Monday, June 18, 2007

Risk factors identify stroke patients at high risk of cardiac events

Risk factors identify stroke patients at high risk of cardiac events

18 June 2007

Stroke 2007; Advance online publication

MedWire News: Stroke patients at high risk for early cardiac morbidity and mortality can be identified using a model based on five clinical and demographic characteristics, say researchers.

These characteristics are a history of congestive heart failure (CHF), the presence of diabetes, baseline creatinine of more than 115 μmol/l, severe stroke, and a long heart rate-corrected QT(c) interval or ventricular extrasystoles on electrocardiogram (ECG), report Jane Prosser (Royal Melbourne Hospital, Australia) and team.

Patients with none of these characteristics have a 6.3% risk of a serious cardiac adverse event within 3 months of acute ischemic stroke, while patients with four or more characteristics have a 62.2% risk, Prosser et al report in the journal Stroke.

They explain: "Approximately 2–6% of all stroke patients die from cardiac causes in the first 3 months after ischemic stroke… Despite these relatively high risks, many patients will not have cardiac events.

"An approach to identifying patients at high risk of cardiac events is required to assess potential pre-emptive strategies, including monitoring, investigation, and treatment."

The researchers analyzed data from a trial in the Virtual International Stroke Trials archive that involved 864 participants with ischemic stroke.

By 12 weeks, 180 (21.3%) patients had died, 35 of them from cardiac causes. The risk of death from cardiac causes was highest at 14 days after stroke.

On multivariate analysis, a history of CHF was associated with an odds ratio (OR) of 3.33 for cardiac mortality within 3 months of stroke, creatinine levels of more than 115 μmol/l with an OR of 1.77, and diabetes with an OR of 2.11.

Furthermore, respective ORs of 1.98 and 1.93 were associated with severe strokes – those that scored less than the group's median score on the European Stroke Scale (ESS) – and a long QTc or ventricular extrasystoles on ECG.

Prosser et al comment: "The main points that emerge from our study are that serious cardiac adverse events are common and begin to occur very early after stroke onset.

"Furthermore, cardiac risk can be stratified with a five-point risk score derived from simple clinical and demographic variables available at the time of admission."

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