Stroke patients more prone to recurrent stroke than fatal MI

Takeaway

• Risk for myocardial infarction (MI) after ischaemic stroke/transient ischaemic attack (IS/TIA) is <2% per year.
• Risk for death because of recurrent stroke is higher than death from fatal MI in patients without coronary artery disease (CAD).

Why this matters

• Stroke patients with vascular risk factors remain at higher risk for subsequent MI, reinforcing the need for optimal secondary prevention to prevent MI as well as recurrent stroke in these patients.

Study design

• Systematic review of 58 studies which includes 131,299 patients with IS/TIA from inception till December 11, 2016.
• Risks for MI, recurrent stroke, cardiac death and vascular death were evaluated.
• Funding: None disclosed.

Key results

• Mean follow-up duration was 3.5 years.
• Annual risk for MI was found to be significantly higher (1.67%/year; P_het<.001 for heterogeneity) and it decreased over time (P_int=.021).
• Annual risk for MI was higher in patients with a history of CAD (1.91%) vs patients without CAD (0.85%; P_int=.036).
• Annual risk for recurrent stroke was 4.26%/year (P_het<.001), and the risk for fatal MI was half the risk of recurrent strokes ending in fatality (incidence ratio, 0.51; P_het=.58).
• Risk for recurrent stroke was significantly higher compared with nonfatal MI (incidence ratio, 0.25; P_het=.68).

Limitations

• Only studies with ≥100 patients were included.
• Risk for bias.