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. 2021 Apr 9;3(5):267-272.
doi: 10.1253/circrep.CR-21-0010.

Impact of Prior Stroke on Long-Term Outcomes in Patients With Acute Coronary Syndrome

Mitsuhiro Takeuchi  1 , Hideki Wada  2 , Manabu Ogita  2 , Daigo Takahashi  2 , Yui Okada-Nozaki  1 , Ryota Nishio  2 , Kentaro Yasuda  2 , Norihito Takahashi  1 , Taketo Sonoda  2 , Shoichiro Yatsu  2 , Jun Shitara  2 , Shuta Tsuboi  2 , Tomotaka Dohi  1 , Satoru Suwa  2 , Katsumi Miyauchi  1 , Hiroyuki Daida  1 , Tohru Minamino  1   3
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Impact of Prior Stroke on Long-Term Outcomes in Patients With Acute Coronary Syndrome

Mitsuhiro Takeuchi et al. Circ Rep. .

Abstract

Background: Cerebrovascular disease often coexists with coronary artery disease (CAD), and it has been associated with worse clinical outcomes in CAD patients. However, the prognostic effect of prior stroke on long-term outcomes in patients with acute coronary syndrome (ACS) is still unclear. Methods and Results: An observational cohort study of ACS patients who underwent emergency percutaneous coronary intervention (PCI) between January 1999 and May 2015 was conducted. Patients were divided into 2 groups according to their history of stroke. We evaluated both all-cause death and cardiac death. Of the 2,548 consecutive ACS patients in the current cohort, 268 (10.5%) had a history of stroke at the onset of ACS. Patients with a history of stroke were older and had a higher prevalence of comorbidities such as hypertension or renal deficiency. The cumulative incidences of all-cause death and cardiac death were significantly higher in patients with a history of stroke (both log-rank P<0.0001). Multivariate Cox hazard regression analysis showed that a history of stroke was significantly associated with the incidences of all-cause death (hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.20-1.85, P=0.0004) and cardiac death (HR 1.41, 95% CI 1.03-1.93, P=0.03). Conclusions: About 10% of the ACS patients had a history of stroke and had worse clinical outcomes.

Keywords: Coronary artery disease; Percutaneous coronary intervention; Polyvascular disease.

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Figures

Figure 1.
Figure 1.
Flow chart of the study. Of the 2,551 consecutive ACS patients treated with the emergency PCI, data of prior stroke were available for 2,548 (99.9%). The patients were divided into 2 groups: with or without a history of stroke on admission. ACS, acute coronary syndrome; PCI, percutaneous coronary intervention.
Figure 2.
Figure 2.
Kaplan-Meier curves for all-cause death (A) and cardiac death (B). Patients with a history of stroke had higher incidences of all-cause death and cardiac death (both log-rank P<0.0001) compared with those without a history of stroke during follow-up.
Figure 3.
Figure 3.
Landmark analysis of Kaplan-Meier curves for all-cause death (A) and cardiac death (B) with landmark point set at 1 month. Patients with a history of stroke had higher incidences of all-cause death and cardiac death compared with those without a history of stroke during follow-up after 1 month (both log-rank P<0.0001).
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