Factors ID Poststroke Cardiac Risk


SAN FRANCISCO — Patients with at least two of five risk factors after a transient ischemic attack or acute ischemic stroke should be admitted to a hospital's telemetry bed, because they have a higher risk for a significant cardiac event, Peter D. Panagos, M.D., said.

A review of records on 27 patients seen after a transient ischemic attack (TIA) and 171 patients seen after an acute ischemic stroke (AIS) found that 16% developed a significant cardiac event within 48 hours of admission to the hospital, he said at the annual meeting of the American College of Emergency Physicians. A significant cardiac event consisted of ECG changes consistent with new‐onset arrhythmia or ischemia, elevated heart enzymes (troponin I), or cardiac‐related death.

Significant cardiac events were more likely to occur in patients with diabetes, hypertension, a current smoking habit, coronary artery disease, and/or a suspected cardioembolic stroke subtype, said Dr. Panagos of Brown University, Providence, R.I.

At his institution, if a post‐TIA or post‐AIS patient has two of these five risk factors, “we tend to admit these patients to telemetry beds instead of floor beds now,” he said.

Patients without these risk factors may not need high‐acuity beds, which could free up telemetry beds for those who need closer monitoring, he added.

Among all patients studied, 26% had diabetes, 70% were hypertensive, 27% were smokers, and 23% had cardiovascular disease. When the strokes were classified by subtypes, 26% were found to be cardioembolic, 32% were large‐artery atherothromboembolic, 32% were small‐vessel thrombotic, and 10% had other etiologies.

Demographic factors and other risk factors did not influence the risk for a significant cardiac event. Other risk factors included cerebrovascular disease (found in 35% of patients), hyperlipidemia (in 41%), atrial fibrillation (in 20%), and a family history of heart disease (in 30%). Patients in the study had a mean age of 70 years, and 55% were women.

The current study is one of the first to evaluate the short‐term risk for cardiac morbidity after a TIA or AIS.

Previous studies identified a 13% risk for a recurrent TIA or stroke within 90 days of the index event.

Dr. Panagos and his coinvestigator, Alyson J. McGregor, M.D., also of Brown University, plan to review more patient records to increase the size of this relatively small study.

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