Risk of Myocardial Infarction and Vascular Death After Transient Ischemic Attack and Ischemic Stroke

Abstract

Background-Whether stroke patients should be investigated for asymptomatic coronary artery disease remains matter of debate. Absolute risks of myocardial infarction (MI) and vascular death after a stroke have not been accurately assessed. We performed a systematic review and a meta-analysis to determine the risk of MI and nonstroke vascular death after transient ischemic attack (TIA) and ischemic stroke. Cohort studies of TIA or ischemic stroke patients were included if they were published between 1980 and March 2005, reported risk of MI and nonstroke vascular death, enrolled Ͼ100 patients, and had at least 1 year of follow-up. We included 39 studies in a total of 65 996 patients with mean follow-up of 3.5 years. Two reviewers independently carried out data extraction using a standardized form. Absolute annual risks were estimated through weighted meta-regressions with a random effect. To test the predictions of expected event rates derived from our analysis, we used individual patient data. Summary of Review-The annual risks were 2.1% (CI 95%: 1.9 to 2.4) for nonstroke vascular death, 2.2% (1.7 to 2.7) for total MI, 0.9% (0.7 to 1.2) for nonfatal MI and 1.1% (0.8 to 1.5) for fatal MI. The time course of risk was linear. Estimated risks fitted well with observed risks at the individual level. There was no heterogeneity in the absolute risks according to baseline study characteristics. Conclusions-Patients

Secondary prophylactic treatment and long‐term prognosis after TIA and different subtypes of stroke. A 25‐year follow‐up hospital‐based observational study

“…Patients with either TIA and/or an ischemic or hemorrhagic stroke have besides an increased risk of suffering (recurrent) stroke, increased risks of experiencing myocardial infarction (MI) or a vascular cause of death over long‐term observation (Appelros, Gunnarsson, & Terent, 2011; Brønnum‐Hansen, Davidsen, & Thorvaldsen, 2001; Burns et al., 2011; Dhamoon, Sciacca, Rundek, Sacco, & Elkind, 2006; Eriksson & Olsson, 2001; Hardie, Hankey, Jamrozik, Broadhurst, & Anderson, 2004; Touze et al., 2005). Warfarin alone or in combination with aspirin was superior to aspirin alone regarding endpoints, but it increased the risk of major, nonfatal bleeding after MI (Hurlen, Abdelnoor, Smith, Erikssen, & Arnesen, 2002).…”

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

“…Although there is evidence that patients suffering a transient ischemic attack (TIA) or ischemic stroke (IS) are at high risk of coronary artery disease (CAD),1, 2, 3, 4, 5 current guidelines for prevention of coronary events in high‐risk individuals do not include stroke patients 6, 7. A writing group committee suggested the inclusion of large atherosclerosis IS, while other subtypes of IS are thought to carry a lower risk of CAD 8.…”

“…A writing group committee suggested the inclusion of large atherosclerosis IS, while other subtypes of IS are thought to carry a lower risk of CAD 8. In a previous systematic review, the annual risk of myocardial infarction (MI) after TIA or IS was shown to be 2.2% 5. However, the current risk of MI remains difficult to predict because the improvement of secondary prevention therapies may be counterbalanced by the aging of the population.…”

Long-Term Effect of Participation in an Early Exercise and Education Program on Clinical Outcomes and Cost Implications, in Patients with TIA and Minor, Non-Disabling Stroke

“…A transient ischemic attack (TIA) is an ischaemic brain attack with focal cerebral or retinal symptoms that last under 24 hours, usually less than 1 hour [3]. Although patients with minor (non-disabling) stroke differ slightly from those with TIA as signs and symptoms last more than 24 hours, minor stroke patients are assessed and treated similarly to TIA patients to prevent a further disabling stroke, myocardial infarction or death [2,4,5].…”