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Cardiovascular events and death after myocardial infarction or ischemic stroke in an older Medicare population.

ABSTRACT: BACKGROUND:Survivors of myocardial infarction (MI) or ischemic stroke (IS) are at high risk for subsequent cardiovascular events. HYPOTHESIS:Older patients with prior MI or IS are at risk for recurrent cardiovascular events, and comorbidities such as diabetes may increase this risk. METHODS:Two cohorts were studied in a retrospective Medicare 20% random sample-a 2008 cohort with up to 6?years of follow-up (MI, N?=?26?460; IS, N?=?17?566) and a 2012 cohort with 1?year of follow-up (MI, N?=?26?548; IS, N?=?17?728). RESULTS:In older patients who survived an event of MI or IS (2012 cohort), 7.2% had a recurrent MI and 6.7% had a recurrent IS in the first year; 32% died. Accounting for multiple recurrent events (2012 cohort), the event rates per 100 patient-years were 11.6 and 10.2 for the MI and IS cohorts, respectively. Cumulative incidence of recurrence (2008 cohort) increased from 7.7% at 1 year to 14.3% at 6 years for recurrent MI and from 6.7% at 1 year to 13.4% at 6 years for recurrent IS. Comorbid diabetes (2012 cohort) was significantly associated (adjusted risk ratio) with MI recurrence (1.44) and risk of coronary revascularization (1.23) in the MI cohort and with IS recurrence (1.26) in the IS cohort. CONCLUSION:In this older population with prior MI or IS, high rates of recurrent cardiovascular events and multiple recurrent events were observed. These findings highlight the need for aggressive intervention for secondary prevention and management of comorbidities in high-risk patients, particularly those with diabetes.

SUBMITTER: Li S

PROVIDER: S-EPMC6712383 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Cardiovascular events and death after myocardial infarction or ischemic stroke in an older Medicare population.

Li Suying S Peng Yi Y Wang Xinyue X Qian Yi Y Xiang Pin P Wade Sally W SW Guo Haifeng H Lopez J Antonio G JAG Herzog Charles A CA Handelsman Yehuda Y

Clinical cardiology 20190225 3

<h4>Background</h4>Survivors of myocardial infarction (MI) or ischemic stroke (IS) are at high risk for subsequent cardiovascular events.<h4>Hypothesis</h4>Older patients with prior MI or IS are at risk for recurrent cardiovascular events, and comorbidities such as diabetes may increase this risk.<h4>Methods</h4>Two cohorts were studied in a retrospective Medicare 20% random sample-a 2008 cohort with up to 6 years of follow-up (MI, N = 26 460; IS, N = 17 566) and a 2012 cohort with 1 year of fol ...[more]

PMID: 30697776

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Project description:BackgroundAcute ischemic stroke (AIS) complicating an acute myocardial infarction (AMI) is not uncommon, but can severely worsen the clinical prognosis. This study aimed to investigate whether remote ischemic conditioning (RIC) could provide clinical benefits to patients with AIS complicating AMI.MethodsSubjects with AIS complicating AMI were recruited in this double-blind, randomized, controlled trial; assigned to the RIC and sham groups; and respectively underwent twice daily RIC and sham RIC for 2 weeks. All subjects received standard medical therapy. The primary endpoint was the rate of major adverse cardiac and cerebrovascular events (MACCEs) within 3 months after enrollment. MACCEs comprise of death from all causes, unstable anginas, AMI, acute ischemic strokes, and transient ischemic attacks.ResultsEighty subjects were randomly assigned; 37 patients in the RIC group and 40 patients in the sham-RIC group completed the 3-month follow-up and were included in the final analysis. Both RIC and sham RIC procedures were well tolerated. At 3-month follow-up, 11 subjects (29.7%) in the RIC group experienced MACCEs compared to 21 (52.5%) in the sham group (hazard ratio [HR], 0.396; 95% confidence interval, 0.187-0.838; adjusted p < 0.05). Six subjects (16.2%) in the RIC group had died at the 3-month follow up, significantly lower than the 15 (37.5%) deaths in the sham group (adjusted HR 0.333; 95% CI 0.126-0.881; p = 0.027). Seventeen subjects (45.9%) in the RIC group and 6 subjects (15.0%) in the sham group achieved functional independence (mRS score ≤ 2) at 3-month follow-up (adjusted OR 12.75; 95% CI 2.104-77.21; p = 0.006).ConclusionsAmong patients with acute ischemic stroke complicating acute myocardial infarction, treatment with remote ischemic conditioning decreased the major adverse cardiac and cerebrovascular events and improved functional outcomes at 90 days.Trial registrationURL: www.Clinicaltrialsgov . Unique identifier: NCT03868007. Registered 8 March 2019.

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Cardiovascular events and death after myocardial infarction or ischemic stroke in an older Medicare population.

Publications

Cardiovascular events and death after myocardial infarction or ischemic stroke in an older Medicare population.

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