Background: Previous reports have associated acute coronary syndromes(ACSs) with cerebrovascular disease but in general have not included long- term patient follow- up or have not analyzed ischemic and hemorrhagic cer...Background: Previous reports have associated acute coronary syndromes(ACSs) with cerebrovascular disease but in general have not included long- term patient follow- up or have not analyzed ischemic and hemorrhagic cerebrovascular events separately. Methods: We analyzed stroke outcomes from the OPUS- TIMI 16 study, a multicenter, randomized, placebo- controlled trial. Patients were randomized to aspirin plus either orbofiban or placebo and followed for up to 1 year. Cerebrovascular events were prospectively identified and classified by a committee of cardiologists and neurologists blinded to treatment assignment. Results: During 10 months of follow- up, there were 150(1.5% ) patients with cerebrovascular events. Risk factors for ischemic stroke(n=67) and transient ischemic attack(TIA)(n=44) were age, prior ischemic stroke, history of hypertension, and increased heart rate. Prior ischemic stroke and history of hypertension were not risk factors for 30- day ischemic stroke or TIA. Risk factors for intracranial hemorrhage(ICH)(n=14) were age, history of hypertension, history of TIA, and coronary angiography with evidence of coronary artery disease. Compared with placebo, treatment with orbofiban was associated with a nonsignificant increased risk of ischemic stroke or TIA(HR 1.15, 95% CI 0.76- 1.74, P=.51)and ICH(HR 1.25, 95% CI 0.39- 4.00, P=.70). Conclusions: The overall incidence of cerebrovascular events after ACS was highest in the first 30 days then declined; risk factors for cerebrovascular events may be different in the different periods. Orbofiban, despite no significant excess risk of ICH, was not effective in preventing ischemic stroke or TIA.展开更多
文摘Background: Previous reports have associated acute coronary syndromes(ACSs) with cerebrovascular disease but in general have not included long- term patient follow- up or have not analyzed ischemic and hemorrhagic cerebrovascular events separately. Methods: We analyzed stroke outcomes from the OPUS- TIMI 16 study, a multicenter, randomized, placebo- controlled trial. Patients were randomized to aspirin plus either orbofiban or placebo and followed for up to 1 year. Cerebrovascular events were prospectively identified and classified by a committee of cardiologists and neurologists blinded to treatment assignment. Results: During 10 months of follow- up, there were 150(1.5% ) patients with cerebrovascular events. Risk factors for ischemic stroke(n=67) and transient ischemic attack(TIA)(n=44) were age, prior ischemic stroke, history of hypertension, and increased heart rate. Prior ischemic stroke and history of hypertension were not risk factors for 30- day ischemic stroke or TIA. Risk factors for intracranial hemorrhage(ICH)(n=14) were age, history of hypertension, history of TIA, and coronary angiography with evidence of coronary artery disease. Compared with placebo, treatment with orbofiban was associated with a nonsignificant increased risk of ischemic stroke or TIA(HR 1.15, 95% CI 0.76- 1.74, P=.51)and ICH(HR 1.25, 95% CI 0.39- 4.00, P=.70). Conclusions: The overall incidence of cerebrovascular events after ACS was highest in the first 30 days then declined; risk factors for cerebrovascular events may be different in the different periods. Orbofiban, despite no significant excess risk of ICH, was not effective in preventing ischemic stroke or TIA.
