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Relationship of cardiac disease to stroke occurrence, recurrence, and mortality
J P Broderick1, S J Phillips, W M O'Fallon
1Department of Neurology, Mayo Clinic, Rochester, Minn. 55905.
Insights
Cardiac conditions are linked to first-time strokes. Congestive heart failure and atrial fibrillation predict stroke death, while cardiac valve disease and heart failure predict recurrent strokes.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- A population-based study examined cardiac diseases in relation to first-time cerebral infarction.
- Data was collected from 1,382 residents of Rochester, Minn., between 1960 and 1984.
Purpose of the Study:
- To investigate the association between cardiac conditions and cerebral infarction.
- To identify cardiac sources of emboli in patients experiencing their first stroke.
- To determine predictors of death and recurrent stroke in this patient cohort.
Main Methods:
- Utilized a medical record-linkage system for a population-based study.
- Identified cardiac disease in patients with first cerebral infarction.
- Analyzed data using Cox proportional-hazards models.
Main Results:
- 23% of patients had a potential cardiac source of emboli, more common in those over 75.
- Stroke recurrence rates were similar for patients with and without cardiac sources of emboli.
- The risk of death within 30 days was significantly higher for patients with cardiac sources of emboli (23%) compared to those without (8%).
Conclusions:
- Age, prior myocardial infarction, atrial fibrillation, congestive heart failure, and an age x congestive heart failure interaction predicted death.
- Cardiac valve disease and congestive heart failure were significant predictors of recurrent stroke.
Background And Purpose:
This is a study of cardiac diseases associated with the 1,382 cases of first cerebral infarction in residents of Rochester, Minn., during 1960-1984.
Methods:
This is a population-based study in Rochester, Minn., for which the medical record-linkage system was used to identify cardiac disease among patients with first cerebral infarction.
Results:
There were 318 patients (23%) who had at least one major potential cardiac source of emboli. The proportion of patients with a cardiac source of emboli was significantly higher among patients older than age 75 years (29%) than among younger patients (17%). The 30-day stroke recurrence rate among patients with a cardiac source of emboli (2%) was not significantly different than that among those without a cardiac source of emboli (2%). Among patients with a cardiac source of emboli, there was no difference in the probability of stroke at 30 days and at 90 days for those treated or not treated with anticoagulants. During the first 30 days after cerebral infarction, the risk of death in patients with a cardiac source of emboli (23%) was 14 times that of recurrent stroke. The risk of death at 30 days in patients without a cardiac source of emboli was 8%.
Conclusions:
Significant independent predictors of death (Cox proportional-hazards analysis) were age, prior myocardial infarction, atrial fibrillation present at onset of stroke, congestive heart failure before the stroke, and an age x congestive heart failure interaction. The only significant independent predictors of recurrent stroke were cardiac valve disease and congestive heart failure.