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  • Title: Risk factors and outcome of in-hospital ischemic stroke in patients with non-ST elevation acute coronary syndromes.
    Author: Segev A, Strauss BH, Tan M, Buller CE, Mendelsohn AA, Langer A, Goodman SG, Canadian Acute Coronary Syndrome Registries Investigators.
    Journal: Int J Cardiol; 2008 Sep 26; 129(2):233-7. PubMed ID: 17976842.
    Abstract:
    OBJECTIVES: To identify predictors of ischemic stroke in patients with suspected non-ST elevation (NSTE) acute coronary syndrome (ACS) and to evaluate in-hospital and 1-year outcomes. METHODS: We analyzed 5842 patients with diagnosed NSTE ACS included in the multi-center Canadian ACS registries. Patients with in-hospital stroke (n=28, 0.5%) were compared to patients without stroke. Risk factors and short- and long-term outcome were evaluated. RESULTS: Baseline characteristics of patients with and without stroke were similar except for a significantly higher proportion of women, higher rates of in-hospital CABG, and greater use of unfractionated heparin. Crude event rates were significantly higher in patients with stroke: in-hospital death 21.4% vs. 1.6% (p<0.0001), MI 10.7% vs. 4.0% (p=0.10), and death or MI 32.1% vs. 5.1% (p<0.0001). One-year event rates were also higher in patients with stroke: death 32.1% vs. 7.4% (p<0.0001), and death or MI 39.3% vs. 13.5% (p<0.001). In multivariable analysis, independent predictors for stroke were female gender (OR 3.12, 95%CI 1.36-7.14, p=0.007), and Killip class >/=2 on admission (OR 2.87, 1.18-6.99, p=0.02). Stroke was an independent predictor of in-hospital death (OR 14.52, 4.57-46.12, p<0.0001), death or MI (6.0, 2.44-14.75, p<0.0001), as well as 1-year death (5.50, 1.94-15.60, p=0.0014), and death or MI (2.89, 1.15-7.27, p=0.025). CONCLUSIONS: In patients with NSTE ACS, stroke is associated with increased short- and long-term rates of death and MI. Stroke is highly predicted by female gender and Killip class on admission.
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