title: The incidence and risk factors of stroke in patients with acute myocardial infarction treated invasively and concomitant impaired renal function.
abstract: BACKGROUND
  Impaired renal function is a marker of poor prognosis in patients with acute myocardial infarction (AMI). The aim of the study was to assess the incidence and independent predictors of stroke in population of patients with AMI treated invasively and concomitant impaired renal function (IRF).
  
  
  METHODS
  We analyzed 2,520 consecutive AMI patients admitted to our Center between 2003 and 2007 and treated with percutaneous coronary intervention. The whole population was divided into patients with IRF, defined as glomerular filtration rate < 60 mL/min/1.73 m(2) or contrast induced nephropathy (IRF group, n = 933; 37.02%) and patients without IRF (control group, n = 1587; 62.98%). The IRF group was subjected to further analysis. Data on long-term follow-up were screened to identify the patients who experienced stroke.
  
  
  RESULTS
  During median of 25.5 months of follow-up 52 (2.07%) the patients experienced stroke - 33 (3.54%) in the IRF group and 19 (1.2%) patients in the control group. The risk of major adverse cardiovascular events in the IRF group, including repeated AMI (68.8 vs.14.9%, p < 0.001) and death (45.5 vs. 25.1%, p < 0.05) was significantly higher in patients with stroke. Previous stroke (HR 6.85), female gender (HR 3.13), as well as STEMI anterior (HR 2.55) were independent risk factors of stroke in this population.
  
  
  CONCLUSIONS
  Patients with AMI treated invasively and concomitant IRF were at higher risk of stroke occurrence in the future. Stroke was associated with poor outcome in the studied population. Independent predictors of stroke in patients with IRF and AMI treated invasively were different from commonly recognized stroke predictors.
authors.affiliation: Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Medical University, Silesian Center of Heart Diseases, Zabrze, Poland. tomekpod@interia.pl.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Podolecki
authors.forename: Radosław
authors.initials: R
authors.lastname: Lenarczyk
authors.forename: Jacek
authors.initials: J
authors.lastname: Kowalczyk
authors.forename: Andrzej
authors.initials: A
authors.lastname: Świątkowski
authors.forename: Piotr
authors.initials: P
authors.lastname: Chodór
authors.forename: Patrycja
authors.initials: P
authors.lastname: Pruszkowska-Skrzep
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Sędkowska
authors.forename: Lech
authors.initials: L
authors.lastname: Poloński
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kalarus
mesh_terms: D000368:Aged; D003287:Contrast Media / Q000009:adverse effects; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D011044:Poland / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media