A History of Stroke/Transient Ischemic Attack Indicates High Risks of Cardiovascular Event and Hemorrhagic Stroke in Patients with Coronary Artery Disease
Background—Randomized trials of antithrombotics in coronary artery disease (CAD) have identified prior stroke/TIA as a marker of increased intracranial bleeding risk. We aimed to further characterize the risk of ischemic and bleeding events associated with a history of stroke/TIA in patients with CAD.
Methods and Results—From the international REACH registry of atherothrombosis, baseline characteristics and 4-year follow-up of 26,389 patients with CAD, including 4460 patients (16.9%) with a history of stroke/TIA, were analyzed. Patients with prior stroke/TIA had a higher rate of recurrent CV events (CV death, MI, or stroke) than patients without: adjusted HR (1.52, 95% CI, 1.40 to 1.65; p<0.001) and specifically of non-fatal ischemic stroke (adjusted HR 3.06; 95% CI, 2.62 to 3.57; p<0.001) and non-fatal hemorrhagic stroke rates (adjusted HR, 1.76; 95% CI, 1.00 to 3.08; p=0.05). Excess risk for non-fatal hemorrhagic stroke appeared confined to the 1st year following a stroke/TIA (adjusted HR, 3.03; 95% CI, 1.51 to 6.08 for the first year) and was particularly high in patients receiving dual antiplatelet therapy (adjusted HR 5.21; 95% CI, 1.24 to 21.90).
Conclusions—In patients with CAD, a history of stroke/TIA is associated with an independent increase in risk of death, MI, or stroke, including both ischemic and hemorrhagic stroke (the latter being smaller in absolute terms). This excess risk of hemorrhagic stroke is particularly high in patients receiving dual antiplatelet therapy and in the first year following stroke/TIA. This observation is important for selection of antithrombotic therapy in these patients.
- Received September 6, 2012.
- Accepted December 27, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited