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Stroke, Vol 24, 1490-1495, Copyright © 1993 by American Heart Association
D Tanne, U Goldbourt, M Zion, H Reicher-Reiss, E Kaplinsky and S Behar
BACKGROUND AND PURPOSE: Stroke complicating acute myocardial infarction is
associated with substantial morbidity and mortality. The purpose of this
study was to assess the incidence, predictors, and impact on mortality of
stroke/transient ischemic attacks occurring after hospital discharge in a
large unselected population of acute myocardial infarction survivors.
METHODS: During a secondary prevention study with nifedipine (SPRINT),
demographic, anamnestic, and clinical data were collected for 5839
consecutive acute myocardial infarction patients admitted to 13 coronary
care units in Israel. Hospital survivors (n = 4808) were followed for a
year after their discharge. Mortality was assessed for a mean follow-up of
5.5 years (range, 4.5 to 7 years). RESULTS: One percent (48/4808) of
hospital survivors from acute myocardial infarction experienced a
stroke/transient ischemic attack in the year after acute myocardial
infarction. Thirty-one percent (15 of 48) of events occurred in the first
month after hospital discharge. Incidence was higher among older patients
(> 70 years; 1.9%), those with anterior site of myocardial infarction
(1.35%), a previous history of myocardial infarction (1.8%), hypertension
(1.4%), stroke in the past (4.1%), and chronic atrial fibrillation (9%).
Multivariate analysis identified the following as independent predictors of
stroke/transient ischemic attacks occurring in the year after hospital
discharge: chronic atrial fibrillation, older age, history of previous
myocardial infarction, anterior myocardial infarction site, serum glutamic
oxaloacetic transaminase levels more than four times above upper normal
limits, and stroke in the past. The age-adjusted 1-year and long-term
mortality rates (4.5 to 7 years; mean, 5.5 years) were significantly higher
in patients with (31% and 62%) than in those without stroke/transient
ischemic attacks (9% and 31%, respectively; P < .01). CONCLUSIONS:
Stroke/transient ischemic attack is a relatively rare (1%) complication in
the year after hospital discharge from acute myocardial infarction, though
more frequent in the first month. Chronic atrial fibrillation, older age,
anterior myocardial infarction site, serum glutamic oxaloacetic
transaminase levels more than four times above upper normal limits, past
myocardial infarction, and stroke identify high-risk patients. Patients
suffering from subsequent stroke/transient ischemic attacks experienced
higher mortality than counterparts who remained free from this
complication.
ARTICLES
Frequency and prognosis of stroke/TIA among 4808 survivors of acute myocardial infarction. The SPRINT Study Group
Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel.
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