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(Circulation. 2002;105:1082.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Risk and Predictors of Stroke After Myocardial Infarction Among the Elderly

Results From the Cooperative Cardiovascular Project

Judith H. Lichtman, PhD; Harlan M. Krumholz, MD; Yun Wang, MS; Martha J. Radford, MD; Lawrence M. Brass, MD

From the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven; Section of Chronic Disease Epidemiology, School of Epidemiology and Public Health (J.H.L., H.M.K., L.M.B.), Department of Cardiology (H.M.K., M.J.R.), and Yale Stroke Program, Department of Neurology (L.M.B.), Yale University School of Medicine, New Haven; Qualidigm (H.M.K., Y.W., M.J.R., L.M.B.), Middletown; and Neurology Service (L.M.B.), VA Connecticut Healthcare System, West Haven, Conn.

Correspondence to Judith Lichtman, PhD, CORE, GB 415, 20 York St, New Haven, CT 06504. E-mail Judith.Lichtman{at}yale.edu

Background— Stroke is an important outcome after acute myocardial infarction. Studies that have examined this relationship have largely excluded older patients, even though half of stroke admissions occur among patients 75 years of age and older.

Methods and Results— Among 111 023 medicare patients discharged with a principal diagnosis of acute myocardial infarction during an 8-month period in 1994 to 1995, we identified hospital admissions for ischemic stroke within 6 months of discharge. The rate of admission was 2.5% within 6 months. Independent predictors of ischemic stroke were age 75 years, black race, no aspirin at discharge, frailty, prior stroke, atrial fibrillation, diabetes, hypertension, and history of peripheral vascular disease. To identify individuals at increased risk for stroke, a risk stratification score was constructed from identified factors. The 6-month stroke admission rate for patients with a score of 4 or higher (20% of the total sample) was 4%.

Conclusions— The risk of stroke after myocardial infarction is substantial, with about 1 in 40 patients suffering an ischemic stroke within 6 months of discharge. Simple clinical factors can predict the risk of stroke and, based on these factors, we identified 20% of older patients who have a 1 in 25 chance of being hospitalized for a stroke within 6 months of discharge.

Key Words: stroke • myocardial infarction • risk factors • aging

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