A History of Stroke/Transient Ischemic Attack Indicates High Risks of Cardiovascular Event and Hemorrhagic Stroke in Patients with Coronary Artery Disease

Ahajournals: 12/31/12

Background—Randomized trials of antithrombotics in coronary artery disease (CAD) have identified prior stroke/TIA as a marker of increased intracranial bleeding risk. We aimed to further characterize the risk of ischemic and bleeding events associated with a history of stroke/TIA in patients with CAD.

Methods and Results—From the international REACH registry of atherothrombosis, baseline characteristics and 4-year follow-up of 26,389 patients with CAD, including 4460 patients (16.9%) with a history of stroke/TIA, were analyzed. Patients with prior stroke/TIA had a higher rate of recurrent CV events (CV death, MI, or stroke) than patients without: adjusted HR (1.52, 95% CI, 1.40 to 1.65; p<0.001) and specifically of non-fatal ischemic stroke (adjusted HR 3.06; 95% CI, 2.62 to 3.57; p<0.001) and non-fatal hemorrhagic stroke rates (adjusted HR, 1.76; 95% CI, 1.00 to 3.08; p=0.05). Excess risk for non-fatal hemorrhagic stroke appeared confined to the 1st year following a stroke/TIA (adjusted HR, 3.03; 95% CI, 1.51 to 6.08 for the first year) and was particularly high in patients receiving dual antiplatelet therapy (adjusted HR 5.21; 95% CI, 1.24 to 21.90). Read More