Acute coronary syndromes in patients with prior cerebrovascular events: Lessons from the Euro-Heart Survey of Acute Coronary Syndromes

David Hasdai*, Moti Haim, Solomon Behar, Valentina Boyko, Alexander Battler

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background: The aim of this study was to determine the frequency of prior cerebrovascular events (CE) among patients with an acute coronary syndrome (ACS) and to compare the clinical characteristics, clinical course, treatment, and outcomes of patients with ACS with and without a prior CE. Methods and Results: We prospectively enrolled 10,484 patients with ACS in 103 hospitals in 25 countries across Europe and the Mediterranean basin. A prior CE was reported in 254 of 4338 patients (5.9%) with ST elevation, 420 of 5215 patients (8.1%) without ST elevation, and 92 of 663 patients (13.9%) with an undetermined electrocardiographic pattern. In general, patients with a prior CE were older, more ikely to be females and nonsmokers, more commonly had prior myocardia infarction, heart failure, bypass surgery, and were more likely to have diabetes, hypertension, and renal failure. While in the hospital, they had more heart failure, and they were more likely to receive warfarin, digoxin, diuretics and calcium-channel blockers, and less likely to receive antiplatelet agents, β-blockers, and statins. The inhospital mortality rates were 9.1% (with a prior CE) versus 6.4% (without a prior CE) for patients with ACS with ST elevation; 5.0% versus 2.0% for patients with ACS with non-ST elevation; and 14.1% versus 10.7% for patients with ACS with undetermined electrocardiographic results. The adjusted risk (95% CI) of inhospital death for patients with a prior CE was 1.12 (0.70, 1.81), 1.79 (1.06, 3.00), and 0.92 (0.44, 1.94) for ST-elevation ACS, non-ST-elevation ACS, and ACS with undetermined electrocardiogram, respectively. The P value for interaction between prior CE and the type of ACS on outcome was .10. Conclusions: Patients with a prior CE constitute 7.5% of patients with ACS and have high-risk features. A prior CE is associated with increased inhospital mortality, particularly in patients with with non-ST-elevation ACS.

Original languageEnglish
Pages (from-to)832-838
Number of pages7
JournalAmerican Heart Journal
Issue number5
StatePublished - Nov 2003


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