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1. Incidence and characteristics of stroke during 90-day follow-up in patients stabilized after an acute
coronary syndrome.......................................................................................................................................... 1
13 May 2014 ii ProQuest
Document 1 of 1

Incidence and characteristics of stroke during 90-day follow-up in patients stabilized after an acute
coronary syndrome
Author: Kassem-Moussa, Hassan; Mahaffey, Kenneth W; Graffagnino, Carmelo; Tasissa, Gudaye; Sila, Cathy
A; Simes, RJohn; White, Harvey D; Califf, Robert M; Bhapkar, Manjshri V; Newby, LKristin

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Abstract: Background
Stroke is a rare but serious event that complicates the course of patients with acute coronary syndromes (ACS).
The type, outcome, and risk factors of stroke occurring in stabilized patients with ACS have not been previously
reported.
Methods
We evaluated stroke incidence, subtypes, and outcomes, in addition to demographics and clinical risk
characteristics associated with stroke among patients enrolled in the Sibrafiban versus Aspirin to Yield
Maximum Protection from Ischemic Heart Events Post-acute Coronary Syndromes (SYMPHONY) and 2nd
SYMPHONY trials.
Results
Of 15,904 stabilized patients with ACS, 113 (0.71%) had a stroke over a median follow-up of 90 days. The
majority of strokes occurred within 30 days of presentation, and the time course for stroke occurrence paralleled
that of myocardial (re)infarction. Most strokes were ischemic (78%), and 52% resulted in moderate or severe
disability or death. Patients with stroke were older and more often had hypertension, diabetes, peripheral
vascular disease, and atrial fibrillation. Among patients with stroke who had cardiac catheterization,
percutaneous coronary intervention, or coronary artery bypass grafting, stroke occurred predominantly after the
procedure. No difference in occurrence or type of stroke was observed in the assigned treatment groups. In
multivariable modeling age, heart failure, prior stroke, left bundle branch block, and systolic blood pressure
predicted the occurrence of stroke.
Conclusions
In patients stabilized after presenting with a spectrum of ACS and treated with sibrafiban and/or aspirin, stroke
occurred in fewer than 1% within 90 days but carried a significant mortality and morbidity risk.
Subject: Heart attacks; Acute coronary syndromes; Cardiology; Coronary vessels;
MeSH: Acute Disease, Aged, Angina, Unstable -- drug therapy, Angina, Unstable -- therapy, Angioplasty,
Balloon, Coronary -- adverse effects, Aspirin -- therapeutic use, Coronary Artery Bypass -- adverse effects,
Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Myocardial Infarction -- drug therapy,
Myocardial Infarction -- therapy, Oximes -- therapeutic use, Piperidines -- therapeutic use, Platelet Aggregation
Inhibitors -- therapeutic use, Proportional Hazards Models, Recurrence, Risk Factors, Stroke -- epidemiology,
Angina, Unstable -- complications (major), Myocardial Infarction -- complications (major), Stroke -- etiology
(major)
Substance: Oximes; Piperidines; Platelet Aggregation Inhibitors; sibrafiban; Aspirin;

Corporate/institutional author: SYMPHONY and 2nd SYMPHONY Investigators
Publication title: The American Heart Journal
Volume: 148
Issue: 3
13 May 2014 Page 1 of 2 ProQuest
Pages: 439-46
Publication year: 2004
Publication date: Sep 2004
Year: 2004
Publisher: Elsevier Limited
Place of publication: Philadelphia
Country of publication: United States
Publication subject: Medical Sciences--Cardiovascular Diseases
ISSN: 00028703
CODEN: AHJOA2
Source type: Scholarly Journals
Language of publication: English
Document type: Journal Article, Clinical Trial
DOI: http://dx.doi.org/10.1016/j.ahj.2004.01.028
Accession number: 15389230
ProQuest document ID: 1504459105
Document URL: http://search.proquest.com/docview/1504459105?accountid=50673
Copyright: Copyright Elsevier Limited Sep 2004
Last updated: 2014-04-30
Database: ProQuest Medical Library,ProQuest Nursing & Allied Health Source
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