title: Incidence and characteristics of stroke during 90-day follow-up in patients stabilized after an acute coronary syndrome.
abstract: BACKGROUND
  Stroke is a rare but serious event that complicates the course of patients with acute coronary syndromes (ACS). The type, outcome, and risk factors of stroke occurring in stabilized patients with ACS have not been previously reported.
  
  
  METHODS
  We evaluated stroke incidence, subtypes, and outcomes, in addition to demographics and clinical risk characteristics associated with stroke among patients enrolled in the Sibrafiban versus Aspirin to Yield Maximum Protection from Ischemic Heart Events Post-acute Coronary Syndromes (SYMPHONY) and 2nd SYMPHONY trials.
  
  
  RESULTS
  Of 15,904 stabilized patients with ACS, 113 (0.71%) had a stroke over a median follow-up of 90 days. The majority of strokes occurred within 30 days of presentation, and the time course for stroke occurrence paralleled that of myocardial (re)infarction. Most strokes were ischemic (78%), and 52% resulted in moderate or severe disability or death. Patients with stroke were older and more often had hypertension, diabetes, peripheral vascular disease, and atrial fibrillation. Among patients with stroke who had cardiac catheterization, percutaneous coronary intervention, or coronary artery bypass grafting, stroke occurred predominantly after the procedure. No difference in occurrence or type of stroke was observed in the assigned treatment groups. In multivariable modeling age, heart failure, prior stroke, left bundle branch block, and systolic blood pressure predicted the occurrence of stroke.
  
  
  CONCLUSIONS
  In patients stabilized after presenting with a spectrum of ACS and treated with sibrafiban and/or aspirin, stroke occurred in fewer than 1% within 90 days but carried a significant mortality and morbidity risk.
authors.affiliation: Duke Clinical Research Institute, Durham, NC 27715, USA.
authors.forename: Hassan
authors.initials: H
authors.lastname: Kassem-Moussa
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Mahaffey
authors.forename: Carmelo
authors.initials: C
authors.lastname: Graffagnino
authors.forename: Gudaye
authors.initials: G
authors.lastname: Tasissa
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Sila
authors.forename: R John
authors.initials: RJ
authors.lastname: Simes
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Manjshri V
authors.initials: MV
authors.lastname: Bhapkar
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
mesh_terms: D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D001241:Aspirin / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D010091:Oximes / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*
chemical_list: D010091:Oximes; D010880:Piperidines; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin; C100917:sibrafiban