Stroke Risk in HF Patients After MI Without AF

Study Questions:

What are the risk factors (other than atrial fibrillation [AF]) for stroke in patients with myocardial infarction (MI) and heart failure (HF) and/or systolic dysfunction?


The authors compiled four trial data sets, including 22,904 patients without AF or oral anticoagulant use who suffered an MI. Multivariable regression was used to identify independent clinical risk factors, and these were converted to a user-friendly scoring system. The primary outcome was stroke or death.


During a mean follow-up of 1.9 years, 660 (2.9%) patients had a stroke. After multivariable adjustment, independent predictors of stroke included older age, Killip class 3 or 4, estimated glomerular filtration rate ≤45 ml/min/1.73 m2, hypertension, and prior stroke. The model was well calibrated and had modest discrimination (c-statistic 0.67). Three-year estimated stroke risk ranged from 1.8% to 10.9% over six sextiles of the stroke risk score.


The authors concluded that a new, easy-to-use risk score can accurately estimate stroke risk in MI patients with reduced systolic function in the absence of AF.


This study builds on prior work, which highlights that risk factors for stroke are similar among AF and non-AF patients. Older age, hypertension, and prior stroke are components of both the CHA2DS2-VASc stroke risk score for AF patients and the newly proposed stroke risk score for post-MI patients. Poor renal function has also been linked to stroke risk in some AF risk scores, such as ATRIA and R2CHADS2 risk scores. Clinicians should be alert to these risk factors and ensure that appropriate preventative measures are initiated. Prospective studies are needed before prophylactic anticoagulation should be offered routinely to these patients.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Chronic Heart Failure, Hypertension

Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Glomerular Filtration Rate, Heart Failure, Heart Failure, Systolic, Hypertension, Myocardial Infarction, Myocardial Ischemia, Risk Factors, Secondary Prevention, Stroke, Stroke Volume, Vascular Diseases

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