title: Ischemic Stroke Risk After Acute Coronary Syndrome.
abstract: Prior studies show an increased risk of ischemic stroke (IS) after myocardial infarction; however, there is limited evidence on long-term risk and whether it is directly related to cardiac injury. We hypothesized that the risk of IS after acute coronary syndrome is significantly higher if there is evidence of cardiac injury, such as ST-segment elevation myocardial infarction (STEMI) or non-STEMI, than when there is no evidence of cardiac injury, such as in unstable angina.
  
  
  
  Administrative claims data were obtained from all emergency department encounters and hospitalizations at California's nonfederal acute care hospitals between 2008 and 2011. Patients with STEMI, non-STEMI, and unstable angina were identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification codes. The primary outcome was IS during 2 years of follow-up. Unadjusted and adjusted Cox proportional hazards models were used to determine the association between acute coronary syndrome subtype and IS risk. We identified 73 059 patients with a diagnosis of STEMI (n=26 427), non-STEMI (n=39 833), or unstable angina (n=6819) during the study period. In the fully adjusted models that included potential confounders such as atrial fibrillation and congestive heart failure, the risk of IS was higher with STEMI (hazard ratio 4.17, 95% CI 3.00-5.83; P<0.001) and non-STEMI (hazard ratio 3.73, 95% CI 2.68-5.19, P<0.001) compared with unstable angina.
  
  
  
  Non-STEMI and STEMI confer an equally increased risk of IS. Studies exploring IS mechanisms in cardiac patients are needed to improve and tailor stroke prevention strategies.
authors.affiliation: Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI shadiyaghi@yahoo.com.
authors.forename: Shadi
authors.initials: S
authors.lastname: Yaghi
authors.affiliation: Department of Public Health and Epidemiology, Loma Linda University, Loma Linda, CA.
authors.forename: Markeith
authors.initials: M
authors.lastname: Pilot
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Christopher
authors.initials: C
authors.lastname: Song
authors.affiliation: Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Blum
authors.affiliation: Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Yakhkind
authors.affiliation: Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Brian
authors.initials: B
authors.lastname: Silver
authors.affiliation: Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Furie
authors.affiliation: Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.affiliation: Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: Dean
authors.initials: D
authors.lastname: Sherzai
authors.affiliation: Department of Neurology, Cedars Sinai Medical Center, Los Angeles, CA.
authors.forename: Ayesha Z
authors.initials: AZ
authors.lastname: Sherzai
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000368:Aged; D000465:Algorithms; D000789:Angina, Unstable / Q000150:complications; D001281:Atrial Fibrillation / Q000150:complications; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications; D053208:Kaplan-Meier Estimate; D008297:Male; D000072658:Non-ST Elevated Myocardial Infarction / Q000150:complications; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000150:complications; D020521:Stroke / Q000209:etiology*
keywords: angina; cardiac biomarkers; coronary artery disease; embolism; ischemic stroke; myocardial infarction