VENTRICULAR DYSFUNCTION AND THE RISK OF STROKE AFTER MYOCARDIAL-INFARCTION

Citation
E. Loh et al., VENTRICULAR DYSFUNCTION AND THE RISK OF STROKE AFTER MYOCARDIAL-INFARCTION, The New England journal of medicine, 336(4), 1997, pp. 251-257
Citations number
34
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Medicine, General & Internal
ISSN journal
0028-4793
Volume
336
Issue
4
Year of publication
1997
Pages
251 - 257
Database
ISI
SICI code
0028-4793(1997)336:4<251:VDATRO>2.0.ZU;2-S
Abstract
Background In patients who have had a myocardial infarction, the long- term risk of stroke and its relation to the extent of left ventricular dysfunction have not been determined. We studied whether a reduced le ft ventricular ejection fraction is associated with an increased risk of stroke after myocardial infarction and whether other factors such a s older age and therapy with anticoagulants, thrombolytic agents, or c aptopril affect long-term rates of stroke. Methods We performed an obs ervational analysis of prospectively collected data on 2231 patients w ho had left ventricular dysfunction after acute myocardial infarction who were enrolled in the Survival and Ventricular Enlargement trial. T he mean follow-up was 42 months. Risk factors for stroke were assessed by both univariate and multivariate Cox proportional-hazards analysis . Results Among these patients, 103 (4.6 percent) had fatal or nonfata l strokes during the study (rate of stroke per year of follow-up, 1.5 percent). The estimated five-year rate of stroke in all the patients w as 8.1 percent. As compared with patients without stroke, patients wit h stroke were older (mean [+/-SD] age, 63+/-9 years vs. 59+/-11 years; P<0.001) and had lower ejection fractions (29+/-7 percent vs. 31+/-7 percent, P=0.01). Independent risk factors for stroke included a lower ejection fraction (for every decrease of 5 percentage points in the e jection fraction there was an 18 percent increase in the risk of strok e), older age, and the absence of aspirin or anticoagulant therapy. Pa tients with ejection fractions of less than or equal to 28 percent aft er myocardial infarction had a relative risk of stroke of 1.86, as com pared with patients with ejection fractions of >35 percent (P=0.01). T he use of thrombolytic agents and captopril had no significant effect on the risk of stroke. Conclusions During the five years after myocard ial infarction, patients have a substantial risk of stroke. A decrease d ejection fraction and older age are both independent predictors of a n increased risk of stroke. Anticoagulant therapy appears to have a pr otective effect against stroke after myocardial infarction. (C) 1997, Massachusetts Medical Society.