Research, Education and Development, Region jämtland Härjedalen, Östersund, Sweden
| | - Lars Söderström
- Unit of Research, Education and Development, Region jämtland Härjedalen, Östersund, Sweden
| | - Thomas Mooe
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Unit of Research, Education and Development, Region jämtland Härjedalen, Östersund, Sweden
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26
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Asymptomatic Coronary Artery Disease in Japanese Patients With the Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2019; 28:612-618. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.10.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/24/2018] [Accepted: 10/31/2018] [Indexed: 11/20/2022] Open
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27
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Ulvenstam A, Henriksson R, Söderström L, Mooe T. Ischemic stroke rates decrease with increased ticagrelor use after acute myocardial infarction in patients treated with percutaneous coronary intervention. Eur J Prev Cardiol 2018; 25:1219-1230. [DOI: 10.1177/2047487318784082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims It is unknown whether dual antiplatelet therapy with ticagrelor instead of clopidogrel reduces the risk of ischaemic stroke in acute myocardial infarction patients that undergo percutaneous coronary intervention. This study investigated whether the introduction of dual antiplatelet therapy with ticagrelor was associated with reduced ischaemic stroke risk in a real-world population. Methods and results Patients with ischaemic stroke after acute myocardial infarction from 8 December 2009–31 December 2013 were identified using the Register for Information and Knowledge on Swedish Heart Intensive Care Admissions and the Swedish National Patient Register. The study period was divided into two similar periods using the date of the first prescription of ticagrelor as the cut-off. The risk of ischaemic stroke in percutaneous coronary intervention-treated acute myocardial infarction patients during the first period (100% clopidogrel treatment) versus the second period (60.7% ticagrelor treatment) was assessed using Kaplan-Meier analysis. Variables associated with ischaemic stroke were identified using a multivariable Cox proportional hazards model. There were 686 ischaemic stroke events (2.0%) among 34931 percutaneous coronary intervention-treated acute myocardial infarction patients within one year, 366 (2.2%) during the first period and 320 (1.8%) during the second period ( p = 0.004). The Cox model showed a 21% relative risk reduction in ischaemic stroke in the second period versus the first one (hazard ratio 0.79, 95% confidence interval, 0.68–0.92; p = 0.003). The independent predictors of increased stroke risk were older age, hypertension, diabetes mellitus, atrial fibrillation, heart failure during hospitalization, previous ischaemic stroke, and ST-segment elevation myocardial infarction. Conclusion The risk of ischaemic stroke in percutaneous coronary intervention-treated acute myocardial infarction patients decreased after the introduction of ticagrelor in Sweden.
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Affiliation(s)
- Anders Ulvenstam
- Unit of Research, Education and Development, Östersund Hospital, Sweden
- Department of Public Health and Clinical Medicine, Östersund, Umeå University, Sweden
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28
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Comorbidities and Psychosocial Characteristics as Determinants of Dropout in Outpatient Cardiac Rehabilitation. J Cardiovasc Nurs 2017; 32:14-21. [DOI: 10.1097/jcn.0000000000000296] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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A new cooperative approach for ST-elevation myocardial infarction patients to receive timely and effective percutaneous coronary reperfusion in China. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:602-7. [PMID: 27605941 PMCID: PMC4996835 DOI: 10.11909/j.issn.1671-5411.2016.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Acute myocardial infarction (AMI) is the most serious type of coronary heart disease. However, less than 30% of these patients have been treated effectively in China. Delayed treatment is a leading cause. This study aimed to evaluate a new regional cooperative model for improving the first medical contact-to-device time and the therapeutic effects on AMI patients. Methods A retrospective analysis of 458 ST-elevation myocardial infarction (STEMI) patients was performed. Patients were divided into two groups in terms of before or after the model were implemented. First medical contact-to-device time (FMC2D), Door to device time (D2D), referral time, cardiac functions, mean cost, days of hospitalization, and major adverse cardiac events (MACE) were analyzed. Results The mean FMC2D time, D2D time and referral time of the model group were significantly lower than the control group. The left ventricular ejection fraction of the model group increased but the left ventricular end-diastolic dimension decreased compared with the control group at 6 months after discharge. These results also showed that mean costs and days of hospitalization were reduced. The MACE rate was reduced in the model group. Conclusions These results suggested that the new model decreased the FMC2D time, which could improve the cardiac function and therapeutic effect of STEMI patients as well as decreased the financial burden.
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Guenancia C, Hachet O, Stamboul K, Béjot Y, Leclercq T, Garnier F, Yameogo NV, de Maistre E, Cottin Y, Lorgis L. Incremental predictive value of mean platelet volume/platelet count ratio in in-hospital stroke after acute myocardial infarction. Platelets 2016; 28:54-59. [PMID: 27459905 DOI: 10.1080/09537104.2016.1203397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Stroke is a serious complication after acute myocardial infarction (AMI) and is associated with an increased risk of death. Though the pathophysiological mechanisms are not exactly known, increased inflammation and platelet reactivity could play an important role in the occurrence of stroke during AMI. We aimed to investigate the relationship between both mean platelet volume (MPV), a parameter of platelet function, and C-reactive protein (CRP) and the occurrence of in-hospital ischemic stroke (IHS) after AMI. Data were obtained from a French regional survey for AMI that included 5976 patients admitted to an intensive care unit (ICU) between 2001 and 2010. Patients were divided into two groups according to the occurrence of IHS. MPV, platelet count (PC), and CRP were routinely measured at admission to the ICU; 99 (1.6%) IHSs were recorded during hospitalization after admission for AMI. In multivariate analysis, IHS was independently associated with a history of stroke (OR: 1.99%, CI: 1.1-3.49, p = 0.01), impaired left ventricular ejection fraction <40% (OR: 1.88, 95% CI: 1.20-2.94, p = 0.006), impaired renal function (OR: 1.94, 95% CI: 1.27-2.95, p = 0.002), CRP > 10 mg/l (OR: 2.19, 95% CI: 1.44-3.33, p < 0.001), and MPV/PC ratio (OR: 1.04, 95% CI: 1.01-1.08, p = 0.023). Compared with the first to fourth quintiles, the last quintile of the MPV/PC ratio was associated with higher rates of IHS on survival curve analysis (p = 0.014). At hospital admission, a high MPV/PC ratio and a high level of CRP might help to identify patients at increased risk of IHS. Moreover, these results provide new insights into the potential role played by increased inflammation and platelet reactivity in the occurrence of stroke after AMI.
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Affiliation(s)
- Charles Guenancia
- a Department of Cardiology , University Hospital , Dijon , France.,b LPPCM, INSERM U866 , University of Burgundy , Dijon , France
| | - Olivier Hachet
- a Department of Cardiology , University Hospital , Dijon , France.,b LPPCM, INSERM U866 , University of Burgundy , Dijon , France
| | - Karim Stamboul
- a Department of Cardiology , University Hospital , Dijon , France.,b LPPCM, INSERM U866 , University of Burgundy , Dijon , France
| | - Yannick Béjot
- b LPPCM, INSERM U866 , University of Burgundy , Dijon , France.,c The Dijon Stroke Registry (EA 4184), University of Burgundy , University Hospital and Faculty of Medicine of Dijon , Dijon , France
| | | | - Fabien Garnier
- a Department of Cardiology , University Hospital , Dijon , France
| | | | | | - Yves Cottin
- a Department of Cardiology , University Hospital , Dijon , France.,b LPPCM, INSERM U866 , University of Burgundy , Dijon , France
| | - Luc Lorgis
- a Department of Cardiology , University Hospital , Dijon , France.,b LPPCM, INSERM U866 , University of Burgundy , Dijon , France
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Kim S, Lee S, Kim JB, Na JO, Choi CU, Lim HE, Rha SW, Park CG, Oh DJ, Yoo H, Kim JW. Concurrent Carotid Inflammation in Acute Coronary Syndrome as Assessed by 18F-FDG PET/CT: A Possible Mechanistic Link for Ischemic Stroke. J Stroke Cerebrovasc Dis 2015; 24:2547-54. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 07/05/2015] [Accepted: 07/12/2015] [Indexed: 11/26/2022] Open
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Álvarez-Álvarez B, Raposeiras-Roubín S, Abu-Assi E, Cambeiro-González C, Gestal-Romaní S, López-López A, Bouzas-Cruz N, Castiñeira-Busto M, Saidhodjayeva O, Redondo-Diéguez A, Pereira López E, García-Acuña JM, González-Juanatey JR. Is 6-month GRACE risk score a useful tool to predict stroke after an acute coronary syndrome? Open Heart 2014; 1:e000123. [PMID: 25544887 PMCID: PMC4275768 DOI: 10.1136/openhrt-2014-000123] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 08/13/2014] [Accepted: 11/04/2014] [Indexed: 11/29/2022] Open
Abstract
Objectives The risk of stroke after an acute coronary syndrome (ACS) has increased. The aim of this study was to do a comparative validation of the 6-month GRACE (Global Registry of Acute Coronary Events) risk score and CH2DS2VASc risk score to predict the risk of post-ACS ischaemic stroke. Methods This was a retrospective study carried out in a single centre with 4229 patients with ACS discharged between 2004 and 2010 (66.9±12.8 years, 27.9% women, 64.2% underwent percutaneous coronary intervention). The primary end point is the occurrence of an ischaemic stroke during follow-up (median 4.6 years, IQR 2.7–7.1 years). Results 184 (4.4%) patients developed an ischaemic stroke; 153 (83.2%) had sinus rhythm and 31 (16.9%) had atrial fibrillation. Patients with stroke were older, with higher rates of hypertension, diabetes, previous stroke and previous coronary artery disease. The HR for CHA2DS2VASc was 1.36 (95% CI, 1.27 to 1.48, p<0.001) and for GRACE, HR was 1.02(95% CI, 1.01 to 1.03, p<0.001). Both risk scores show adequate discriminative ability (c-index 0.63±0.02 and 0.60±0.02 for CHA2DS2VASc and GRACE, respectively). In the reclassification method there was no difference (Net Reclassification Improvement 1.98%, p=0.69). Comparing moderate-risk/high-risk patients with low-risk patients, both risk scores showed very high negative predictive value (98.5% for CHA2DS2VASc, 98.1% for GRACE). The sensitivity of CHA2DS2VASc score was higher than the GRACE risk score (95.1% vs 87.0%), whereas specificity was lower (14.4% vs 30.2%). Conclusions The 6-month GRACE model is a clinical risk score that facilitates the identification of individual patients who are at high risk of ischaemic stroke after ACS discharge.
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Affiliation(s)
- Belén Álvarez-Álvarez
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Sergio Raposeiras-Roubín
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Emad Abu-Assi
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Cristina Cambeiro-González
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Santiago Gestal-Romaní
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Andrea López-López
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Noelia Bouzas-Cruz
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - María Castiñeira-Busto
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Ozoda Saidhodjayeva
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Alfredo Redondo-Diéguez
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - Eva Pereira López
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - José María García-Acuña
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
| | - José Ramón González-Juanatey
- Department of Cardiology , University Clinical Hospital of Santiago de Compostela , Santiago de Compostela , Spain
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Yan J, Wang Z, Xu LJ, Liang Y. Effects of new regional cooperative rescue model on patients with ST-elevation myocardial infarction. Int J Cardiol 2014; 177:494-6. [PMID: 25168092 DOI: 10.1016/j.ijcard.2014.08.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 08/11/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Jinchuan Yan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Jiangsu 212001, China.
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Jiangsu 212001, China
| | - Liang Jie Xu
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Jiangsu 212001, China
| | - Yi Liang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Jiangsu 212001, China
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Hachet O, Guenancia C, Stamboul K, Daubail B, Richard C, Béjot Y, Yameogo V, Gudjoncik A, Cottin Y, Giroud M, Lorgis L. Frequency and Predictors of Stroke After Acute Myocardial Infarction. Stroke 2014; 45:3514-20. [DOI: 10.1161/strokeaha.114.006707] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Stroke is a serious complication after acute myocardial infarction (AMI) and is closely associated with decreased survival. This study aimed to investigate the frequency, characteristics, and factors associated with in-hospital and postdischarge stroke in patients with AMI.
Methods—
Eight thousand four hundred eighty-five consecutive patients admitted to a cardiology intensive care unit for AMI, between January 2001 and July 2010. Stroke/transient ischemic attack were collected during 1-year follow-up.
Results—
One hundred twenty-three in-hospital strokes were recorded: 65 (52.8%) occurred on the first day after admission for AMI, and 108 (87%) within the first 5 days. One hundred six patients (86.2%-incidence rate 1.25%) experienced in-hospital ischemic stroke, and 14 patients (11.4%-incidence rate 0.16%) were diagnosed with an in-hospital hemorrhagic stroke. In-hospital ischemic stroke subtypes according to the Trial of Org 10 172 in Acute Stroke Treatment (TOAST) classification showed that only 2 types of stroke were identified more frequently. As expected, the leading subtype of in-hospital ischemic stroke was cardioembolic stroke (n=64, 60%), the second was stroke of undetermined pathogenesis (n=38, 36%). After multivariable backward regression analysis, female sex, previous transient ischemic attack (TIA)/stroke, new-onset atrial fibrillation, left ventricular ejection fraction (odds ratio per point of left ventricular ejection fraction), and C-reactive protein were independently associated with in-hospital ischemic stroke. When antiplatelet and anticoagulation therapy within the first 48 hours was introduced into the multivariable model, we found that implementing these treatments (≥1) was an independent protective factor of in-hospital stroke. In-hospital hemorrhagic stroke was dramatically increased (5-fold) when thrombolysis was prescribed as the reperfusion treatment. However, the different parenteral anticoagulants were not predictors of risk in univariable analysis. Finally, only 45 postdischarge strokes were recorded. Postdischarge stroke subtypes showed a more heterogeneous distribution of mechanisms. The annual rate of stroke post-AMI remained stable throughout the 10-year study period.
Conclusions—
The present study describes specific predictors of in-hospital and postdischarge stroke in patients with AMI. It showed a marked increase in the risk of death, both during hospitalization and in the year after AMI. After hospital discharge, stroke remains a rare event and is mostly associated with high cardiovascular risk.
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Affiliation(s)
- Olivier Hachet
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Charles Guenancia
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Karim Stamboul
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Benoit Daubail
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Carole Richard
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Yannick Béjot
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Valentin Yameogo
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Aurélie Gudjoncik
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Yves Cottin
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Maurice Giroud
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Luc Lorgis
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
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Jakobsson S, Graipe A, Huber D, Björklund F, Mooe T. The risk of ischemic stroke after an acute myocardial infarction in patients with decreased renal function. Cerebrovasc Dis 2014; 37:460-9. [PMID: 25073588 DOI: 10.1159/000363616] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 05/15/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Data on the incidence, trends over time and predictors of ischemic stroke after an acute myocardial infarction (AMI) are sparse for patients with chronic kidney disease (CKD). METHODS Data for unselected AMI patients were obtained from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA) between 2003 and 2010. Patients with and without CKD were compared. Multiple logistic regression was performed to identify predictors of ischemic stroke during the hospitalization for AMI, Kaplan-Meier analysis was used to analyze the 1-year postdischarge ischemic stroke trends over time and Cox regression analysis was used to identify predictors. RESULTS Of 118,434 AMI patients, 40,679 had CKD. The CKD patients had more extensive previous cardiovascular disease and received less reperfusion and secondary preventive therapies than the patients without CKD. An inhospital ischemic stroke occurred in 2.3 and 1.2% of CKD and non-CKD patients, respectively. The incidence of ischemic stroke during hospitalization for AMI was stable during the study period. The occurrence of ischemic stroke after hospital discharge decreased between 2003-2004 and 2009-2010 from 4.1 to 2.5% in CKD patients and from 2.0 to 1.3% in non-CKD patients, respectively. Percutaneous coronary intervention (PCI) and statins were independently associated with a reduced risk of stroke after discharge from hospital. CONCLUSIONS Ischemic stroke is a more common complication after an AMI in CKD patients than in non-CKD patients, but the risk has decreased in recent years. The increased use of PCI and statins may have contributed to this reduction.
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Affiliation(s)
- Stina Jakobsson
- Department of Public Health and Clinical Medicine, Östersund, Umeå University, Umeå, Sweden
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