Abstract 12423: Trends and Incidence of Stroke After Myocardial Infarction in Patients With Chronic Kidney Disease
Background: There is a paucity of information about the incidence and trends of stroke after myocardial infarction (MI) in patients with chronic kidney disease (CKD).
Methods: Using the New Jersey statewide MIDAS database, 158,296 patients (pts) with first admission for MI were identified between year 2000 and 2012. Of those, 29,005 pts had CKD and 4390 pts had a stroke. After controlling for demographic variables and comorbidities, predictors of stroke were analyzed using multiple logistic regression. The Cochran-Armitage test was used to assess the trend of strokes over time.
Results: During the study period, there were 3370 (2.61%) strokes in the non-CKD pts and 1020 (3.52%) strokes in the CKD-pts (χ2= 72.77, p<0.0001). Among non-CKD pts, with percutaneous coronary intervention (PCI) during hospitalization (n=37461), the risk of stroke was1.39 % and without PCI (n=91830) was 3.10% (adjusted χ2 = 67.05, p<.0001). Among CKD pts, the risk of stroke in pts with PCI (n=4731) was 3.06% and without PCI (n=24,274) was 3.60% (adjusted χ2 = 1.27, p=NS).
Multiple logistic regression analysis identified as significant predictors of stroke: age (OR=1.03, 95%CI: 1.02~1.03), female gender (OR=1.28, 95%CI: 1.20~1.36), Black race (OR=1.34, 95%CI: 1.21~1.48), and not having PCI during hospitalization (OR=1.51, 95% CI: 1.37~1.67).
The risk of stroke from 2000-2012 decreased in the non-CKD pts (Z= 4.12, p<0.0001) and fluctuated but did not decrease in CKD pts (Z= 0.75, p=NS).
Conclusion: The incidence of stroke after MI is higher in pts with CKD compared to pts with non-CKD, but this difference is eliminated after adjustment for demographics. PCI during hospitalization decreased the risk of stroke in non-CKD pts, however the benefit of PCI was not seen in CKD pts. During the past decade, pts with CKD did not experience any change in the overall risk of stroke after MI.
Author Disclosures: A.E. Moreyra: None. H. Gu: None. N.M. Cosgrove: None. J.N. Swerdel: None. J. Cabrera: None. J.B. Kostis: None.
- © 2014 by American Heart Association, Inc.