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(Circulation. 2002;105:e9079.)
© 2002 American Heart Association, Inc.

Cardiovascular News

Ruth SoRelle, MPH

Circulation Newswriter

Predicting Stroke After Myocardial Infarction in the Elderly

Although the elderly (those over age 65) are considered at increased risk for stroke, they usually are excluded from studies that examine the relationship between acute myocardial infarction and stroke—a mistake, according to a report by researchers from the Yale–New Haven Hospital and the Yale University School of Medicine. In this week’s issue of the journal Circulation, a retrospective review by these researchers of the charts of 111 023 Medicare patients who were discharged with the diagnosis of stroke showed that there was a 2.5% rate of readmission for ischemic stroke within 6 months (Circulation. 2002;105:1082–1087).

Assessment of risk factors revealed several independent predictors of ischemic stroke in this group, including age >75 years, black race, no aspirin at discharge, frailty, prior stroke, atrial fibrillation, diabetes, hypertension, and history of peripheral vascular disease. When the authors, including Judith H. Lichtman, PhD, Harlan M. Krumholz, MD, Yun Wang, MS, Martha J. Radford, MD, and Lawrence M. Brass, MD, created a risk stratification strategy and assigned points to risk, they found that 4% of patients with a score of 4 or more were admitted to the hospital within 6 months of their heart attack admission.

The authors conclude: "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 . . . [Full Text of this Article]