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Predictors of strok...
Predictors of stroke within 30 days in patients with non-ST-segment elevation acute coronary syndromes
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Westerhout, Cynthia M. (författare)
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Hernández, Adrián V. (författare)
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Steyerberg, Ewout W. (författare)
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Bueno, Héctor (författare)
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White, Harvey (författare)
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Théroux, Pierre (författare)
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Moliterno, David J. (författare)
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Armstrong, Paul W. (författare)
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Califf, Robert M. (författare)
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- Wallentin, Lars, 1943- (författare)
- Uppsala universitet,Institutionen för medicinska vetenskaper,Uppsala kliniska forskningscentrum (UCR)
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Simoons, Maarten L. (författare)
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Boersma, Eric (författare)
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(creator_code:org_t)
- 2006-04-07
- 2006
- Engelska.
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 27:24, s. 2956-2961
- Relaterad länk:
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https://academic.oup...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
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- AIMS: Stroke is an uncommon but serious complication after non-ST-segment elevation acute coronary syndrome (NSTE-ACS). We aimed to identify predictors of stroke within 30 days in patients who suffered NSTE-ACS. METHODS AND RESULTS: We pooled data from six trials (n=31 402) that randomized NSTE-ACS patients either to platelet glycoprotein (GP) IIb/IIIa receptor blockers or to placebo/control therapy. Potential predictors of stroke included treatment, demographic, and clinical characteristics. We identified predictors using univariable and multivariable logistic models, and their performance was evaluated with calibration (Hosmer-Lemeshow test) and discrimination (c-statistic). We found 228 (0.7%) all-cause strokes: 155 (0.5%) non-haemorrhagic, 20 (0.06%) haemorrhagic, and 53 without computed tomography (CT) confirmation. Patients with any type of stroke had a 30-day mortality of 25%. Randomization to GP IIb/IIIa receptor blockers was not significantly associated with all-cause stroke [OR (95% CI) 1.08 (0.83-1.41)]. Older age [OR per 10-year increase 1.5 (1.3-1.7)], prior stroke [2.1 (1.4-3.1)], and elevated heart rate [per 10-beat increase 1.1 (1.0-1.2)] were the strongest predictors of 30-day all-cause stroke. Similar predictors were found for non-haemorrhagic and haemorrhagic strokes. Smoking, previous myocardial infarction, diabetes, and hypertension were not independent predictors of all-cause stroke. The multivariable model to predict all-cause stroke was well calibrated, but its discrimination was only moderate [c-statistic 0.69 (0.65-0.72)]. CONCLUSION: Stroke is a rare complication occurring early after NSTE-ACS, but is associated with high mortality. We found no evidence that GP IIb/IIIa receptor blockers increase stroke risks. A few clinical characteristics predicted higher stroke risks. Thus, incident strokes in NSTE-ACS patients remain largely unexplained.
Nyckelord
- Mortality
- Non-ST-segment elevation acute coronary syndromes
- Platelet glycoprotein IIb/IIIa receptor blocker
- Prediction
- Stroke
- MEDICINE
- MEDICIN
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Westerhout, Cynt ...
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Hernández, Adriá ...
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Steyerberg, Ewou ...
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Bueno, Héctor
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White, Harvey
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Théroux, Pierre
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visa fler...
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Moliterno, David ...
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Armstrong, Paul ...
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Califf, Robert M ...
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Wallentin, Lars, ...
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Simoons, Maarten ...
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Boersma, Eric
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visa färre...
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European Heart J ...
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Uppsala universitet