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| Death due to cardiac causes nearly doubles after first ischaemic stroke |
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23 March 2006
Cardiac mortality is nearly twice as high as mortality due to recurrent stroke following first ischaemic stroke, according to a study published in the March issue of Neurology. However, the long-term risk of all strokes is higher than that of all cardiac events.
"Few population-based studies with long-term follow-up have compared risk of recurrent stroke and cardiac events after first ischaemic stroke," Dr MS Elkind and colleagues from Columbia University, New York, write. "The relative risk of these two outcomes may inform treatment decisions."
The researchers prospectively followed a total of 655 ischaemic stroke patients enrolled in the population-based Northern Manhattan Study for recurrent stroke, myocardial infarction (MI), and cause-specific mortality. The team defined fatal cardiac events as death secondary to MI, congestive heart failure, sudden death/arrhythmia, and cardiopulmonary arrest. Kaplan-Meier survival analysis was used to calculate the risk of events. Risk data were adjusted for age and sex using Cox proportional hazards models. The mean age of the cohort was 69.7 years. Median follow-up was 4 years. The adjusted risk of recurrent stroke was higher than the risk of cardiac events: approximately 2.5 times the risk of cardiac events at 30 days (1.5 versus 0.6%) and more than twice the risk at 5 years (18.3 versus 8.6%). The 5-year risk of non-fatal stroke (14.8%) was approximately twice as high as fatal cardiac events (6.4%) and four times higher than risk of fatal stroke (3.7%).
At 5 years, the risk of non-fatal stroke was approximately four times that of non-fatal MI. Patients who survived at least 30 days after stroke had a higher risk of recurrent stroke than of a cardiac event throughout follow-up. For fatal outcomes, the 5-year risk of a fatal cardiac event was 6.4% compared to 3.7% for fatal stroke.
Reference:
Neurology 2006; 66 (5): 641-646.
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