Abstract 14882: Incidence, Trends Over Time and Predictors of Ischemic Stroke 30 Days After Acute Myocardial Infarction
Background Ischemic stroke is a known complication after acute myocardial infarction (AMI). In recent years the treatment of AMI has changed drastically with a corresponding increase in survival. The changes in treatment both in hospital and in secondary prevention could potentially have a positive effect on the incidence of ischemic stroke after AMI. We wanted to investigate if the treatment changes would correspond to a lower incidence of ischemic stroke and what factors predicted ischemic stroke after AMI.
Methods Patient’s data was taken from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA). All patients with their first registered AMI between the years of 1998 and 2008 were included. To identify the ischemic strokes we used the Swedish national patient register (PAR). To study a potential trend in the incidence of ischemic stroke after AMI over time, we divided the patient population into 5 consecutive time periods. The event free survival was studied by Kaplan-Meier analysis. The Cox proportional hazards regression model was used to identify independent predictors of stroke.
Results Out of 173233 patients with an AMI, 3531 (2.0%) developed an ischemic stroke within 30 days. The incidence of ischemic stroke was significantly lower in the years 2007-2008 compared with the years 1998-2000 with respective rates of 1.9% and 2.2% (Hazard ratio 0.88, 95% confidence interval, 0.79 to 0.97; P=0.01). Independent predictors of an increased risk of stroke were: age, female sex, prior stroke, diabetes mellitus, atrial fibrillation, clinical signs of heart failure at admission, STEMI, CABG and ACE-inhibitor treatment at discharge. PCI, fibrinolysis, ASA, statins and P2Y12-inhibitors where all independently associated with a reduced risk of ischemic stroke after AMI.
Conclusions The incidence of ischemic stroke within 30 days after an AMI has decreased during the period 1998-2008. This decrease is associated with the increased use of ASA, P2Y12 inhibitors, statins and reperfusion treatments.
- © 2012 by American Heart Association, Inc.