Wang Yun, Lichtman Judith H, Dharmarajan Kumar, Masoudi Frederick A, Ross Joseph S, Dodson John A, Chen Jersey, Spertus John A, Chaudhry Sarwat I, Nallamothu Brahmajee K, Krumholz Harlan M
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Department of Biostatistics, Harvard School of Public Health, Boston, MA.
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
Am Heart J. 2015 Jan;169(1):78-85.e4. doi: 10.1016/j.ahj.2014.06.011. Epub 2014 Jun 14.
Stroke is a common and important adverse event after acute myocardial infarction (AMI) in the elderly. It is unclear whether the risk of stroke after AMI has changed with improvements in treatments and outcomes for AMI in the last decade.
To assess trends in risk of stroke after AMI, we used a national sample of Medicare data to identify Fee-for-Service patients (n = 2,305,441) aged ≥65 years who were discharged alive after hospitalization for AMI from 1999 to 2010.
We identified 57,848 subsequent hospitalizations for ischemic stroke and 4,412 hospitalizations for hemorrhagic stroke within 1 year after AMI. The 1-year rate of ischemic stroke decreased from 3.4% (95% CI 3.3%-3.4%) to 2.6% (2.5%-2.7%; P < .001). The risk-adjusted annual decline was 3% (hazard ratio, 0.97; [0.97-0.98]) and was similar across all age and sex-race groups. The rate of hemorrhagic stroke remained stable at 0.2% and did not differ by subgroups. The 30-day mortality for patients admitted with ischemic stroke after AMI decreased from 19.9% (18.8%-20.9%) to 18.3% (17.1%-19.6%) and from 48.3% (43.0%-53.6%) to 45.7% (40.3%-51.2%) for those admitted with hemorrhagic stroke. We observed a decrease in 1-year mortality from 37.8% (36.5%-39.1%) to 35.3% (33.8%-36.8%) for ischemic stroke and from 66.6% (61.4%-71.5%) to 60.6% (55.1%-65.9%) for hemorrhagic stroke.
From 1999 to 2010, the 1-year risk for ischemic stroke after AMI declined, whereas the risk of hemorrhagic stroke remained unchanged. However, 30-day and 1-year mortality continued to be high.
中风是老年急性心肌梗死(AMI)后常见且重要的不良事件。目前尚不清楚在过去十年中,随着AMI治疗方法和预后的改善,AMI后中风的风险是否发生了变化。
为了评估AMI后中风风险的趋势,我们使用了医疗保险数据的全国样本,以确定1999年至2010年因AMI住院后存活出院的65岁及以上的按服务付费患者(n = 2,305,441)。
我们确定了AMI后1年内57,848例缺血性中风的后续住院病例和4,412例出血性中风的住院病例。缺血性中风的1年发生率从3.4%(95%CI 3.3%-3.4%)降至2.6%(2.5%-2.7%;P <.001)。风险调整后的年下降率为3%(风险比,0.97;[0.97 - 0.98]),在所有年龄和性别种族组中相似。出血性中风的发生率保持在0.2%稳定,各亚组间无差异。AMI后因缺血性中风入院患者的30天死亡率从19.9%(18.8%-20.9%)降至18.3%(17.1%-19.6%),因出血性中风入院患者的30天死亡率从48.3%(43.0%-53.6%)降至45.7%(40.3%-51.2%)。我们观察到缺血性中风的1年死亡率从37.8%(36.5%-39.1%)降至35.3%(33.8%-36.8%),出血性中风的1年死亡率从66.6%(61.4%-71.5%)降至60.6%(55.1%-65.9%)。
从1999年到2010年,AMI后缺血性中风的1年风险下降,而出血性中风的风险保持不变。然而,30天和1年死亡率仍然很高。