title: The risk of stroke in patients with acute myocardial infarction treated invasively.
abstract: BACKGROUND
  To assess the incidence, clinical significance, and independent risk factors of stroke in patients with acute myocardial infarction (AMI) treated invasively.
  
  
  METHODS
  We analyzed 2520 consecutive patients with AMI admitted between 2003 and 2007. Data on long-term follow-up were screened to identify patients who had stroke.
  
  
  RESULTS
  During a median of 25.5 months, 52 patients (2.07%) had stroke. The cumulative risk of stroke was the highest during the first year (1.23%) and particularly within the first month after AMI (0.28%). Patients with stroke were at a significantly higher risk of developing major adverse cardiovascular events, including repeated AMI (26.9 vs. 14.6%, P<0.05) and death (40.4 vs. 13.6%, P<0.001). Previous stroke [hazard ratio (HR) 5.89], female sex (HR 2.60), glomerular filtration rate <60 ml/min/1.73 m (HR 1.92), and contrast nephropathy (HR 1.87, all P<0.05) were independent predictors of stroke. The receiver-operating curve calculated for the Contrast nephropathy, renal Insufficiency, Female, prior Stroke (CIFS) risk scale demonstrated a significant predictive value of this scale (area under curve 0.73, P<0.001). Patients with the lowest, median, and highest risk scores (<4, 4-5, ≥6 points, respectively) differed significantly with regard to stroke incidence (2.1 vs. 7.9 vs. 14.0%, respectively, P<0.05).
  
  
  CONCLUSIONS
  The risk of stroke is the highest within the first month after AMI. Stroke is a marker of unfavorable outcome in this population. Independent risk factors for stroke after invasive treatment of AMI are different from those commonly perceived as stroke predictors. A risk scale based on sex, stroke history, and renal impairment is useful in risk stratification.
authors: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Center of Heart Diseases, Zabrze, Poland. tomekpod@interia.pl
authors: Tomasz Stanislaw
authors: TS
authors: Podolecki
authors: Radosław K
authors: RK
authors: Lenarczyk
authors: Jacek P
authors: JP
authors: Kowalczyk
authors: Michał H
authors: MH
authors: Mazurek
authors: Andrzej M
authors: AM
authors: Swiątkowski
authors: Piotr K
authors: PK
authors: Chodór
authors: Patrycja I
authors: PI
authors: Pruszkowska-Skrzep
authors: Agnieszka A
authors: AA
authors: Sędkowska
authors: Lech
authors: L
authors: Poloński
authors: Zbigniew F
authors: ZF
authors: Kalarus
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011044:Poland; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome