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Predicting Stroke Risk in Patients With ACS

Predicting Stroke Risk in Patients With ACS

Clinical outcomes after stroke can be devastating and include high risks of mortality and severe debilitation. In a study published in the American Journal of Cardiology, my colleagues and I sought to develop a clinical risk prediction model that would allow physicians to identify patients with acute coronary syndrome (ACS) who are at a higher risk of developing in-hospital stroke. We wanted to identify independent risk factors for developing a stroke in the acute time period of an ACS. The final model was created based on data from 63,118 patients with a total of 217 ischemic strokes. Testing a New Model Using a multivariable analysis, eight baseline and presenting clinical characteristics were independently associated with the occurrence of ischemic stroke: 1. Older age. 2. Atrial fibrillation or flutter on index electrocardiogram. 3. Systolic blood pressure ≥160 mm Hg. 4. Positive initial cardiac biomarkers. 5. No previous or current smoking. 6. ST segment change. 7. Killip class II to IV. 8. Lower body weight. The risk prediction model for the primary endpoint of ischemic stroke within 14 days of hospitalization was developed by converting final model estimates to points. For example, each 10-kg decrease in weight, starting with 210 kg to 219 kg, was assigned 1 point. Atrial fibrillation or flutter was assigned 4 points. Points for each of any of the eight patient factors were summed to obtain a total patient risk score. Patients with risk scores of 21 to 27 had a 14-day stroke risk of about 0.4%. This risk increased to more than 1.0% when scores rose above 30 points and to 1.0% or 2.0% in those...
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