Prediction of myocardial infarction in patients with transient ischaemic attack (original) (raw)
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[Prediction of cerebrovascular event risk following myocardial infarction]
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2011
Introduction: Patients with coronary artery disease (CAD) are at increased risk of stroke. The aim of this study was to analyze the prognostic accuracy of selected clinical and laboratory variables in stroke risk prediction following discharge after myocardial infarction (MI). Methods: We analyzed 404 consecutive patients (aged 68.1±13.7 years; 63.4 % male; 37.4 % with diabetes) without previous stroke who were discharged in sinus rhythm after being admitted for MI. The following data were collected: cardiovascular risk factors, admission blood glucose (BG), HbA1c, creatinine, peak troponin levels; glomerular filtration rate (GFR) by the MDRD formula; maximum Killip class; GRACE score for in-hospital and 6-month mortality; and extent of CAD. Patients were followed for two years and each variable was tested as a possible predictor of cerebrovascular events (stroke or transient ischemic attack [TIA]). Results: During follow-up, 27 patients were admitted for stroke or TIA. The presence of diabetes, hypertension, dyslipidemia and previously known CAD, type of MI (STEMI vs NSTEMI) and extent of CAD did not predict cerebrovascular risk. The following variables were associated with higher stroke risk: GFR <60 ml/min/m 2 (p=0.029, OR 2.65, 95 % CI 1.07-6.55); maximum Killip class >1 (p=0.025, OR 2.71, 95 % CI 1.10-6.69); GRACE in-hospital mortality >180 (p=0.001, OR 4.09, 95 % CI 1.64-10.22); admission BG >140 mg/dl (p=0.001, OR 5.74, 95 % CI 1.87-17.58); GRACE 6-month mortality >150 (p=0.001, OR 4.50, 95 % CI 1.80-6.27); and peak troponin >42 ng/ml (p=0.032, OR 2.64, 95 % CI 1.06-6.59). Logistic regression analysis produced a model with the predictors GRACE 6-month mortality >150 (OR 3.26; p=0.014) and admission BG >7.7 mmol/l (OR 4.09; p=0.017) that fitted the data well (Hosmer-Lemeshow: p=0.916). Discussion/Conclusions: In patients with MI, variables known to be predictors of in-hospital mortality, including admission BG, renal function, acute heart failure and GRACE score, were found to be useful predictors of stroke during 2-year follow-up. While both GRACE score for
Coronary Risk Evaluation in Patients With Transient Ischemic Attack and Ischemic Stroke
Circulation, 2003
To what extent are stroke patients at increased risk for cardiac-related death? Data on short-(Ͻ90 days), The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. This statement was approved by the American Heart Association Science Advisory and Coordinating Committee in June 2003. A single reprint is available by calling 800-242-8721
Objective: Whether or not patients of ischaemic stroke should undergo investigations for coronary artery disease (asymptomatic) is debatable yet scarcely ever have the risk of vascular death and myocardial infarction after a stroke been quantitatively evaluated. Immediately preceding the incidence of an acute stroke, a high risk of recurrence is seen yet the prime factor driving up mortality rates after a stroke is myocardial infarction and coronary artery disease. This paper hopes to indirectly assess the risk of schaemic heart disease in patients who have formerly faced episode(s) of acute ischaemic stroke. Methodology: A sample of consecutive 100 known cases of Myocardial Infarction presenting at Liaquat University Hospital, Department of Cardiology (Emergency and Out-Patient Department) was included in this retrospective quantitative analysis during the month of January 2016. After taking written informed consent, inquiries were made regarding previous incidences of ischaemic stroke (if any) and the time elapsed since the incident. Inquiries were also made regarding previous history of cardiac illness. The data obtained was analyzed using SPSS v. 17. Results: 60% of the sample comprised of males while 40% comprised of females, each with a mean age of 59 years and 65 years respectively. 20 out of a total of 100 patients presenting with Myocardial Infarction gave affirmative previous history of ischaemic stroke. 80% of the patients with a positive history of ischaemic stroke were males while the remaining 20% with a positive history were females. Conclusion : A careful evaluation of the results reveals that incidence of myocardial infarction among known patients of ischaemic stroke is worrisomely high. More worryingly the incidence is particularly higher in males as compared to females. Keywords: Ischaemic Stroke, Myocardial Infarction, Retrospective & Quantitative Analysis
European Heart Journal - Quality of Care and Clinical Outcomes, 2016
Aims Acute myocardial infarction (AMI) and stroke are important causes of mortality and morbidity. Our aims are to determine the comparative epidemiology of AMI and ischaemic stroke; and examine the differences in cardiovascular outcomes or mortality occurring after an AMI or stroke. Methods and results The Singapore National Registry of Diseases Office collects countrywide data on AMI, stroke, and mortality. Index events of AMI and ischaemic stroke between 2007 and 2012 were identified. Patients were then matched for occurrences of subsequent AMI, stroke, or death within 1-year of the index event. There were 33 222 patients with first-ever AMI and 20 982 with first-ever stroke. AMI patients were significantly more likely to be men (66.3% vs. 56.9%), non-Chinese (32.1% vs. 24.1%), and smokers (43.1% vs. 38.6%), but less likely to have hypertension (65.6% vs. 79%) and hyperlipidaemia (61.1% vs. 65.5%), compared with stroke patients. In total 6.8% of the AMI patients had recurrent AMI...
Myocardial infarction after acute ischaemic stroke: incidence, mortality, and risk factors
Acta Neurologica Scandinavica, 2019
Objectives: To determine the risk factor profiles associated with post-acute ischaemic stroke (AIS) myocardial infarction (MI) over long-term follow-up. Methods: This observational study includes prospectively identified AIS patients (n=9840) admitted to a UK regional centre between January 2003-December 2016 (median follow-up: 4.72 years). Predictors of post-stroke MI during follow up were examined using logistic and Cox regression models for in-hospital and post-discharge events, respectively. MI incidence was determined using a competing risk non-parametric estimator. The influence of poststroke MI on mortality was examined using Cox regressions. Results: Mean age (SD) of study participants was 77.3(12.2) years (48% males). Factors associated with in-hospital MI (OR(95%CI)) were increasing blood glucose (1.80(1.17-2.77) per 10mmol/L), total leukocyte count (1.25(1.01-1.54) per 10x10 9 /L), and CRP (1.05(1.02-1.08) per 10mg/L increase). Age (HR(95%CI) =1.03(1.01-1.06)), coronary heart disease (1.59(1.01-2.50)), chronic kidney disease (2.58(1.44-4.63)), and cancers (1.76(1.08-2.89)) were associated with incident MI between discharge and one year follow-up. Age
Cerebrovascular Diseases Extra, 2014
Background: Literature on prognosis of transient ischemic attack (TIA) in Chinese is scarce. The short-term prognosis of TIA and the predictive value of the ABCD 2 score in Hong Kong Chinese patients attending the emergency department (ED) were studied to provide reference for TIA patient management in our ED. Methods: A cohort of TIA patients admitted through the ED to 13 acute public hospitals in 2006 was recruited through the centralized electronic database by the Hong Kong Hospital Authority (HA). All inpatients were e-coded by the HA according to the International Classification of Diseases, Ninth Revision (ICD9). Electronic records and hard copies were studied up to 90 days after a TIA. The stroke risk of a separate TIA cohort diagnosed by the ED was compared. Results: In the 1,000 recruited patients, the stroke risk after a TIA at days 2, 7, 30, and 90 was 0.2, 1.4, 2.9, and 4.4%, respectively. Antiplatelet agents were prescribed in 89%, warfarin in 6.9%, statin in 28.6%, antihypertensives in 39.3%, and antidiabetics in 11.9% of patients after hospitalization. Before the index TIA, the prescribed medications were 27.6, 3.7, 11.3, 27.1, and 9.7%, respectively. The accuracy of the ABCD 2 score in predicting stroke risk was 0.607 at 7 days, 0.607 at 30 days, and 0.574 at 90 days. At 30 days, the p for trend across ABCD 2 score levels was 0.038 (OR for every score point = 1.36, p = 0.040). Diabetes mellitus, previous stroke and carotid bruit were associated with stroke within 90 days (p = 0.038, 0.045, 0.030, respectively). A total of 45.4% of CTs of the brain showed lacunar infarcts or small vessel disease. There was an increased stroke risk at 90
Background and Purpose-A 6-point score, based on age, blood pressure, clinical features, and duration (ABCD), was shown to effectively stratify the short-term risk of stroke after a transient ischemic attack (TIA). Prospective validation in different populations of patients should precede its widespread use. Whether adding computed tomography (CT) scan findings to the score would improve its performance deserves exploring. We aimed to validate the ABCD score in a prospective cohort of patients accessing Emergency Departments within 24 hours of a TIA in an area of northern Italy and to acquire preliminary data on CT-based refinement. Methods-During a 6-month period, all TIA patients accessing the Emergency Departments of 13 Piemonte and Valle d'Aosta hospitals were prospectively enrolled and stratified according to the 6-point ABCD score and to a 7-point score (ABCDI, where Iϭimaging) incorporating CT findings. Results-Of 274 patients, stroke occurred in 10 (3.6%) within 7 days and in 15 (5.5%) within 30 days. The ABCD score was predictive of stroke risk at both 7 and 30 days (odds ratio for every point of the scoreϭ2.55 at 7 days and 2.62 at 30 days; P for linear trend across the ABCD score levelsϭ0.018 at 7 days and 0.0017 at 30 days). CT scan findings further increased prediction (odds ratio for every point of the scoreϭ2.68 at 7 days and 2.89 at 30 days; P for linear trend across the ABCDI score levelsϭ0.0043 at 7 days and 0.0003 at 30 days).
A new risk score predicting 1- and 5-year mortality following acute myocardial infarction
International Journal of Cardiology, 2012
Risk stratification of patients following acute myocardial infarction (AMI), in order to identify patients whose clinical outcomes can be improved through specific medical interventions, is needed. Development and validation of a prognostic tool comprising a variety of non-cardiovascular co-morbidities, to predict mortality of hospital survivors after AMI. The study cohort included 2773 consecutive patients with AMI who were discharged live from the Soroka University Medical Center between 2002 and 2004. Two-thirds were used obtain the model (training set) and one-third to validate it (validation set). Data were collected from the hospital&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s routine computerized information systems. The primary outcome was post-discharge 1-year all-cause mortality. The weight of each variable in the final score was computed based on the odds ratio values of the multivariate model. Additionally, the ability of the index to predict 5-year mortality was assessed. These are comprised of the following parameters: 4 points - age &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;75 years, abnormal echocardiography findings; 3 points - at least one of following: gastro-intestinal hemorrhage, COPD, malignancy, alcohol or drug addiction, neurological disorders, psychiatric disorders; 2 points - no echocardiography results, renal diseases, anemia, hyponatremia; -3 points for PCI or thrombolytic therapy; -6 points - CABG; -2 points - obesity. The c-statistics for 1-year all-cause mortality were 0.86 and 0.83 in the training and validation sets, respectively. The c-statistics for 5-year mortality was 0.858 for both sets combined. The new score is a simple robust tool for predicting mortality in patients discharged alive following AMI.