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Document 1 of 1 Incidence and characteristics of stroke during 90-day follow-up in patients stabilized after an acutecoronary syndrome Author: Kassem-Moussa, Hassan; Mahaffey, Kenneth W; Graffagnino, Carmelo; Tasissa, Gudaye; Sila, CathyA; Simes, RJohn; White, Harvey D; Califf, Robert M; Bhapkar, Manjshri V; Newby, LKristin ProQuest document link Abstract: Background Stroke is a rare but serious event that complicates the course of patients with acute coronary syndromes (ACS).The type, outcome, and risk factors of stroke occurring in stabilized patients with ACS have not been previouslyreported. Methods We evaluated stroke incidence, subtypes, and outcomes, in addition to demographics and clinical riskcharacteristics associated with stroke among patients enrolled in the Sibrafiban versus Aspirin to YieldMaximum Protection from Ischemic Heart Events Post-acute Coronary Syndromes (SYMPHONY) and 2ndSYMPHONY trials. Results Of 15,904 stabilized patients with ACS, 113 (0.71%) had a stroke over a median follow-up of 90 days. Themajority of strokes occurred within 30 days of presentation, and the time course for stroke occurrence paralleledthat of myocardial (re)infarction. Most strokes were ischemic (78%), and 52% resulted in moderate or severedisability or death. Patients with stroke were older and more often had hypertension, diabetes, peripheralvascular disease, and atrial fibrillation. Among patients with stroke who had cardiac catheterization,percutaneous coronary intervention, or coronary artery bypass grafting, stroke occurred predominantly after theprocedure. No difference in occurrence or type of stroke was observed in the assigned treatment groups. Inmultivariable modeling age, heart failure, prior stroke, left bundle branch block, and systolic blood pressurepredicted the occurrence of stroke. Conclusions In patients stabilized after presenting with a spectrum of ACS and treated with sibrafiban and/or aspirin, strokeoccurred in fewer than 1% within 90 days but carried a significant mortality and morbidity risk. Subject: Heart attacks; Acute coronary syndromes; Cardiology; Coronary vessels; MeSH: Acute Disease, Aged, Angina, Unstable -- drug therapy, Angina, Unstable -- therapy, Angioplasty,Balloon, Coronary -- adverse effects, Aspirin -- therapeutic use, Coronary Artery Bypass -- adverse effects,Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Myocardial Infarction -- drug therapy,Myocardial Infarction -- therapy, Oximes -- therapeutic use, Piperidines -- therapeutic use, Platelet AggregationInhibitors -- therapeutic use, Proportional Hazards Models, Recurrence, Risk Factors, Stroke -- epidemiology,Angina, Unstable -- complications (major), Myocardial Infarction -- complications (major), Stroke -- etiology(major) Substance: Oximes; Piperidines; Platelet Aggregation Inhibitors; sibrafiban; Aspirin; Corporate/institutional author: SYMPHONY and 2nd SYMPHONY Investigators Publication title: The American Heart Journal Volume: 148 Issue: 3

Pages: 439-46 Publication year: 2004 Publication date: Sep 2004 Year: 2004 Publisher: Elsevier Limited Place of publication: Philadelphia Country of publication: United States Publication subject: Medical Sciences--Cardiovascular Diseases ISSN: 00028703 CODEN: AHJOA2 Source type: Scholarly Journals Language of publication: English Document type: Journal Article, Clinical Trial DOI: http://dx.doi.org/10.1016/j.ahj.2004.01.028 Accession number: 15389230 ProQuest document ID: 1504459105 Document URL: http://search.proquest.com/docview/1504459105?accountid=50673 Copyright: Copyright Elsevier Limited Sep 2004 Last updated: 2014-04-30 Database: ProQuest Medical Library,ProQuest Nursing & Allied Health Source

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