Analysis Of The Clinical Characteristics And Prognosis In The Patients Of Acute Stroke Complicated By Acute Coronary Syndrome

Objective:To investigate the risk factors,the clinical characteristics and prognosis in the patients of acute stroke complicated by acute coronary syndrome。Methods:We evaluated 7394 patients with ACS who diagnosed and admitted to Beijing Friendship Hospital,Capital Medical University from January 2011 to December 2014。34 patients who had acute stroke complicated by acute coronary syndrome were found。We focused on the clinical characteristics of the disease,and clinical outcomes of the patients, compared them with 66 patients with acute coronary syndrome who did not cause acute stroke,to find the risk factors for cardiovascular disease。Major adverse cardiovascular events were observed during 12~54 months follow-up。Results:In-hospital acute strokes occurred in a total of 34 patients(0.46%).The incidences of in-hospital stroke were significantly higher in patients with STEMI and NSTEMI than unstable angina(0.68%、0.82% vs.0.30%,P<0.05)。Of the 34 patients,11(32.35%)had STEMI, 9(26.47%) had NSTEMI, and 14(41.18%) had unstable angina. The median age of the patients was 68.06±11.19 years, and 19(55.88%)were male and 30(88.24%)were acute cerebral infarction or TIA。The hospitalized days Of 34 patients were 6 to 67 days。4(11.76%) of these patients died during hospital,one of acute cerebral infarction,three of cerebral hemorrhage and the disability rate was 47.06%。During the follow-up,6(17.65%) of these patients with acute cerebral infarction died,and there patients had the recurrence of cardiovascular events。The total incidence of mace events was 38.24%.。Half of the 34 patients with acute stroke complicated by acute coronary syndrome were after percutaneous coronary intervention。9 patients(53%) happened in less than one day after the operation。15 of those who developed acute stroke after PCI were acute cerebral infarction and there was no deaths happened in hospital and the follow-up period。2 of those who developed acute stroke after PCI were cerebral hemorrhage and all of them died in hospital。The mortality of acute stroke related to PCI and the total incidence of MACE events both were lower than acute stroke not related to PCI by Kaplan and Meier methods,but it has no statistical significance。(P = 0.07/229)。Multiple logistic regression analysis reveals that only the carotid plaques and RDW are the independent risk factors of the patients of acute ischemic stroke complicated by acute coronary syndrome(carotid plaques P=0.004,OR1.178,OR95%CI 1.055--1.580;RDW P=0.006,OR1.624,OR95%CI 1.147--2.300)。The hospitalized days was longer than the control group(median 17.5,quartile range 12.5,22.0 to median 7,quartile range 5,10,P=0.00)。Conclusion :In-hospital acute stroke occurred in a total of 34 ACS patients(0.46%).Stroke is an uncommon event in patients with ACS but is associated with high mortality.The survivors suffered from the limbs powerless、activity obstacle or aphasia。50% acute stroke occured after percutaneous coronary interventionsin and happened at the early period of the post operating more often。The incidence rate decreased gradually as the time passed too。...