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Risk for adverse events linked to stroke history in CAD
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CAD patients with history of stroke also appear to be at increased risk for death, MI or stroke, researchers reported in Circulation.
“This excess risk of hemorrhagic stroke is particularly high in patients receiving dual antiplatelet therapy and in the first year following stroke or transient ischemic attack,” Gregory Ducrocq, MD, of the AP-HP, Hôpital Bichat, Paris, and colleagues wrote in the study. “This observation is important for selection of antithrombic therapy in these patients.”
Researchers analyzed baseline characteristics and 4-year follow-up data on 26,389 patients with CAD, 17% of whom had a history of stroke or TIA. All were included in the international REACH registry of atherothrombosis.
The rate of recurrent CV events was higher among patients with a history of stroke/TIA when compared with patients with no history (adjusted HR=1.52; 95% CI, 1.4-1.65). This association was especially high for nonfatal ischemic stroke (adjusted HR=3.06; 95% CI, 2.62-3.57) and nonfatal hemorrhagic stroke (adjusted HR=1.76; 95% CI, 1.00-3.08). The researchers found that the higher risk for nonfatal hemorrhagic stroke was limited to the first year after a stroke/TIA (adjusted HR=3.03; 95% CI, 1.51-6.08). In addition, risk for nonfatal hemorrhagic stroke was particularly high among patients receiving dual antiplatelet therapy (adjusted HR=5.21; 95% CI, 1.24-21.9).
“This analysis of the REACH registry revealed that in patients with CAD, a history of CVD is frequent (affecting approximately 17% of patients) and associated with an independent increase in risk of death, MI or stroke. This greater risk of stroke (13.1% vs. 4.1%) was observed for both nonfatal ischemic (9.6% vs. 2.5%) and nonfatal hemorrhagic stroke (0.6% vs. 0.3%),” the researchers wrote. “While the former was much higher in absolute terms, the latter is a concern when considering increased potency of antithrombotic interventions.”
Disclosure:See the full study for a list of the researchers’ relevant financial disclosures.
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