European Heart Journal Advance Access originally published online on November 8, 2006
European Heart Journal 2006 27(24):2956-2961; doi:10.1093/eurheartj/ehl356
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Predictors of stroke within 30 days in patients with non-ST-segment elevation acute coronary syndromes
1 Clinical Epidemiology Unit, Department of Cardiology, Erasmus MC, Dr Molewaterplein 50, PO Box 2040, Rotterdam 3000 CA, The Netherlands
2 Department of Cardiology, University of Alberta, Edmonton, Canada
3 Center for Medical Decision Making, Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
4 Department of Cardiology, Hospital Universitario Gregorio Marañón, Madrid, Spain
5 Department of Cardiology, Green Lane Hospital, Auckland, New Zealand
6 Montreal Heart Institute, Montreal, Canada
7 University of Kentucky, Lexington, KY, USA
8 Duke Clinical Research Institute, Durham, NC, USA
9 University Hospital Uppsala, Uppsala, Sweden
Received 1 April 2006; revised 7 October 2006; accepted 12 October 2006; online publish-ahead-of-print 8 November 2006.
* Corresponding author. Tel: +31 10 463 8470; fax: +31 10 463 8474. E-mail address: a.hernandez{at}erasmusmc.nl
Aims Stroke is an uncommon but serious complication after non-ST-segment elevation acute coronary syndrome (NSTE-ACS). We aimed to identify predictors of stroke within 30 days in patients who suffered NSTE-ACS.
Methods and results We pooled data from six trials (n=31 402) that randomized NSTE-ACS patients either to platelet glycoprotein (GP) IIb/IIIa receptor blockers or to placebo/control therapy. Potential predictors of stroke included treatment, demographic, and clinical characteristics. We identified predictors using univariable and multivariable logistic models, and their performance was evaluated with calibration (Hosmer–Lemeshow test) and discrimination (c-statistic). We found 228 (0.7%) all-cause strokes: 155 (0.5%) non-haemorrhagic, 20 (0.06%) haemorrhagic, and 53 without computed tomography (CT) confirmation. Patients with any type of stroke had a 30-day mortality of 25%. Randomization to GP IIb/IIIa receptor blockers was not significantly associated with all-cause stroke [OR (95% CI) 1.08 (0.83–1.41)]. Older age [OR per 10-year increase 1.5 (1.3–1.7)], prior stroke [2.1 (1.4–3.1)], and elevated heart rate [per 10-beat increase 1.1 (1.0–1.2)] were the strongest predictors of 30-day all-cause stroke. Similar predictors were found for non-haemorrhagic and haemorrhagic strokes. Smoking, previous myocardial infarction, diabetes, and hypertension were not independent predictors of all-cause stroke. The multivariable model to predict all-cause stroke was well calibrated, but its discrimination was only moderate [c-statistic 0.69 (0.65–0.72)].
Conclusion Stroke is a rare complication occurring early after NSTE-ACS, but is associated with high mortality. We found no evidence that GP IIb/IIIa receptor blockers increase stroke risks. A few clinical characteristics predicted higher stroke risks. Thus, incident strokes in NSTE-ACS patients remain largely unexplained.
Key Words: Stroke • Non-ST-segment elevation acute coronary syndromes • Platelet glycoprotein IIb/IIIa receptor blocker • Prediction • Mortality
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