Long‐Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta‐Analysis

Boulanger, Marion; Béjot, Yannick; Rothwell, Peter M.; Touzé, Emmanuel

doi:10.1161/jaha.117.007267

Cited by 121 publications

(112 citation statements)

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“…Given that our cohort was only composed of stroke patients who were much older (mean age ~ 77 years), it is likely that the gender differences in MI incidence rates observed in younger ages would not be present. 6 Nevertheless, our results are derived from real-world data and it is F I G U R E 3 Incidence curve illustrating the cumulative incidence of MI in the patient population over the entire follow-up period after hospital discharge likely that our estimates are accurate in the context of populations similar to our cohort receiving the same secondary prevention. 6,10,[21][22][23][24][25][26][27][28][29] Nevertheless, these studies appear to yield different risk factor profiles, likely due to the high between-study heterogeneity, as indicated by the most recent meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

“…In a systematic review of 39 studies in patients with first transient ischaemic attack (TIA) or stroke, annual risks were 2.2% (95% CI: 1.7-2.7) for total MI, 0.9% (0.7-1.2) for non-fatal MI and 1.1% (0.8-1.5) for fatal MI. 6 Given that there is significant overlap between stroke secondary preventative therapies and acute coronary syndrome (ACS) primary prevention, it may not seem surprising that the annual incidence of post-stroke MI is not as high expected in such a highly co-morbid population. 5 The most recent systematic review calculated that the yearly risk of post-stroke MI is 1.67%.…”

Section: Introductionmentioning

confidence: 99%

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

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confidence: 99%

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

et al. 2019

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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 and 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 postdischarge events, respectively. MI incidence was determined using a competing risk non-parametric estimator. The influence of post-stroke 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 10 mmol/L), total leucocyte count (1.25 [1.01-1.54] per 10 × 10 9 /L) and CRP (1.05 [1.02-1.08] per 10 mg/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 (1.02 [1.00-1.03]), diabetes (1.96 [1.38-2.65]), congestive heart failure (2.07 [1.44-2.99]), coronary heart disease (1.81 [1.31-2.50]), hypertension [1.86 (1.24-2.79)] and peripheral vascular disease (2.25 [1.40-3.63]) were associated with incident MI between 1 and 5 years after discharge. Diabetes (2.01 [1.09-3.72]), hypertension (3.69 [1.44-9.45]) and peripheral vascular disease

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…1 Despite progress and declining trends, recurrent stroke is still frequent. 4,5 Recurrent ischemic stroke (IS) has been associated with increased mortality and functional dependence, 6,7 but this remains insufficiently explored. 4,5 Recurrent ischemic stroke (IS) has been associated with increased mortality and functional dependence, 6,7 but this remains insufficiently explored.…”

Section: Introductionmentioning

confidence: 99%

Recurrent ischemic stroke: Incidence, predictors, and impact on mortality

et al. 2019

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Background and purpose Recurrent ischemic stroke (IS) or TIA is frequent with a considerable variation in incidence and mortality across populations. Current data on stroke recurrence and mortality are useful to examine trends, risk factors, and treatment effects. In this study, we calculated the incidence of recurrent IS or TIA in a hospital‐based stroke population in Western Norway, investigated recurrence factors, and estimated the effect of recurrence on all‐cause mortality. Methods This prospective cohort study registered recurrence and mortality among 1872 IS and TIA survivors admitted to the stroke unit at Haukeland University Hospital between July 2007 and December 2013. Recurrence and death until September 1, 2016, were identified by medical chart review. Cumulative incidences of recurrence were estimated with a competing risks Cox model. Multivariate Cox models were used to examine recurrence factors and mortality. Results During follow‐up, 220 patients had 277 recurrent IS or TIAs. The cumulative recurrence rate was 5.4% at 1 year, 11.3% at 5 years, and 14.2% at the end of follow‐up. Hypertension (HR = 1.65, 95% CI 1.21‐2.25), prior symptomatic stroke (HR = 1.63, 95% CI 1.18‐2.24), chronic infarcts on MRI (HR = 1.48, 95% CI 1.10‐1.99), and age (HR 1.02/year, 95% CI 1.00‐1.03) were independently associated with recurrence. A total of 668 (35.7%) patients died during follow‐up. Recurrence significantly increased the all‐cause mortality (HR = 2.55, 95% CI 2.04‐3.18). Conclusions The risk of recurrent IS stroke or TIA was modest in our population and was associated with previously established risk factors. Recurrence more than doubled the all‐cause mortality.

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“…In recent decades, several studies conducted in a wide range of different settings have focused on the association between transient ischaemic attack (TIA) and the risk of stroke [3][4][5][6][7][8][9][10][11][12][13][14]. Whilst these results have shed some light on the association between TIA and stroke, they also have had several limitations that must be acknowledged.…”

Section: Introductionmentioning

confidence: 99%

Long‐term risk of stroke and its predictors in transient ischaemic attack patients in Germany

Jacob

Tanislav

Kostev³

2019

Euro J of Neurology

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Background and purpose Little is known about the long‐term association between transient ischaemic attack (TIA) and stroke. Therefore, the goal of this study was to analyze the long‐term risk of stroke and associated predictors in a large cohort of TIA patients followed in general practices in Germany. Methods This study included patients with an initial TIA diagnosis and subsequently followed up in one of 1262 general practices in Germany between January 2007 and December 2016 (N = 19 824 patients). The primary outcome of the study was the risk of ischaemic stroke within 10 years of the initial diagnosis of TIA. The secondary outcome was the identification of demographic, clinical and pharmaceutical variables significantly associated with stroke in TIA patients. Results Within 10 years of the initial TIA diagnosis, 18.3% of individuals were diagnosed with stroke. Age was positively associated with stroke, with hazard ratios ranging from 1.88 in patients aged 51–60 years to 4.00 in those aged >80 years (reference group: patients aged ≤50 years). Furthermore, male sex, hypertension, diabetes mellitus, atrial fibrillation and ischaemic heart diseases had an additional impact on the risk of stroke. Finally, new oral anticoagulants, heparins, diuretics, angiotensin II receptor blockers and platelet aggregation inhibitors were identified as protective factors. Conclusions In a cohort of almost 20 000 TIA patients, 18.3% were diagnosed with stroke within 10 years after the TIA index event. Several demographic, clinical and pharmaceutical variables significantly predicted the long‐term risk of stroke in TIA patients.

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Long‐Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta‐Analysis

Cited by 121 publications

References 46 publications

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

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

Recurrent ischemic stroke: Incidence, predictors, and impact on mortality

Long‐term risk of stroke and its predictors in transient ischaemic attack patients in Germany

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