Novel Risk Score Evaluates Stroke Risk After Myocardial Infarction

A stroke is the most frequent neurologic complication of APS, and produces the most serious consequences.4 They can occur in any vascular region of the brain, and women are more likely to be affected than men. Patients who are APL-positive also tend to be younger compared with other patients with stroke who are APL-negative, with at least 20% of these strokes occurring in people <45 years. People who have APS secondary to SLE may be at higher risk for stroke.6 The risk for recurrence in primary APS may be higher, but this is not well established.4,5

A stroke is the most frequent neurologic complication of APS, and produces the most serious consequences.4 They can occur in any vascular region of the brain, and women are more likely to be affected than men. Patients who are APL-positive also tend to be younger compared with other patients with stroke who are APL-negative, with at least 20% of these strokes occurring in people <45 years. People who have APS secondary to SLE may be at higher risk for stroke.6 The risk for recurrence in primary APS may be higher, but this is not well established.4,5

A new risk score incorporates readily accessible risk factors linked with stroke in patients after myocardial infarction.

HealthDay News — A new risk score incorporates readily accessible risk factors associated with the occurrence of stroke in patients after myocardial infarction (MI) in the absence of atrial fibrillation (AF), according to a study published in the issue of the Journal of the American College of Cardiology.

João Pedro Ferreira, MD, PhD, from the University of Lorraine in France, and colleagues pooled data from 4 trials (22,904 patients) to identify risk factors (excluding AF) for the occurrence of stroke and to develop a calibrated and validated stroke risk score in patients with MI and heart failure and/or systolic dysfunction.

The researchers found that over a median 1.9 years of follow-up, 660 patients (2.9%) had a stroke. These patients were older and more often female, smokers, and hypertensive. In addition, stroke patients had a higher Killip class; a lower estimated glomerular filtration rate; and a higher proportion of histories of MI, heart failure, diabetes, and stroke. The final stroke risk model included older age, Killip class 3 or 4, estimated glomerular filtration rate ≤45 ml/min/1.73 m², hypertension history, and previous stroke. The models showed moderate to good discrimination and were well-calibrated. The observed three-year event rates increased steeply for each sextile of the stroke risk score (1.8%, 2.9%, 4.1%, 5.6%, 8.3%, and 10.9%, respectively) and were in agreement with the expected event rates.

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“This score may help in the identification of patients with MI and heart failure and a high risk for stroke despite their not presenting with AF,” the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

Reference

Ferreira JP, Girerd N, Gregson J, et al. Stroke risk in patients with reduced ejection fraction after myocardial infarction without atrial fibrillation. J Am Coll Cardiol. 2018;71(7).