Long-term risk of Stroke after Acute Coronary Syndrome. The ABC-10* Study on Heart Disease.

Abstract Background Previous studies link myocardial infarction to increased stroke risk. This long-term prospective study examines stroke incidence and outcomes in acute coronary syndrome (ACS) patients, identifying risk factors and geographic disparities. Methods We enrolled 535 ACS patients admitted to hospitals across three provinces in the Veneto region of Italy. Patients’ residences were classified into three urban and three rural areas in each province. Patients were followed prospectively for 24 years or until death. Results All patients, except for three, completed the follow-up, totaling 6151 person-years. During follow-up, 84 patients experienced a stroke, with 85% being ischemic and 15% hemorrhagic, proving fatal in 43 cases. The stroke incidence rate was 14/1000 person-years. Multivariable Cox regression analysis identified older age (HR 1.84; 95% CI 1.30-2.60), atrial fibrillation (AF) (HR 2.64; 95% CI 1.49-4.67), and a higher albumin-to-creatinine ratio (HR 1.38; 95% CI 1.04-1.83) as independent predictors of overall stroke risk, while higher eGFR (HR 0.71; 95% CI 0.53-0.95) was independently associated with a lower risk. A sub-analysis revealed older age (HR 2.67; 95% CI 1.60-4.45) and AF (HR 2.95; 95% CI 1.38-6.32) as independent predictors of fatal stroke. Unexpectedly, we observed a higher fatal stroke risk in urban areas (HR 1.89; 95% CI 1.03-3.48) and southern provinces (HR 1.71; 95% CI 1.15-2.53). Conclusion The ABC study identified several baseline clinical predictors associated with higher stroke risk long after ACS. A geographical association with the risk of fatal stroke was also observed, underscoring the importance of considering both individual clinical predictors and broader geographic factors in stroke prevention policies.