Effect of prior stroke on the use of evidence-based therapies and in-hospital outcomes in patients with myocardial infarction (from the NCDR ACTION GWTG Registry)

Farhad Abtahian, Benjamin Olenchock, Fang-Shu Ou, Michael C. Kontos, Jorge F. Saucedo, Benjamin M. Scirica, Nihar Desai, Eric Peterson, Matthew Roe, Christopher P. Cannon, Stephen D. Wiviott

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Patients with previous stroke are at high-risk for myocardial infarction (MI). Concern regarding increased risk of bleeding or recurrent stroke in this patient population might alter therapeutic decisions. Data were collected from 281 hospitals in the United States in the NCDR ACTION Registry. Patients with ST-segment elevation MI (STEMI; n = 15,997) or non-STEMI (NSTEMI; n = 25,514) entered into the registry from January 1, 2007 through December 31, 2007 were included. We assessed use of evidence-based medications and procedures in patients with and without previous stroke. Risk-adjusted odds ratio of death, major bleeding not related to coronary artery bypass grafting, and a composite outcome (major adverse cardiac events [MACEs], i.e., death/MI/stroke/cardiogenic shock/congestive heart failure) were calculated using logistic regression. Previous stroke was reported in 5.1% of patients with STEMI and 9.3% of those with NSTEMI. Of patients with STEMI eligible for reperfusion therapy, those with previous stroke were less likely to receive reperfusion therapy compared to patients without previous stroke. Patients with previous stroke had longer door-to-needle and door-to-balloon times. Of patients with STEMI and NSTEMI, those with previous stroke were less likely to receive evidence-based therapies. Death, MACEs, and major bleeding were more common with previous stroke. When adjusted for baseline risk, patients with previous stroke were at increased risk of death (only those with STEMI) and MACEs but not bleeding. In conclusion, patients with STEMI and previous stroke are at increased risk for death and patients with STEMI and NSTEMI are at increased risk of MACE. Despite this, previous stroke patients are less likely to receive guideline-based MI therapies.

Original languageEnglish (US)
Pages (from-to)1441-1446
Number of pages6
JournalAmerican Journal of Cardiology
Volume107
Issue number10
DOIs
StatePublished - May 15 2011
Externally publishedYes

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Registries
Stroke
Myocardial Infarction
Therapeutics
Hemorrhage
Reperfusion
Cardiogenic Shock
ST Elevation Myocardial Infarction
Coronary Artery Bypass
Needles
Heart Failure
Logistic Models
Odds Ratio
Guidelines
Non-ST Elevated Myocardial Infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of prior stroke on the use of evidence-based therapies and in-hospital outcomes in patients with myocardial infarction (from the NCDR ACTION GWTG Registry). / Abtahian, Farhad; Olenchock, Benjamin; Ou, Fang-Shu; Kontos, Michael C.; Saucedo, Jorge F.; Scirica, Benjamin M.; Desai, Nihar; Peterson, Eric; Roe, Matthew; Cannon, Christopher P.; Wiviott, Stephen D.

In: American Journal of Cardiology, Vol. 107, No. 10, 15.05.2011, p. 1441-1446.

Research output: Contribution to journalArticle

Abtahian, F, Olenchock, B, Ou, F-S, Kontos, MC, Saucedo, JF, Scirica, BM, Desai, N, Peterson, E, Roe, M, Cannon, CP & Wiviott, SD 2011, 'Effect of prior stroke on the use of evidence-based therapies and in-hospital outcomes in patients with myocardial infarction (from the NCDR ACTION GWTG Registry)', American Journal of Cardiology, vol. 107, no. 10, pp. 1441-1446. https://doi.org/10.1016/j.amjcard.2011.01.020
Abtahian, Farhad ; Olenchock, Benjamin ; Ou, Fang-Shu ; Kontos, Michael C. ; Saucedo, Jorge F. ; Scirica, Benjamin M. ; Desai, Nihar ; Peterson, Eric ; Roe, Matthew ; Cannon, Christopher P. ; Wiviott, Stephen D. / Effect of prior stroke on the use of evidence-based therapies and in-hospital outcomes in patients with myocardial infarction (from the NCDR ACTION GWTG Registry). In: American Journal of Cardiology. 2011 ; Vol. 107, No. 10. pp. 1441-1446.
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abstract = "Patients with previous stroke are at high-risk for myocardial infarction (MI). Concern regarding increased risk of bleeding or recurrent stroke in this patient population might alter therapeutic decisions. Data were collected from 281 hospitals in the United States in the NCDR ACTION Registry. Patients with ST-segment elevation MI (STEMI; n = 15,997) or non-STEMI (NSTEMI; n = 25,514) entered into the registry from January 1, 2007 through December 31, 2007 were included. We assessed use of evidence-based medications and procedures in patients with and without previous stroke. Risk-adjusted odds ratio of death, major bleeding not related to coronary artery bypass grafting, and a composite outcome (major adverse cardiac events [MACEs], i.e., death/MI/stroke/cardiogenic shock/congestive heart failure) were calculated using logistic regression. Previous stroke was reported in 5.1{\%} of patients with STEMI and 9.3{\%} of those with NSTEMI. Of patients with STEMI eligible for reperfusion therapy, those with previous stroke were less likely to receive reperfusion therapy compared to patients without previous stroke. Patients with previous stroke had longer door-to-needle and door-to-balloon times. Of patients with STEMI and NSTEMI, those with previous stroke were less likely to receive evidence-based therapies. Death, MACEs, and major bleeding were more common with previous stroke. When adjusted for baseline risk, patients with previous stroke were at increased risk of death (only those with STEMI) and MACEs but not bleeding. In conclusion, patients with STEMI and previous stroke are at increased risk for death and patients with STEMI and NSTEMI are at increased risk of MACE. Despite this, previous stroke patients are less likely to receive guideline-based MI therapies.",
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AU - Saucedo, Jorge F.

AU - Scirica, Benjamin M.

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AU - Cannon, Christopher P.

AU - Wiviott, Stephen D.

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AB - Patients with previous stroke are at high-risk for myocardial infarction (MI). Concern regarding increased risk of bleeding or recurrent stroke in this patient population might alter therapeutic decisions. Data were collected from 281 hospitals in the United States in the NCDR ACTION Registry. Patients with ST-segment elevation MI (STEMI; n = 15,997) or non-STEMI (NSTEMI; n = 25,514) entered into the registry from January 1, 2007 through December 31, 2007 were included. We assessed use of evidence-based medications and procedures in patients with and without previous stroke. Risk-adjusted odds ratio of death, major bleeding not related to coronary artery bypass grafting, and a composite outcome (major adverse cardiac events [MACEs], i.e., death/MI/stroke/cardiogenic shock/congestive heart failure) were calculated using logistic regression. Previous stroke was reported in 5.1% of patients with STEMI and 9.3% of those with NSTEMI. Of patients with STEMI eligible for reperfusion therapy, those with previous stroke were less likely to receive reperfusion therapy compared to patients without previous stroke. Patients with previous stroke had longer door-to-needle and door-to-balloon times. Of patients with STEMI and NSTEMI, those with previous stroke were less likely to receive evidence-based therapies. Death, MACEs, and major bleeding were more common with previous stroke. When adjusted for baseline risk, patients with previous stroke were at increased risk of death (only those with STEMI) and MACEs but not bleeding. In conclusion, patients with STEMI and previous stroke are at increased risk for death and patients with STEMI and NSTEMI are at increased risk of MACE. Despite this, previous stroke patients are less likely to receive guideline-based MI therapies.

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