Incidence and Characteristics of Stroke During 90-Day Follow-up
Background: Stroke is a rare but serious event that complicates the course of patients with acute coronary syndromes (ACS). The type, outcome, and risk factors of stroke occurring in stabilized patients with ACS have not been previously reported.
Methods: We evaluated stroke incidence, subtypes, and outcomes, in addition to demographics and clinical risk characteristics associated with stroke among patients enrolled in the Sibrafiban versus Aspirin to Yield Maximum Protection from Ischemic Heart Events Post-acute Coronary Syndromes (SYMPHONY) and 2nd SYMPHONY trials.
Results: Of 15,904 stabilized patients with ACS, 113 (0.71%) had a stroke over a median follow-up of 90 days. The majority of strokes occurred within 30 days of presentation, and the time course for stroke occurrence paralleled that of myocardial (re)infarction. Most strokes were ischemic (78%), and 52% resulted in moderate or severe disability or death. Patients with stroke were older and more often had hypertension, diabetes, peripheral vascular disease, and atrial fibrillation. Among patients with stroke who had cardiac catheterization, percutaneous coronary intervention, or coronary artery bypass grafting, stroke occurred predominantly after the procedure. No difference in occurrence or type of stroke was observed in the assigned treatment groups. In multivariable modeling age, heart failure, prior stroke, left bundle branch block, and systolic blood pressure predicted the occurrence of stroke.
Conclusions: In patients stabilized after presenting with a spectrum of ACS and treated with sibrafiban and/or aspirin, stroke occurred in fewer than 1% within 90 days but carried a significant mortality and morbidity risk.
Stroke can complicate the course of patients presenting with acute coronary syndromes (ACS). Whereas hemorrhagic strokes constitute a significant proportion of strokes after thrombolysis for acute ST-segment elevation myocardial infarction (MI), ischemic strokes are the predominant type in non-ST-segment elevation ACS clinical trial populations. In non-ST-segment elevation ACS patient populations, stroke incidence has ranged between 0.4% and 1.0% at 30 days. Less is known about the incidence of stroke in patients who have been medically stabilized for several days after ACS or over longer follow-up periods. The large combined data set from the SYMPHONY (Sibrafiban versus Aspirin to Yield Maximum Protection from Ischemic Heart Events Post-acute Coronary Syndromes) and 2nd SYMPHONY trials provided a unique opportunity to investigate the incidence, types, outcomes, and predictors of stroke in stabilized patients with ACS with follow-up beyond 30 days.
Background: Stroke is a rare but serious event that complicates the course of patients with acute coronary syndromes (ACS). The type, outcome, and risk factors of stroke occurring in stabilized patients with ACS have not been previously reported.
Methods: We evaluated stroke incidence, subtypes, and outcomes, in addition to demographics and clinical risk characteristics associated with stroke among patients enrolled in the Sibrafiban versus Aspirin to Yield Maximum Protection from Ischemic Heart Events Post-acute Coronary Syndromes (SYMPHONY) and 2nd SYMPHONY trials.
Results: Of 15,904 stabilized patients with ACS, 113 (0.71%) had a stroke over a median follow-up of 90 days. The majority of strokes occurred within 30 days of presentation, and the time course for stroke occurrence paralleled that of myocardial (re)infarction. Most strokes were ischemic (78%), and 52% resulted in moderate or severe disability or death. Patients with stroke were older and more often had hypertension, diabetes, peripheral vascular disease, and atrial fibrillation. Among patients with stroke who had cardiac catheterization, percutaneous coronary intervention, or coronary artery bypass grafting, stroke occurred predominantly after the procedure. No difference in occurrence or type of stroke was observed in the assigned treatment groups. In multivariable modeling age, heart failure, prior stroke, left bundle branch block, and systolic blood pressure predicted the occurrence of stroke.
Conclusions: In patients stabilized after presenting with a spectrum of ACS and treated with sibrafiban and/or aspirin, stroke occurred in fewer than 1% within 90 days but carried a significant mortality and morbidity risk.
Stroke can complicate the course of patients presenting with acute coronary syndromes (ACS). Whereas hemorrhagic strokes constitute a significant proportion of strokes after thrombolysis for acute ST-segment elevation myocardial infarction (MI), ischemic strokes are the predominant type in non-ST-segment elevation ACS clinical trial populations. In non-ST-segment elevation ACS patient populations, stroke incidence has ranged between 0.4% and 1.0% at 30 days. Less is known about the incidence of stroke in patients who have been medically stabilized for several days after ACS or over longer follow-up periods. The large combined data set from the SYMPHONY (Sibrafiban versus Aspirin to Yield Maximum Protection from Ischemic Heart Events Post-acute Coronary Syndromes) and 2nd SYMPHONY trials provided a unique opportunity to investigate the incidence, types, outcomes, and predictors of stroke in stabilized patients with ACS with follow-up beyond 30 days.