Predictors of stroke in high-risk patients after acute myocardial infarction: insights from the VALIANT Trial

Area of Science:

• Cardiology
• Neurology
• Clinical Research

Background:

• Patients with acute myocardial infarction (MI) complicated by heart failure or left ventricular systolic dysfunction are at high risk for subsequent stroke.
• Understanding stroke risk in this population is crucial for developing targeted preventive strategies.

Purpose of the Study:

• To develop risk models for predicting early and late stroke in a large cohort of high-risk post-myocardial infarction (MI) patients.
• Identify key predictors of stroke in this specific patient group.

Main Methods:

• Prospective analysis of 14,703 patients from the VALIANT trial, randomized to valsartan, captopril, or combination therapy post-MI.
• Multivariable Cox proportional hazards regression was used to evaluate 92 pre-specified potential predictor variables for early (<45 days) and late (>45 days) stroke.

Main Results:

• A total of 463 strokes (3.2%) occurred, with 134 in the first 45 days. Ischaemic stroke was most common (348 cases).
• Key predictors for early stroke included estimated glomerular filtration rate and heart rate in sinus rhythm.
• Diastolic blood pressure >90 mmHg, prior stroke, and atrial fibrillation were the strongest predictors of overall stroke.

Conclusions:

• The risk of stroke within 6 weeks post-MI in high-risk patients without neurological symptoms is approximately 0.94%.
• Diastolic blood pressure and atrial fibrillation are significant, modifiable risk factors for stroke in post-MI patients, warranting therapeutic attention.