Risk factors and outcome of in-hospital ischemic stroke in patients with non-ST elevation acute coronary syndromes

Objectives To identify predictors of ischemic stroke in patients with suspected non-ST elevation (NSTE) acute coronary syndrome (ACS) and to evaluate in-hospital and 1-year outcomes. Methods We analyzed 5842 patients with diagnosed NSTE ACS included in the multi-center Canadian ACS registries. Patients with in-hospital stroke (n = 28, 0.5%) were compared to patients without stroke. Risk factors and short- and long-term outcome were evaluated. Results Baseline characteristics of patients with and without stroke were similar except for a significantly higher proportion of women, higher rates of in-hospital CABG, and greater use of unfractionated heparin. Crude event rates were significantly higher in patients with stroke: in-hospital death 21.4% vs. 1.6% (p < 0.0001), MI 10.7% vs. 4.0% (p = 0.10), and death or MI 32.1% vs. 5.1% (p < 0.0001). One-year event rates were also higher in patients with stroke: death 32.1% vs. 7.4% (p < 0.0001), and death or MI 39.3% vs. 13.5% (p < 0.001). In multivariable analysis, independent predictors for stroke were female gender (OR 3.12, 95%CI 1.36–7.14, p = 0.007), and Killip class ≥ 2 on admission (OR 2.87, 1.18–6.99, p = 0.02). Stroke was an independent predictor of in-hospital death (OR 14.52, 4.57–46.12, p < 0.0001), death or MI (6.0, 2.44–14.75, p < 0.0001), as well as 1-year death (5.50, 1.94–15.60, p = 0.0014), and death or MI (2.89, 1.15–7.27, p = 0.025). Conclusions In patients with NSTE ACS, stroke is associated with increased short- and long-term rates of death and MI. Stroke is highly predicted by female gender and Killip class on admission.