Stroke is the most common ischemic event after index stroke

Cardiology Review® Online, March 2004, Volume 21, Issue 3

SAN DIEGO—Stroke patients with or without a previous myocardial infarction (MI) are more likely to have a stroke than an MI as their next vascular event. As such, treatment of stroke patients should focus on secondary stroke prevention, said Carol Zaher, MD, MPH, at the 29th International Stroke Conference.

The rate of secondary stroke is approximately twice that of acute MI at both 1 and 2 years of follow-up in patients with an index stroke, said Dr. Zaher, a consultant at Zynx Health in Beverly Hills, California. Efforts at secondary stroke prevention are generally underused, she said. “Unlike the aggressive efforts seen for primary and secondary prevention of acute MI, secondary stroke prevention is often relegated to a less important role,” she said.

Using a managed care database, she and colleagues identified 1,776 patients who required hospitalization for an ischemic stroke. Patients were categorized into two subgroups: those with or without a history of acute MI during the 6 months before the index stroke. Some 17.3% of the study group had an MI in the 6 months before the ischemic stroke. Secondary outcomes were measured at 1 and 2 years after the index event.

Recurrent stroke occurred in 6.1% of the patients at 1 year and 7.9% at 2 years, which was significantly more often than the occurrence of acute MI at 1 and 2 years, 3.1% and 4.7%, respectively (P < .001). The subgroup that had a subsequent acute MI was more likely than the subgroup with subsequent stroke to have diabetes.

“If you have an index stroke, you’re more likely to have a stroke than an MI, and you’re likely to have it soon,” said Dr. Zaher. Of the patients who had a subsequent ischemic event, nearly one fifth had the event within 1 week of the index stroke, and almost one third had the event within 1 month. Most patients (73.7%) had their initial recurrent event within the first year after the stroke. “If you’ve had an MI in the previous 6 months, your chance of having a stroke is about equal to your chance of having an MI as your next ischemic event,” she said.

Patients aged 45 to 54 years had the highest secondary event rates: 13.8% had at least one stroke and 6.9% had at least one acute MI within 2 years of the index stroke. Early secondary stroke prevention efforts should be the hallmark of stroke management interventions regardless of cardiac history, said Dr. Zaher. Additional antiatherosclerotic therapies are key in stroke patients with

a cardiac history, she indicated, although the optimal combination of therapies requires study.