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The risk of stroke following coronary revascularization -- a population-based long-term follow-up study
Minna M Kaarisalo1, Pirjo Immonen-Räihä, Reijo J Marttila
1Department of Neurology, University of Turku, Turku, Finland. minna.kaarisalo@utu.fi
Insights
Stroke risk is significantly elevated in the year following coronary revascularization (coronary artery bypass grafting or percutaneous transluminal coronary angioplasty). Key risk factors include prior stroke, diabetes, male sex, and lower socioeconomic status.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Public Health
Background:
- Coronary artery disease often requires revascularization procedures like coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA).
- Stroke is a significant complication following cardiac procedures, impacting patient outcomes and healthcare costs.
- Understanding the incidence and risk factors for post-revascularization stroke is crucial for preventative strategies.
Purpose of the Study:
- To determine the incidence of stroke after coronary revascularization (CABG or PTCA).
- To identify significant risk factors associated with stroke development in patients undergoing these procedures.
Main Methods:
- A population-based cohort study utilizing the FINMONICA Myocardial Infarction Register.
- Inclusion of 2160 patients aged 35-64 who underwent coronary revascularization between 1983-1992.
- Ascertainment of stroke events through the FINMONICA Stroke Register and National Hospital Discharge Register during an average follow-up of 5.83 years.
Main Results:
- A total of 155 patients (7.2%) experienced a stroke during follow-up.
- The cumulative incidence of stroke was 1.55% in the first year post-revascularization.
- Significant risk factors identified via Cox proportional hazard models included previous stroke (RR 3.01), diabetes mellitus (RR 2.61), low income (RR 2.15), male sex (RR 2.06), and increasing age (RR 1.43 per decade).
Conclusions:
- The incidence of stroke in the first year after revascularization is substantially higher (fivefold) compared to the general population.
- Patients with a history of stroke, diabetes, advanced age, male gender, and lower socioeconomic status require heightened vigilance due to their elevated stroke risk post-CABG or PTCA.
Objective:
To study the incidence and risk factors of stroke after coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA).
Design:
During 1983-1992, coronary revascularization procedures (n = 2160) were recorded in patients aged 35-64 years as part of the population-based FINMONICA Myocardial Infarction Register. The FINMONICA Stroke Register and National Hospital Discharge Register were used to ascertain subsequent stroke events in such patients.
Results:
During the average follow-up of 5.83 years, 155 patients (7.2%) had a stroke. The cumulative incidence of stroke was 1.55% in the first year after revascularization and varied between 0.8 and 1.4% during subsequent years. In Cox proportional hazard models the relative risk of stroke was 3.01 (p = 0.0007) for a previous stroke, 2.61 (p = 0.0001) for diabetes mellitus, 2.15 (p = 0.007) for low income (compared with high income), 2.06 (p = 0.03) for male sex, and 1.43 (p = 0.02) for a 10-year increment in age.
Conclusion:
The incidence of stroke during the first year after revascularization was five times higher than among the age- and sex-matched general population. Patients with a previous stroke, diabetes mellitus, advanced age, male sex and low socioeconomic status need special attention because of increased risk of stroke after CABG or PTCA.