TY - JOUR
T1 - A history of stroke/transient ischemic attack indicates high risks of cardiovascular event and hemorrhagic stroke in patients with coronary artery disease
AU - Ducrocq, Gregory
AU - Amarenco, Pierre
AU - Labreuche, Julien
AU - Alberts, Mark J.
AU - Mas, Jean Louis
AU - Ohman, E. Magnus
AU - Goto, Shinya
AU - Lavallée, Philippa
AU - Bhatt, Deepak L.
AU - Steg, Ph Gabriel
N1 - Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.
PY - 2013/2/12
Y1 - 2013/2/12
N2 - Background-Randomized trials of antithrombotics in coronary artery disease have identified previous stroke/transient ischemic attack (TIA) as a marker of increased intracranial bleeding risk. We aimed to further characterize the risk of ischemic and bleeding events associated with a history of stroke/TIA in patients with coronary artery disease. Methods and Results-From the international REduction of Atherothrombosis for Continued Health (REACH) registry of atherothrombosis, baseline characteristics and 4-year follow-up of 26 389 patients with coronary artery disease, including 4460 patients (16.9%) with a history of stroke/TIA, were analyzed. Patients with previous stroke/TIA had a higher rate of recurrent cardiovascular events (cardiovascular death, myocardial infarction, or stroke) than patients without (adjusted hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.40-1.65; P<0.001) and specifically of nonfatal ischemic stroke (adjusted HR, 3.06; 95% CI, 2.62-3.57; P<0.001) and nonfatal hemorrhagic stroke rates (adjusted HR, 1.76; 95% CI, 1.00-3.08; P=0.05). Excess risk for nonfatal hemorrhagic stroke appeared confined to the 1st year after a stroke/TIA (adjusted HR, 3.03; 95% CI, 1.51-6.08 for the first year) and was particularly high in patients receiving dual antiplatelet therapy (adjusted HR, 5.21; 95% CI, 1.24-21.90). Conclusions-In patients with coronary artery disease, a history of stroke/TIA is associated with an independent increase in risk of death, myocardial infarction, or stroke, including both ischemic and hemorrhagic stroke (the latter being smaller in absolute terms). This excess risk of hemorrhagic stroke is particularly high in patients receiving dual antiplatelet therapy and in the 1st year after stroke/TIA. This observation is important for selection of antithrombotic therapy in these patients. (Circulation. 2013;127:730-738.).
AB - Background-Randomized trials of antithrombotics in coronary artery disease have identified previous stroke/transient ischemic attack (TIA) as a marker of increased intracranial bleeding risk. We aimed to further characterize the risk of ischemic and bleeding events associated with a history of stroke/TIA in patients with coronary artery disease. Methods and Results-From the international REduction of Atherothrombosis for Continued Health (REACH) registry of atherothrombosis, baseline characteristics and 4-year follow-up of 26 389 patients with coronary artery disease, including 4460 patients (16.9%) with a history of stroke/TIA, were analyzed. Patients with previous stroke/TIA had a higher rate of recurrent cardiovascular events (cardiovascular death, myocardial infarction, or stroke) than patients without (adjusted hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.40-1.65; P<0.001) and specifically of nonfatal ischemic stroke (adjusted HR, 3.06; 95% CI, 2.62-3.57; P<0.001) and nonfatal hemorrhagic stroke rates (adjusted HR, 1.76; 95% CI, 1.00-3.08; P=0.05). Excess risk for nonfatal hemorrhagic stroke appeared confined to the 1st year after a stroke/TIA (adjusted HR, 3.03; 95% CI, 1.51-6.08 for the first year) and was particularly high in patients receiving dual antiplatelet therapy (adjusted HR, 5.21; 95% CI, 1.24-21.90). Conclusions-In patients with coronary artery disease, a history of stroke/TIA is associated with an independent increase in risk of death, myocardial infarction, or stroke, including both ischemic and hemorrhagic stroke (the latter being smaller in absolute terms). This excess risk of hemorrhagic stroke is particularly high in patients receiving dual antiplatelet therapy and in the 1st year after stroke/TIA. This observation is important for selection of antithrombotic therapy in these patients. (Circulation. 2013;127:730-738.).
KW - Antiplatelet agents
KW - Hemorrhage
KW - Myocardial ischemia
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=84873985510&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84873985510&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.112.141572
DO - 10.1161/CIRCULATIONAHA.112.141572
M3 - Article
C2 - 23277306
AN - SCOPUS:84873985510
SN - 0009-7322
VL - 127
SP - 730
EP - 738
JO - Circulation
JF - Circulation
IS - 6
ER -