Ten year decline in ischemic stroke after AMI
The analysis of data from two Swedish registries was presented by Dr Anders Ulvenstam, and suggests that the reduction is due to improvements in AMI care.
Ischemic stroke is a well known, relatively rare but potentially devastating complication following myocardial infarction. It can lead to severe neurological handicap and death for the patient and it is associated with great costs for society.
"The risk of ischemic stroke after myocardial infarction has been studied previously, but there are many questions that remain unanswered," said Dr Ulvenstam. "Many studies have been conducted within clinical trials but these trials tend to focus on a particular patient group. Few, if any, studies have been done on the broader group of patients seen in day to day clinical practice. We based our analysis on two registries which include all AMI patients in Sweden."
"Great variation in the incidence of ischemic stroke after AMI has been found in previous studies, which tells us that we do not have a realistic estimate of the risk of suffering from ischemic stroke after myocardial infarction," he added.
"Furthermore, many of the earlier studies were done before modern AMI care -with different drugs and interventional procedures- was established, which is why we do not know how this has affected the risk over time. There is also conflicting data regarding independent predictors of stroke risk."
The study presented at ESC Congress 2012 was based on 173,233 Swedish AMI patients between 1998-2008, from the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA). In order to identify which of these AMI patients suffered an ischemic stroke within one year, the RIKS-HIA database was merged with the Swedish National Registry, which contains diagnoses for all patients at discharge from hospital care.
Dr Ulvenstam said: "Based on this patient information we were able to answer the questions raised above, regarding the incidence, time trends and independent predictors of ischemic stroke at one year after AMI."
The researchers found that during 1998-2008 the average risk of ischemic stroke one year after AMI was 4.1%. This was nearly twice as high as the incidence found in an important meta-analysis performed by Witt et al. in 2006 which showed an average risk of 2.1% (1). Dr Ulvenstam said: "The higher incidence in our study could be explained by the fact that we have such an unselected patient group. The registries used exclude very few AMI patients which means that there are more potential stroke victims."
A second finding from the study was that the risk of ischemic stroke one year after AMI fell by 21% over a ten year period, from 4.7% in 1998-2000 to 3.8% in 2007-2008. "We are the first to show that the risk of suffering from stroke after AMI seems to be diminishing," said Dr Ulvenstam. "This is probably a direct result of the great improvement in AMI care which has taken place during the last two decades. For the first time we can see the impact of different drugs and interventional procedures on stroke risk after AMI."
The researchers also conducted an analysis of independent predictors of stroke risk. Multiple regression analysis showed for the first time that each of the following factors independently reduced stroke risk: reperfusion therapy with percutaneous coronary intervention (PCI), blood clot dissolving therapy (fibrinolysis), thrombocyte aggregation inhibitors (aspirin and P2Y12-inhibitors) and statins. Dr Ulvenstam said: "The finding that PCI actually reduces stroke risk is somewhat surprising, being an invasive procedure. It has traditionally been associated with an increased stroke risk. We speculate that early reperfusion of the myocardium reduces infarction size and thereby leads to a reduced burden of atrial fibrillation and heart failure and in turn, reduced stroke risk."
He concluded: "The risk of stroke after myocardial infarction is higher than previously thought, but seems to be decreasing with the modernization of coronary care. We predict that this risk will continue to decline if clinicians treat their AMI patients with the recommended drugs and interventions."
More information: 1 Witt BJ, Ballman KV, Brown RD Jr, Meverden RA, Jacobsen SJ, Roger VL. The incidence of stroke after myocardial infarction: a meta-analysis. Am J Med. 2006;119(4):354.e1-9. Review.
Provided by European Society of Cardiology
- Study evaluates blood potassium levels after heart attack and risk of in-hospital mortality Jan 10, 2012 | not rated yet | 0
- Heart attack patients who stop statin risk death, say researchers Aug 27, 2008 | not rated yet | 0
- Angiotensin receptor blockers reduce no-reflow post-PCI Apr 24, 2012 | not rated yet | 0
- Spouses of people suffering a heart attack need care for increased risk of depression and suicide Aug 21, 2012 | not rated yet | 0
- Findings released from 1 of the largest percutaneous coronary intervention trials ever May 23, 2008 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Assumptions of Griffith's fracture theory
10 hours ago Any experts on Griffith's fracture theory? I am studying the subject and I am having hard time finding out if the theory is valid for all possible...
Current leading voltage or vice versa concept
11 hours ago Hello, I was wondering if there is a conceptual explanation for when current leads voltage or vice versa for capacitors or inductors with AC...
Angular Frequency of AC voltage
14 hours ago Hello, I am wondering, what is the physical interpretation of the angular frequency of AC voltage? I don't see the physicality of what the angle...
Modeling Rigid Body - Unsure about Euler angles and angular velocity
15 hours ago I'm modeling a single 3D rigid body in preparation for some more complicated modeling in order to gain a better understanding of Euler angles, the...
Function for a bullet's path
16 hours ago I've been mulling this over all weekend, and I've decided to get some help on this. The problem is writing a function to describe a bullet's path....
Elementary questions relating to Newton's laws of motion
17 hours ago i) If a wall breaks when it gets hit by a cannonball, did the wall exert an equal and opposite force on the cannonball? ii) Would the force...
- More from Physics Forums - Classical Physics
More news stories
(Medical Xpress)—In a recent subgroup analysis of the largest blood pressure treatment trial in history, University of Alabama at Birmingham (UAB) researchers found that women and men react the same to ...
Cardiology 4 hours ago | 5 / 5 (1) | 0
Over the past few decades, scientists have developed many devices that can reopen clogged arteries, including angioplasty balloons and metallic stents. While generally effective, each of these treatments ...
Cardiology 5 hours ago | 5 / 5 (3) | 0 |
(Medical Xpress)—Cardiologists have identified a trio of biomarkers that may predict which patients with heart disease have a high risk of heart attack or death in the next two years.
Cardiology 6 hours ago | 4 / 5 (1) | 0 |
Hospitals with the highest rates of cardiac arrests tend to have the poorest survival rates for those cases, new University of Michigan Health System research shows.
Cardiology 20 hours ago | not rated yet | 0
A clinical trial of 75 patients hospitalized with acute decompensated heart failure (ADHF) suggests that aggressive fluid and sodium restriction has no effect on weight loss or clinical stability at three days but was associated ...
Cardiology 20 hours ago | not rated yet | 0
The level of immunity to the recently circulating H7N9 influenza virus in an urban and rural population in Vietnam is very low, according to the first population level study to examine human immunity to the virus, which was ...
46 minutes ago | not rated yet | 0 |
Researchers at Emory University have identified a protein that stimulates a pair of "orphan receptors" found in the brain, solving a long-standing biological puzzle and possibly leading to future treatments for neurological ...
43 minutes ago | not rated yet | 0 |
Widely available in pharmacies and health stores, phosphatidylserine is a natural food supplement produced from beef, oysters, and soy. Proven to improve cognition and slow memory loss, it's a popular treatment for older ...
13 minutes ago | not rated yet | 0 |
In a striking, unexpected discovery, researchers at Albert Einstein College of Medicine of Yeshiva University have determined that vitamin C kills drug-resistant tuberculosis (TB) bacteria in laboratory culture. The finding ...
58 minutes ago | 5 / 5 (1) | 0 |
Prostaglandin analogues (PGAs), drugs which lower intraocular pressure, are often the first line of treatment for people with glaucoma, but their use is not without risks. PGAs have long been associated with blurred vision, ...
45 minutes ago | not rated yet | 0
Youth who had a schoolmate die by suicide are significantly more likely to consider or attempt suicide, according to a study in published in CMAJ (Canadian Medical Association Journal). This effect can last 2 years or mo ...
23 minutes ago | not rated yet | 0