AMSTERDAM—The risk of ischemic stroke after an acute myocardial infarction decreased markedly for patients with diabetes during a recent 10-year period, according to a study presented at the 2013 Annual Congress of the European Society of Cardiology. The reduction in ischemic stroke risk during the first year after a myocardial infarction was significantly greater in patients with diabetes than in patients without diabetes during the course of a decade.
“We believe that the larger risk reduction seen in the diabetic patients may indicate that they have gained more from the increased use of evidence-based secondary preventive treatment,” said Stina Jakobsson, a medical student at Umeå University in Sweden. She presented an analysis of 173,233 patients discharged from Swedish coronary care units after an acute myocardial infarction from 1998 to 2008. Approximately 19% of the patients had a previous diagnosis of diabetes.
Among patients with diabetes and a myocardial infarction from 1998 to 2000, the rate of ischemic stroke within one year of the coronary event was 7.1%. But from 2007 to 2008, the rate of ischemic stroke within one year of myocardial infarction decreased to 4.7% in patients with diabetes. This improvement was much larger than the improvement observed during the same time span among patients without diabetes. For the latter individuals, the rate of ischemic stroke during the first year after an acute myocardial infarction was 4.2% from 1998 to 2000 and decreased to 3.7% from 2007 to 2008.
Neurologists can still improve their use of reperfusion therapy and secondary preventive medications for patients with diabetes and myocardial infarction, said Ms. Jakobsson. Although the use of these key interventions increased over time in diabetic and nondiabetic patients with myocardial infarction, rates remained lower in the diabetic group in the most recent study years.
The 4.7% one-year incidence of ischemic stroke among Swedish patients with diabetes and acute myocardial infarction from 2007 to 2008 was significantly greater than the 3.7% rate among patients without diabetes. Moreover, even among patients on optimized secondary prevention therapies, the ischemic stroke rate was higher among patients with diabetes. This finding is not surprising because these patients more often had a history of prior cardiovascular disease at the time of their acute myocardial infarction. “They were sicker to start with,” said Ms. Jakobsson.
In this study, the most powerful predictors of increased risk of ischemic stroke after myocardial infarction included older age, atrial fibrillation, an ST-elevation myocardial infarction, and prior ischemic stroke.
—Bruce Jancin
IMNG Medical News