Risk of Stroke in Chronic Heart Failure Patients Without Atrial Fibrillation: Analysis of the Controlled Rosuvastatin in Multinational Trial Heart Failure (CORONA) and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure (GISSI-HF) Trials

• BACKGROUND: Our aim was to describe the incidence and predictors of stroke in patients who have heart failure without atrial fibrillation (AF). METHODS AND RESULTS: We pooled 2 contemporary heart failure trials, the Controlled Rosuvastatin in Multinational Trial Heart Failure (CORONA) and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza cardiaca-Heart Failure trial (GISSI-HF). Of the 9585 total patients, 6054 did not have AF. Stroke occurred in 165 patients (4.7%) with AF and in 206 patients (3.4%) without AF (rates 16.8/1000 patient-years and 11.1/1000 patient-years, respectively). Using Cox proportional-hazards models, we identified the following independent predictors of stroke in patients without AF (ranked by chi(2) value): age (hazard ratio, 1.34; 95% confidence interval, 1.18-1.63 per 10 years), New York Heart Association class (1.60, 1.21-2.12 class III/IV versus II), diabetes mellitus treated with insulin (1.87, 1.22-2.88), body mass index (0.74, 0.60-0.91 per 5 kg/m(2) up to 30), and previous stroke (1.81, 1.19-2.74). N-terminal pro B-type natriuretic peptide (available in 2632 patients) was also an independent predictor of stroke (hazard ratio, 1.31; 1.11-1.57 per log unit) when added to this model. With the use of a risk score formulated from these predictors, we found that patients in the upper third of risk had a rate of stroke that approximated the risk in patients with AF. CONCLUSIONS: A small number of demographic and clinical variables identified a subset of patients who have heart failure without AF at a high risk of stroke.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

Adult

Aged

Aged

80 and over

Atrial Fibrillation/etiology

Benzimidazoles/therapeutic use

Biological Markers/blood

Cardiovascular Agents/therapeutic use

Diabetes Mellitus

Type 1/complications

Fatty Acids

Omega-3/ therapeutic use

Female

Fluorobenzenes/ therapeutic use

Follow-Up Studies

Heart Failure/complications/ drug therapy

Humans

Hydroxymethylglutaryl-CoA Reductase Inhibitors/ therapeutic use

Kaplan-Meier Estimate

Male

Middle Aged

Natriuretic Peptide

Brain/ blood

Peptide Fragments/ blood

Proportional Hazards Models

Pyrimidines/ therapeutic use

Randomized Controlled Trials as Topic

Risk Factors

Stroke/epidemiology/ etiology/prevention & control

Stroke Volume

Sulfonamides/ therapeutic use

Tetrazoles/therapeutic use

atrial fibrillation

heart failure

sinus rhythm

stroke

ventricular ejection fraction

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)