Long-term risk of stroke after acute coronary syndrome: the ABC-10* study on heart disease
Abstract Background Previous studies link myocardial infarction to increased stroke risk. This long-term prospective study examines stroke incidence and stroke-related mortality in acute coronary syndrome (ACS) patients, identifying risk factors and geographic disparities. Methods We enrolled 535 AC...
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BMC
2025-08-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-025-05040-9 |
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| author | Heba T. Mahmoud Rocco Cordiano David Merotto Mattia Ludovico Dario Fiorella Cavuto Giuseppe Berton |
| author_facet | Heba T. Mahmoud Rocco Cordiano David Merotto Mattia Ludovico Dario Fiorella Cavuto Giuseppe Berton |
| author_sort | Heba T. Mahmoud |
| collection | DOAJ |
| description | Abstract Background Previous studies link myocardial infarction to increased stroke risk. This long-term prospective study examines stroke incidence and stroke-related mortality in acute coronary syndrome (ACS) patients, identifying risk factors and geographic disparities. Methods We enrolled 535 ACS patients admitted to hospitals across three provinces in the Veneto region of Italy. Patients’ residences were classified into three urban and three rural areas in each province. Patients were followed prospectively for 24 years or until death. Survival analysis was conducted using uni- and Multivariable Cox regression models. Results All patients, except for three, completed the follow-up, totaling 6.151 person-years. During follow-up, 84 patients experienced a stroke, with 85% being ischemic and 15% hemorrhagic, proving fatal in 43 cases. The stroke incidence rate was 14/1.000 person-years. Older age (HR 1.84; 95% CI 1.30–2.60), atrial fibrillation (AF) (HR 2.64; 95% CI 1.49–4.67), and a higher albumin-to-creatinine ratio (ACR) tertile (HR 1.38; 95% CI 1.04–1.83) were independent predictors of overall stroke risk, while higher estimated glomerular filtration rate tertile (eGFR) (HR 0.71; 95% CI 0.53–0.95) was independent predictor a lower risk. A sub-analysis revealed older age (HR 2.67; 95% CI 1.60–4.45) and AF (HR 2.95; 95% CI 1.38–6.32) as independent predictors of fatal stroke. Unexpectedly, we observed a higher fatal stroke risk in urban areas (HR 1.89; 95% CI 1.03–3.48) and southern provinces (HR 1.71; 95% CI 1.15–2.53). Conclusion This long-term cohort study reinforces the role of established clinical predictors (age, AF, renal function) in post-ACS stroke risk and highlights novel geographic disparities in fatal stroke outcomes. These findings support the integration of geographic and clinical risk stratification in long-term secondary prevention strategies. |
| format | Article |
| id | doaj-art-4a982fe38fca4e8390bb6e78860a2ae2 |
| institution | Kabale University |
| issn | 1471-2261 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
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| series | BMC Cardiovascular Disorders |
| spelling | doaj-art-4a982fe38fca4e8390bb6e78860a2ae22025-08-24T11:06:55ZengBMCBMC Cardiovascular Disorders1471-22612025-08-0125111310.1186/s12872-025-05040-9Long-term risk of stroke after acute coronary syndrome: the ABC-10* study on heart diseaseHeba T. Mahmoud0Rocco Cordiano1David Merotto2Mattia Ludovico Dario3Fiorella Cavuto4Giuseppe Berton5The ABC Study on Heart Disease Foundation-ONLUSDepartment of Internal Medicine and Cardiology, Adria General HospitalThe ABC Study on Heart Disease Foundation-ONLUSThe ABC Study on Heart Disease Foundation-ONLUSThe ABC Study on Heart Disease Foundation-ONLUSThe ABC Study on Heart Disease Foundation-ONLUSAbstract Background Previous studies link myocardial infarction to increased stroke risk. This long-term prospective study examines stroke incidence and stroke-related mortality in acute coronary syndrome (ACS) patients, identifying risk factors and geographic disparities. Methods We enrolled 535 ACS patients admitted to hospitals across three provinces in the Veneto region of Italy. Patients’ residences were classified into three urban and three rural areas in each province. Patients were followed prospectively for 24 years or until death. Survival analysis was conducted using uni- and Multivariable Cox regression models. Results All patients, except for three, completed the follow-up, totaling 6.151 person-years. During follow-up, 84 patients experienced a stroke, with 85% being ischemic and 15% hemorrhagic, proving fatal in 43 cases. The stroke incidence rate was 14/1.000 person-years. Older age (HR 1.84; 95% CI 1.30–2.60), atrial fibrillation (AF) (HR 2.64; 95% CI 1.49–4.67), and a higher albumin-to-creatinine ratio (ACR) tertile (HR 1.38; 95% CI 1.04–1.83) were independent predictors of overall stroke risk, while higher estimated glomerular filtration rate tertile (eGFR) (HR 0.71; 95% CI 0.53–0.95) was independent predictor a lower risk. A sub-analysis revealed older age (HR 2.67; 95% CI 1.60–4.45) and AF (HR 2.95; 95% CI 1.38–6.32) as independent predictors of fatal stroke. Unexpectedly, we observed a higher fatal stroke risk in urban areas (HR 1.89; 95% CI 1.03–3.48) and southern provinces (HR 1.71; 95% CI 1.15–2.53). Conclusion This long-term cohort study reinforces the role of established clinical predictors (age, AF, renal function) in post-ACS stroke risk and highlights novel geographic disparities in fatal stroke outcomes. These findings support the integration of geographic and clinical risk stratification in long-term secondary prevention strategies.https://doi.org/10.1186/s12872-025-05040-9Acute coronary syndromeStrokeFatal strokeMyocardial infarctionUrban-ruralGeographic difference |
| spellingShingle | Heba T. Mahmoud Rocco Cordiano David Merotto Mattia Ludovico Dario Fiorella Cavuto Giuseppe Berton Long-term risk of stroke after acute coronary syndrome: the ABC-10* study on heart disease BMC Cardiovascular Disorders Acute coronary syndrome Stroke Fatal stroke Myocardial infarction Urban-rural Geographic difference |
| title | Long-term risk of stroke after acute coronary syndrome: the ABC-10* study on heart disease |
| title_full | Long-term risk of stroke after acute coronary syndrome: the ABC-10* study on heart disease |
| title_fullStr | Long-term risk of stroke after acute coronary syndrome: the ABC-10* study on heart disease |
| title_full_unstemmed | Long-term risk of stroke after acute coronary syndrome: the ABC-10* study on heart disease |
| title_short | Long-term risk of stroke after acute coronary syndrome: the ABC-10* study on heart disease |
| title_sort | long term risk of stroke after acute coronary syndrome the abc 10 study on heart disease |
| topic | Acute coronary syndrome Stroke Fatal stroke Myocardial infarction Urban-rural Geographic difference |
| url | https://doi.org/10.1186/s12872-025-05040-9 |
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