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(Circulation. 2001;104:269.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Stroke in Relation to Cardiac Procedures in Patients With Non–ST-Elevation Acute Coronary Syndrome

A Study Involving >18 000 Patients

Lisa Cronin, MD, MSc; Shamir R. Mehta, MD, FRCPC; Feng Zhao, MSc; Janice Pogue, MSc; Andrzej Budaj, MD, PhD; David Hunt, MD; Salim Yusuf, DPhil, FRCP; , for the OASIS Investigators

From the Preventive Cardiology and Therapeutics Program and the Division of Cardiology, McMaster University, Hamilton, Canada (L.C., S.R.M., F.Z., J.P., S.Y.); Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland (A.B.); and Royal Melbourne Hospital, Melbourne, Australia (D.H.).

Reprint requests to Professor Salim Yusuf, Preventive Cardiology and Therapeutics Program, McMaster University, HGH-McMaster Clinic, 237 Barton St E, Hamilton, ON L8L 2X2 Canada. E-mail yusuf{at}ccc.mcmaster.ca

Background— There are few published data on risk factors for stroke in patients with non–ST-elevation acute coronary syndrome (ACS). We investigated prognostic factors for stroke in 2 large cohorts of patients from the Organization to Assess Strategies for Ischemic Syndromes (OASIS) registry (8010) and the OASIS-2 trial (10 141)

Methods and Results— A total of 18 151 patients with non–ST-elevation ACS were enrolled in the OASIS program. Data from these 2 studies were pooled (a test for heterogeneity was nonsignificant, P=0.34). Overall, 238 patients (1.3%) had a stroke over a 6-month follow-up. Those who experienced stroke had a 4-fold increase in 6-month mortality (27.0% versus 6.3%, P<0.001). A Cox multivariate regression analysis identified CABG surgery as the most important predictor of stroke (hazard ratio [HR], 4.6), followed by history of stroke (HR, 2.3), diabetes mellitus (HR, 1.7), older age (HR, 1.6 per 10-year increase), higher heart rate (HR, 1.1 per 10-bpm increase), and on-site catheterization facility (HR, 1.4). There was no significant excess in stroke in patients undergoing percutaneous coronary intervention (P=0.21). Patients who underwent early CABG surgery were at a substantially increased risk compared with those who had later CABG (3.3% versus 1.6%; HR, 2.1; P=0.003) or who had no surgery (3.3% versus 1.1%; HR, 3.95; P=0.0001).

Conclusions— In this large cohort of patients with ACS, stroke was an uncommon but serious event associated with high mortality. The performance of early CABG surgery was a powerful independent predictor of stroke.

Key Words: stroke • coronary disease • angina • risk factors • prognosis

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