Stroke Risk in Patients With Reduced Ejection Fraction After Myocardial Infarction Without Atrial Fibrillation

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:71

Article

Ferreira, Joao Pedro^1,2  Girerd, Nicolas¹  Gregson, John³  Latar, Ichraq¹  Sharma, Abhinav^4,5  Pfeffer, Marc A.⁶  McMurray, John J. V.⁷  Abdul-Rahim, Azmil H.⁸  Pitt, Bertram⁹  Dickstein, Kenneth¹⁰  Rossignol, Patrick¹  Zannad, Faiez¹ 

[1] Univ Lorraine, Reg Univ Hosp Nancy,F CRIN, INSERM,Ctr Clin Multidisciplinary Res 1433,U1116, Invest Network Initiat Cardiovasc & Renal Clin Tr, Nancy, France

[2] Univ Porto, Fac Med, Dept Physiol & Cardiothorac Surg, Cardiovasc Res & Dev Unit, Oporto, Portugal

[3] London Sch Hyg & Trop Med, Dept Biostat, London, England

[4] Duke Univ, Duke Clin Res Inst, Durham, NC USA

[5] Univ Alberta, Mazankowski Alberta Heart Inst, Edmonton, AB, Canada

[6] Harvard Med Sch, Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA USA

[7] Univ Glasgow, BHF Cardiovasc Res Ctr, Glasgow, Lanark, Scotland

[8] Univ Glasgow, Inst Neurosci & Psychol, Glasgow, Lanark, Scotland

[9] Univ Michigan, Sch Med, Dept Med, Ann Arbor, MI 48104 USA

[10] Univ Bergan, Stavanger Univ Hosp, Dept Cardiol, Stavanger, Norway

关键词: heart failure;    myocardial infarction;    risk score;    stroke;   

DOI  :  10.1016/j.jacc.2017.12.011

来源: Elsevier

【 摘 要 】

BACKGROUND Stroke can occur after myocardial infarction (MI) in the absence of atrial fibrillation (AF). OBJECTIVES This study sought to identify risk factors (excluding AF) for the occurrence of stroke and to develop a calibrated and validated stroke risk score in patients with MI and heart failure (HF) and/or systolic dysfunction. METHODS The datasets included in this pooling initiative were derived from 4 trials: CAPRICORN (Effect of Carvedilol on Outcome After Myocardial Infarction in Patients With Left Ventricular Dysfunction), OPTIMAAL (Optimal Trial in Myocardial Infarction With Angiotensin II Antagonist Losartan), VALIANT (Valsartan in Acute Myocardial Infarction Trial), and EPHESUS (Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study); EPHESUS was used for external validation. A total of 22,904 patients without AF or oral anticoagulation were included in this analysis. The primary outcome was stroke, and death was treated as a competing risk. RESULTS During a median follow-up of 1.9 years (interquartile range: 1.3 to 2.7 years), 660 (2.9%) patients had a stroke. These patients were older, more often female, smokers, and hypertensive; they had a higher Killip class; a lower estimated glomerular filtration rate; and a higher proportion of MI, HF, diabetes, and stroke histories. The final stroke risk model retained older age, Killip class 3 or 4, estimated glomerular filtration rate #45 ml/min/1.73 m(2), hypertension history, and previous stroke. The models were well calibrated and showed moderate to good discrimination (C-index = 0.67). The observed 3-year event rates increased steeply for each sextile of the stroke risk score (1.8%, 2.9%, 4.1%, 5.6%, 8.3%, and 10.9%, respectively) and were in agreement with the expected event rates. CONCLUSIONS Readily accessible risk factors associated with the occurrence of stroke were identified and incorporated in an easy-to-use risk score. This score may help in the identification of patients with MI and HF and a high risk for stroke despite their not presenting with AF. (c) 2018 the American College of Cardiology Foundation. Published by Elsevier. All rights reserved.

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