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Year : 2020  |  Volume : 2  |  Issue : 1  |  Page : 13-18

Incidence, predictors, and mortality of in-hospital stroke after acute coronary syndrome in the Middle East

1 Department of cardiology, Sabah Al Ahmad Cardiac Center, Al Amiri hospital, Kuwait City, Kuwait
2 Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University; Gulf Health Research, Muscat, Oman
3 Department of Cardiology, Royal Hospital, Muscat, Sultanate of Oman
4 Department of internal medicine with the subspecialty of cardiology, Mubarak hospital, Kuwait City, Kuwait
5 Department of Cardiology, Illinois Masonic Medical Center, Chicago, IL, USA

Correspondence Address:
Dr. Wadhha AlSaeed
Department of Cardiology, Sabah Al Ahmad Cardiac Center, Al Amiri Hospital, Kuwait City, Kuwait. 32001.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ACCJ.ACCJ_4_20

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Background and Objectives: The aim of this study is to determine the incidence, predictors, and outcomes of patients that developed in-hospital stroke in acute coronary syndrome (ACS) in the Middle East region. Methods: Data were analyzed from 4044 patients with a diagnosis of ACS admitted to 29 hospitals in 4 Arabian Gulf countries (Bahrain, Kuwait, Oman, and United Arab Emirates) from January 2012 to January 2013. Stroke was defined as a loss of neurological function caused by an ischemic or hemorrhagic event with residual symptoms at least 24 h after onset or leading to death. Analyses were performed using univariate and multivariate statistics. Results: Mean age of the cohort was 60 ± 13 years and 66% (n = 2686) were male. A total of 0.89% (n = 36) developed acute stroke during the index hospital admission. Of these, 25 (69%) were diagnosed with thrombotic, 9 (25%) hemorrhagic, and 2 (6%) unknown. Those patients that developed in-hospital stroke were more likely to suffer in-hospital death (31 vs. 4.0%; P < 0.001), cardiogenic shock (25 vs. 5.1%; P < 0.001), major bleeding (8.3 vs. 1.6%; P = 0.022), heart failure (39 vs. 13%; P < 0.001), and cardiac arrest (17 vs. 3.2%; P < 0.001). At 1 year, the cumulative all-cause mortality was 53% (n = 19) in those that developed in-hospital stroke. In hospital stroke was also associated with more prolonged hospital stay (7.5 vs. 4.0 days; P < 0.001). Adjusting for other factors in the model, the multivariate logistic regression model demonstrated that prior stroke (adjusted odds ratio [aOR], 4.61; 95% confidence interval [CI]: 1.97–10.8; P < 0.001) and left ventricular ejection fraction (LVEF) of <40% (aOR, 2.26; 95% CI: 1.05–4.87; P = 0.038) were associated with the development of in-hospital stroke. Conclusions: The incidence of in-hospital stroke in patients with ACS in the Middle East is low, but, when it occurs is associated with high all-cause in-hospital and 1-year mortality. Prior stroke and LVEF <40% were associated with the development of in-hospital stroke in this population.

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