National trends in stroke after acute myocardial infarction among Medicare patients in the United States: 1999 to 2010

Wang, Yun; Lichtman, Judith H.; Dharmarajan, Kumar; Ross, Joseph S.; Dodson, John A.; Chen, Jersey; Spertus, John A.; Chaudhry, Sarwat I.; Nallamothu, Brahmajee K.; Krumholz, Harlan M.

doi:10.1016/j.ahj.2014.06.011

Cited by 17 publications

(11 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A summary of the incidence from each study is presented by length of follow-up, bleeding definition used and in-hospital management strategy in table 2 for observational studies and table 3 for RCTs. The overall incidence of bleeding within 12 months post hospital discharge varied from 0.2%44 to 37.5%20 in observational studies, and between 0.96%42 and 39.4%63 in RCTs.…”

Section: Resultsmentioning

confidence: 99%

Incidence and prognostic impact of post discharge bleeding post acute coronary syndrome within an outpatient setting: a systematic review

et al. 2019

View full text Add to dashboard Cite

ObjectiveThe primary objective was to determine the incidence of bleeding events post acute coronary syndrome (ACS) following hospital discharge. The secondary objective was to determine the prognostic impact of bleeding on mortality, major adverse cardiovascular events (MACE), myocardial re-infarction and rehospitalisation in the postdischarge setting.DesignA narrative systematic review.Data sourceMedline, Embase, Amed and Central (Cochrane) were searched up to August 2018.Study selectionFor the primary objective, randomised controlled trials (RCT) and observational studies reporting on the incidence of bleeding post hospital discharge were included. For the secondary objective, RCTs and observational studies that compared patients with bleeding versus those without bleeding post hospital discharge vis-à-vis mortality, MACE, myocardial re-infarction and rehospitalisation were included.Results53 studies (36 observational studies and 17 RCTs) with a combined cohort of 714 458 participants for the primary objectives and 187 317 for the secondary objectives were included. Follow-up ranged from 1 month to just over 4 years. The incidence of bleeding within 12 months post hospital discharge ranged from 0.20% to 37.5% in observational studies and between 0.96% and 39.4% in RCTs. The majority of bleeds occurred in the initial 3 months after hospital discharge with bruising the most commonly reported event. Major bleeding increased the risk of mortality by nearly threefold in two studies. One study showed an increased risk of MACE (HR 3.00,95% CI 2.75 to 3.27; p<0.0001) with bleeding and another study showed a non-significant association with rehospitalisation (HR 1.20,95% CI 0.95 to 1.52; p=0.13).ConclusionBleeding complications following ACS management are common and continue to occur in the long term after hospital discharge. These bleeding complications may increase the risk of mortality and MACE, but greater evidence is needed to assess their long-term effects.PROSPERO registration numberCRD42017062378.

show abstract

Section: Resultsmentioning

confidence: 99%

Incidence and prognostic impact of post discharge bleeding post acute coronary syndrome within an outpatient setting: a systematic review

et al. 2019

View full text Add to dashboard Cite

show abstract

“…These high all‐cause death rates may reflect the advanced age, history of CVD, and prevalence of comorbid conditions in the study population and are relatively consistent with other studies in similar populations. For example, 1‐year all‐cause mortality rates (2010) for Medicare patients who experienced a recurrent MI or stroke within 1 year of hospitalization for MI were 30% for patients with recurrent MI, 35% for those with IS following MI, and 61% for those with hemorrhagic stroke following MI . In another study of MI survivors at least 65 years old who subsequently died within 3 years of follow‐up, >50% of the deaths were attributed specifically to CVD .…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular events and death after myocardial infarction or ischemic stroke in an older Medicare population

Peng

Wang

et al. 2019

Clinical Cardiology

View full text Add to dashboard Cite

Background Survivors of myocardial infarction (MI) or ischemic stroke (IS) are at high risk for subsequent cardiovascular events. Hypothesis Older patients with prior MI or IS are at risk for recurrent cardiovascular events, and comorbidities such as diabetes may increase this risk. Methods Two cohorts were studied in a retrospective Medicare 20% random sample—a 2008 cohort with up to 6 years of follow‐up (MI, N = 26 460; IS, N = 17 566) and a 2012 cohort with 1 year of follow‐up (MI, N = 26 548; IS, N = 17 728). Results In older patients who survived an event of MI or IS (2012 cohort), 7.2% had a recurrent MI and 6.7% had a recurrent IS in the first year; 32% died. Accounting for multiple recurrent events (2012 cohort), the event rates per 100 patient‐years were 11.6 and 10.2 for the MI and IS cohorts, respectively. Cumulative incidence of recurrence (2008 cohort) increased from 7.7% at 1 year to 14.3% at 6 years for recurrent MI and from 6.7% at 1 year to 13.4% at 6 years for recurrent IS. Comorbid diabetes (2012 cohort) was significantly associated (adjusted risk ratio) with MI recurrence (1.44) and risk of coronary revascularization (1.23) in the MI cohort and with IS recurrence (1.26) in the IS cohort. Conclusion In this older population with prior MI or IS, high rates of recurrent cardiovascular events and multiple recurrent events were observed. These findings highlight the need for aggressive intervention for secondary prevention and management of comorbidities in high‐risk patients, particularly those with diabetes.

show abstract

“…Additionally, the standard gold treatment for the acute cardiac ischemia, the percutaneous coronary intervention, has an intrinsic risk for ischemic stroke of ≈0.1% with the modern techniques [ 136 ]. Nowadays, better methods of reperfusion, the knowledge of the relevance of the antiplatelet therapy, and the optimized medical therapy for the secondary prevention have reduced the risk of cerebral ischemia compared to the past [ 137 ].…”

Section: Cardioembolic Strokementioning

confidence: 99%

Neuroinflammatory Mechanisms in Ischemic Stroke: Focus on Cardioembolic Stroke, Background, and Therapeutic Approaches

Maida

Norrito

Daidone

et al. 2020

IJMS

370

266

View full text Add to dashboard Cite

One of the most important causes of neurological morbidity and mortality in the world is ischemic stroke. It can be a result of multiple events such as embolism with a cardiac origin, occlusion of small vessels in the brain, and atherosclerosis affecting the cerebral circulation. Increasing evidence shows the intricate function played by the immune system in the pathophysiological variations that take place after cerebral ischemic injury. Following the ischemic cerebral harm, we can observe consequent neuroinflammation that causes additional damage provoking the death of the cells; on the other hand, it also plays a beneficial role in stimulating remedial action. Immune mediators are the origin of signals with a proinflammatory position that can boost the cells in the brain and promote the penetration of numerous inflammatory cytotypes (various subtypes of T cells, monocytes/macrophages, neutrophils, and different inflammatory cells) within the area affected by ischemia; this process is responsible for further ischemic damage of the brain. This inflammatory process seems to involve both the cerebral tissue and the whole organism in cardioembolic stroke, the stroke subtype that is associated with more severe brain damage and a consequent worse outcome (more disability, higher mortality). In this review, the authors want to present an overview of the present learning of the mechanisms of inflammation that takes place in the cerebral tissue and the role of the immune system involved in ischemic stroke, focusing on cardioembolic stroke and its potential treatment strategies.

show abstract

National trends in stroke after acute myocardial infarction among Medicare patients in the United States: 1999 to 2010

Cited by 17 publications

References 37 publications

Incidence and prognostic impact of post discharge bleeding post acute coronary syndrome within an outpatient setting: a systematic review

Incidence and prognostic impact of post discharge bleeding post acute coronary syndrome within an outpatient setting: a systematic review

Cardiovascular events and death after myocardial infarction or ischemic stroke in an older Medicare population

Neuroinflammatory Mechanisms in Ischemic Stroke: Focus on Cardioembolic Stroke, Background, and Therapeutic Approaches

Contact Info

Product

Resources

About