Risk factors and outcome of in-hospital ischemic stroke in patients with non-ST elevation acute coronary syndromes.
OBJECTIVE
To identify predictors of ischemic stroke in patients with suspected non-ST elevation (NSTE) acute coronary syndrome (ACS) and to evaluate in-hospital and 1-year outcomes.


METHODS
We analyzed 5842 patients with diagnosed NSTE ACS included in the multi-center Canadian ACS registries. Patients with in-hospital stroke (n=28, 0.5%) were compared to patients without stroke. Risk factors and short- and long-term outcome were evaluated.


RESULTS
Baseline characteristics of patients with and without stroke were similar except for a significantly higher proportion of women, higher rates of in-hospital CABG, and greater use of unfractionated heparin. Crude event rates were significantly higher in patients with stroke: in-hospital death 21.4% vs. 1.6% (p<0.0001), MI 10.7% vs. 4.0% (p=0.10), and death or MI 32.1% vs. 5.1% (p<0.0001). One-year event rates were also higher in patients with stroke: death 32.1% vs. 7.4% (p<0.0001), and death or MI 39.3% vs. 13.5% (p<0.001). In multivariable analysis, independent predictors for stroke were female gender (OR 3.12, 95%CI 1.36-7.14, p=0.007), and Killip class >/=2 on admission (OR 2.87, 1.18-6.99, p=0.02). Stroke was an independent predictor of in-hospital death (OR 14.52, 4.57-46.12, p<0.0001), death or MI (6.0, 2.44-14.75, p<0.0001), as well as 1-year death (5.50, 1.94-15.60, p=0.0014), and death or MI (2.89, 1.15-7.27, p=0.025).


CONCLUSIONS
In patients with NSTE ACS, stroke is associated with increased short- and long-term rates of death and MI. Stroke is highly predicted by female gender and Killip class on admission.
Segev
Amit
A
Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Strauss
Bradley H
BH
Tan
Mary
M
Buller
Christopher E
CE
Mendelsohn
Aurora A
AA
Langer
Anatoly
A
Goodman
Shaun G
SG
D054058:Acute Coronary Syndrome / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D002545:Brain Ischemia / Q000150:complications*; D002170:Canada; D016022:Case-Control Studies; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control; D016896:Treatment Outcome
D000925:Anticoagulants; D006493:Heparin