Initial acute myocardial infarction was associated with a lower risk of secondary acute ischemic stroke than initial acute ischemic stroke (aHR 0.318; 95% CI 0.306-0.330; p<0.001).
Cohort (n=241,894)
What are the long-term risks of recurrence and mortality in patients with first incident acute ischemic stroke, acute myocardial infarction, or acute hemorrhagic stroke?
Initial AMI and AHS are associated with higher long-term mortality compared to initial AIS, while initial AIS carries a higher risk for recurrent AIS and AMI.
Effect estimate: aHR 0.318 (95% CI 0.306-0.330)
p-value: p=<0.001
Background: We aimed to identify the long-term risk of recurrence and mortality in patients who experienced acute ischemic stroke (AIS), acute myocardial infarction (AMI), or acute hemorrhagic stroke (AHS) using a population-level database. Methods: This retrospective cohort study included adults aged ≥55 years diagnosed with AIS, AMI, and AHS in the National Health Insurance Service Database between 2004 and 2007. The target outcomes were secondary AIS, AMI, AHS, and all-cause mortality. Predetermined covariates, such as age, sex, socioeconomic status, hypertension, diabetes, and dyslipidemia, were adjusted. Results: We included 151,181, 49,077, and 41,636 patients in the AIS, AHS, and AMI groups, respectively. The AMI (adjusted hazard ratio aHR, 0.318; 95% confidence interval CI, 0.306−0.330; p < 0.001) and AHS (aHR, 0.489; 95% CI, 0.472−0.506; p < 0.001) groups had a significantly lower risk of developing secondary AIS than the AIS group. The risk of developing secondary AMI was significantly lower in the AMI (aHR, 0.388; 95% CI, 0.348−0.433; p < 0.001) and AHS (aHR, 0.711; 95% CI, 0.640−0.790; p < 0.001) groups than in the AIS group. Initial AHS was a decisive risk factor for secondary AHS (aHR, 8.546; 95% CI, 8.218−8.887; p < 0.001). The AMI (aHR, 1.436; 95% CI, 1.412−1.461; p < 0.001) and AHS (aHR, 1.328; 95% CI, 1.309−1.348; p < 0.001) groups were associated with a significantly higher risk of long-term mortality than the AIS group. Conclusion: Our results elucidated that initial AIS was a significant risk factor for recurrent AIS and AMI; initial AHS was a decisive risk factor for developing secondary AHS. Further, AMI and AHS were more closely related to long-term mortality than AIS.
Park et al. (Tue,) conducted a cohort in Acute ischemic stroke, acute myocardial infarction, or acute hemorrhagic stroke (n=241,894). Initial acute myocardial infarction or acute hemorrhagic stroke vs. Initial acute ischemic stroke was evaluated on Secondary acute ischemic stroke (aHR 0.318, 95% CI 0.306-0.330, p=<0.001). Initial acute myocardial infarction was associated with a lower risk of secondary acute ischemic stroke than initial acute ischemic stroke (aHR 0.318; 95% CI 0.306-0.330; p<0.001).