Incidence and predictors of stroke in patients discharged with the diagnosis of acute coronary syndrome

Background: Stroke is one the most feared cardiovascular disease due to its high risk of disability and its incidence after an acute coronary syndrome (ACS) is not uncommon. Methods: Retrospective study of all consecutive patients admitted for an ACS in two hospitals. Competing risk regression, taking all-cause mortality as a competing event, was used for the assessment of stroke incidence. Results: We included 8771 patients, AF prevalence 12.4%. AF patients were older and presented higher prevalence of cardiovascular risk factors, previous cardiovascular disease, and lower glomerular filtration rate. Less than half of AF patients were receiving oral anticoagulation before admission. In-hospital mortality was 5.1% and it was more than two-fold higher in AF patients (10.2% vs. 4.4%; p < 0.01). Relevant differences on medical treatments were observed at discharge and oral anticoagulation was roughly <50% in AF patients. During a median follow-up was 58.7 months, 313 patients experienced at least one stroke (incidence 3.8%, 95% CI 3.4-4.2,) and it was 2-fold higher in patients with AF: 7.8% vs. 3.3% (p < 0.01). Median time to first stroke was 33.0 (30.1) months and it was shorter for AF patients compared to non-AF patients (28.2 +/- 22.3 vs. 34.6 +/- 31.1; p < 0.01). The adjusted competing risk regression identified AF, previous stroke and CHA(2)DS(2-)VASc score = 2 or >= 3 as independent predictors of stroke; CHA(2)DS(2-)VASc score = 2 was associated to higher risk of stroke only in AF patients. Conclusions: The long-term incidence of stroke after an ACS was 3.8%, 7.8% in AF-patients and 3.3% in patients without any diagnosis of AF. (c) 2018 Elsevier B.V. All rights reserved.