Long-term risk of stroke after acute coronary syndrome: the ABC-10* study on heart disease
Heba T Mahmoud1,2, Rocco Cordiano3, David Merotto1
1The ABC Study on Heart Disease Foundation-ONLUS, Conegliano, Italy.
Insights
Acute coronary syndrome patients face increased stroke risk, influenced by age, atrial fibrillation, and renal function. Fatal stroke risk is higher in urban areas and southern provinces, suggesting geographic disparities in care.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Myocardial infarction is linked to elevated stroke risk.
- Acute coronary syndrome (ACS) patients require long-term monitoring for stroke incidence and mortality.
- Identifying risk factors and geographic disparities is crucial for secondary prevention.
Purpose of the Study:
- To examine stroke incidence and mortality in ACS patients over a 24-year period.
- To identify independent predictors of overall and fatal stroke risk.
- To investigate potential geographic variations in stroke outcomes within the Veneto region of Italy.
Main Methods:
- A prospective cohort study involving 535 ACS patients from three Italian provinces.
- Patients were followed for 24 years, with residences categorized as urban or rural.
- Survival analysis utilized uni- and multivariable Cox regression models.
Main Results:
- The stroke incidence rate was 14 per 1,000 person-years over 6,151 person-years of follow-up.
- Independent predictors for overall stroke included older age, atrial fibrillation (AF), and higher albumin-to-creatinine ratio (ACR).
- Higher estimated glomerular filtration rate (eGFR) was associated with lower stroke risk. Fatal stroke risk was higher in urban areas and southern provinces.
Conclusions:
- Established clinical factors like age, AF, and renal function are key predictors of post-ACS stroke.
- Novel geographic disparities in fatal stroke outcomes were observed, particularly in urban and southern regions.
- Integrating geographic and clinical risk stratification is recommended for long-term secondary prevention strategies in ACS patients.
Background:
Previous studies link myocardial infarction to increased stroke risk. This long-term prospective study examines stroke incidence and stroke-related mortality in acute coronary syndrome (ACS) patients, identifying risk factors and geographic disparities.
Methods:
We enrolled 535 ACS patients admitted to hospitals across three provinces in the Veneto region of Italy. Patients' residences were classified into three urban and three rural areas in each province. Patients were followed prospectively for 24 years or until death. Survival analysis was conducted using uni- and Multivariable Cox regression models.
Results:
All patients, except for three, completed the follow-up, totaling 6.151 person-years. During follow-up, 84 patients experienced a stroke, with 85% being ischemic and 15% hemorrhagic, proving fatal in 43 cases. The stroke incidence rate was 14/1.000 person-years. Older age (HR 1.84; 95% CI 1.30-2.60), atrial fibrillation (AF) (HR 2.64; 95% CI 1.49-4.67), and a higher albumin-to-creatinine ratio (ACR) tertile (HR 1.38; 95% CI 1.04-1.83) were independent predictors of overall stroke risk, while higher estimated glomerular filtration rate tertile (eGFR) (HR 0.71; 95% CI 0.53-0.95) was independent predictor a lower risk. A sub-analysis revealed older age (HR 2.67; 95% CI 1.60-4.45) and AF (HR 2.95; 95% CI 1.38-6.32) as independent predictors of fatal stroke. Unexpectedly, we observed a higher fatal stroke risk in urban areas (HR 1.89; 95% CI 1.03-3.48) and southern provinces (HR 1.71; 95% CI 1.15-2.53).
Conclusion:
This long-term cohort study reinforces the role of established clinical predictors (age, AF, renal function) in post-ACS stroke risk and highlights novel geographic disparities in fatal stroke outcomes. These findings support the integration of geographic and clinical risk stratification in long-term secondary prevention strategies.
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