title: A history of stroke/transient ischemic attack indicates high risks of cardiovascular event and hemorrhagic stroke in patients with coronary artery disease.
abstract: BACKGROUND
  Randomized trials of antithrombotics in coronary artery disease have identified previous stroke/transient ischemic attack (TIA) as a marker of increased intracranial bleeding risk. We aimed to further characterize the risk of ischemic and bleeding events associated with a history of stroke/TIA in patients with coronary artery disease.
  
  
  RESULTS
  From the international REduction of Atherothrombosis for Continued Health (REACH) registry of atherothrombosis, baseline characteristics and 4-year follow-up of 26,389 patients with coronary artery disease, including 4460 patients (16.9%) with a history of stroke/TIA, were analyzed. Patients with previous stroke/TIA had a higher rate of recurrent cardiovascular events (cardiovascular death, myocardial infarction, or stroke) than patients without (adjusted hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.40-1.65; P<0.001) and specifically of nonfatal ischemic stroke (adjusted HR, 3.06; 95% CI, 2.62-3.57; P<0.001) and nonfatal hemorrhagic stroke rates (adjusted HR, 1.76; 95% CI, 1.00-3.08; P=0.05). Excess risk for nonfatal hemorrhagic stroke appeared confined to the 1st year after a stroke/TIA (adjusted HR, 3.03; 95% CI, 1.51-6.08 for the first year) and was particularly high in patients receiving dual antiplatelet therapy (adjusted HR, 5.21; 95% CI, 1.24-21.90).
  
  
  CONCLUSIONS
  In patients with coronary artery disease, a history of stroke/TIA is associated with an independent increase in risk of death, myocardial infarction, or stroke, including both ischemic and hemorrhagic stroke (the latter being smaller in absolute terms). This excess risk of hemorrhagic stroke is particularly high in patients receiving dual antiplatelet therapy and in the 1st year after stroke/TIA. This observation is important for selection of antithrombotic therapy in these patients.
authors.affiliation: INSERM U 698 and Cardiology, Hôpital Bichat, 46 rue Henri Huchard, 75877 Paris Cedex 18, France.
authors.forename: Gregory
authors.initials: G
authors.lastname: Ducrocq
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
authors.forename: Julien
authors.initials: J
authors.lastname: Labreuche
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Alberts
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Mas
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.forename: Shinya
authors.initials: S
authors.lastname: Goto
authors.forename: Philippa
authors.initials: P
authors.lastname: Lavallée
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: Ph Gabriel
authors.initials: PG
authors.lastname: Steg
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000453:epidemiology*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D012042:Registries; D012306:Risk; D020521:Stroke / Q000453:epidemiology*
chemical_list: D010975:Platelet Aggregation Inhibitors