Post-ACS stroke risk exceeded expected rates up to 2 years (SIR 1.40; 95% CI 1.03-1.87; p=0.028) but progressively reversed to below the population norm at 10-15 years (SIR 0.50; p<0.001).
Cohort (n=2,424)
Does intensive risk factor management after acute coronary syndrome alter the long-term risk of incident stroke compared to the general population?
Post-ACS stroke risk is initially elevated but falls below the population norm after 5 years, suggesting that long-term intensive secondary prevention for ACS effectively acts as primary prevention for stroke.
Estimación del efecto: SIR 1.40 (95% CI 1.03-1.87)
valor p: p=0.028
Abstract Background and aims The impact of multi-intervention primary prevention of stroke has proved difficult to assess even in people with vascular risk factors due to poor treatment-adherence on long-term trial follow-up. However, a measure of potential could be estimated from the time-course of stroke incidence on intensive risk factor management after acute coronary syndrome (ACS). Long-term stroke risk should be high due to shared vascular risk factors, but intensive prevention could gradually reduce risk. In the absence of previous studies, we compared the time-course of long-term stroke risk after ACS with age/sex-specific expected rates. Methods In a UK population-based study of all vascular events (2002–2022), post-90-day incident strokes after an incident ACS were identified to 15-years by face-to-face follow-up and multiple other sources. Follow-up period-specific observed vs expected stroke rates (age/sex-adjusted Poisson standardised incidence ratios -SIRs) were derived using contemporaneous underlying population stroke incidence. Results During 23,396 years of follow-up of 2,424 90-day post-ACS survivors there were 167 incident strokes. The incidence exceeded expected up to 2-years (SIR=1.40, 95%CI=1.03-1.87, p=0.028), but progressively reversed (pint0.001) at 2-5-years (0.86,0.62-1.16, p=0.39), 5-10 years (0.68,0.51-0.89, p=0.005) and 10-15 years (0.50,0.33-0.72, p0.001). Results were similar after accounting for competing risks of cardiac and other causes of death. Conclusions Post-ACS stroke risk is increased until 2-years, but subsequently reverses to below the population norm, even without adjustment for risk factor burden. Long-term primary prevention of incident stroke could be highly effective in other settings if similarly intensive management could be achieved. Conflict of interest Li zhang. nothing to disclose
Zhang et al. (Fri,) conducted a cohort in Acute Coronary Syndrome (n=2,424). Intensive risk factor management post-ACS vs. Age/sex-specific expected population rates was evaluated on Incident strokes (SIR 1.40, 95% CI 1.03-1.87, p=0.028). Post-ACS stroke risk exceeded expected rates up to 2 years (SIR 1.40; 95% CI 1.03-1.87; p=0.028) but progressively reversed to below the population norm at 10-15 years (SIR 0.50; p<0.001).