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Published on: August 18, 2015
Risk Factors Associated with Major Adverse Cardiovascular Events after Ischemic Stroke: A Linked Registry Study
Ajay S Dharan1, Lachlan L Dalli2, Muideen T Olaiya1
1Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
Insights
Major adverse cardiovascular events (MACE) are common after a first ischemic stroke, especially within the first year. Identifying risk factors and protective strategies is crucial for preventing recurrent events in stroke survivors.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Epidemiology
Background:
- Stroke survivors face a significant risk of subsequent major adverse cardiovascular events (MACE).
- Understanding the incidence and predictors of post-stroke MACE is vital for secondary prevention strategies.
Purpose of the Study:
- To determine the incidence and risk factors for MACE after a first-ever ischemic stroke.
- To analyze these factors separately for younger (18-64 years) and older (≥65 years) adult populations.
Main Methods:
- An observational cohort study utilized Australian Stroke Clinical Registry data (2009-2013) linked with administrative data.
- Patients with a first ischemic stroke and no prior cardiovascular admissions were followed for 2 years post-discharge.
- A Fine-Gray sub-distribution hazard model accounted for competing risks of non-cardiovascular death.
Main Results:
- 17% of 5,994 first-ever ischemic stroke patients experienced MACE within 2 years (129 events/1,000 person-years).
- Younger patients (18-64 years) receiving intravenous thrombolysis or discharged to rehabilitation had reduced MACE risk.
- Older patients (≥65 years) with mobility issues, smoking history, or atrial fibrillation had increased MACE risk.
- Management in large hospitals reduced MACE risk across all age groups.
Conclusions:
- MACE is a frequent complication within two years post-stroke, with a peak in the first year.
- Specific interventions targeting identified risk factors are needed for secondary prevention.
- Particular attention is required for younger stroke survivors (<65 years) to mitigate MACE risk.
Introduction:
Survivors of stroke are at risk of experiencing subsequent major adverse cardiovascular events (MACE). We aimed to determine the incidence of, and risk factors for, MACE after first-ever ischemic stroke, by age group (18-64 years vs. ≥65 years).
Methods:
Observational cohort study using patient-level data from the Australian Stroke Clinical Registry (2009-2013), linked with hospital administrative data. We included adults with first-ever ischemic stroke who had no previous acute cardiovascular admissions and followed these patients for 2 years post-discharge, or until the first post-stroke MACE event. A Fine-Gray sub-distribution hazard model, accounting for the competing risk of non-cardiovascular death, was used to determine factors for incident post-stroke MACE.
Results:
Among 5,994 patients with a first-ever ischemic stroke (median age 73 years, 45% female), 17% were admitted for MACE within 2 years (129 events per 1,000 person-years). The median time to first post-stroke MACE was 117 days (89 days if aged <65 years vs. 126 days if aged ≥65 years; p = 0.025). Among patients aged 18-64 years, receiving intravenous thrombolysis (sub-distribution hazard ratio [SHR] 0.51 [95% CI, 0.28-0.92]) or being discharged to inpatient rehabilitation (SHR 0.65 [95% CI, 0.46-0.92]) were associated with a reduced incidence of post-stroke MACE. In those aged ≥65 years, being unable to walk on admission (SHR 1.33 [95% CI 1.15-1.54]), and history of smoking (SHR 1.40 [95% CI 1.14-1.71]) or atrial fibrillation (SHR 1.31 [95% CI 1.14-1.51]) were associated with an increased incidence of post-stroke MACE. Acute management in a large hospital (>300 beds) for the initial stroke event was associated with reduced incidence of post-stroke MACE, irrespective of age group.
Conclusions:
MACE is common within 2 years of stroke, with most events occurring within the first year. We have identified important factors to consider when designing interventions to prevent MACE after stroke, particularly among those aged <65 years.
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