Predictors of Ischemic Stroke After Acute Coronary Syndrome: A Retrospective Analysis

Javaria Riaz; Hasan Shafique; Hanzalah Bin Arshad; Muhammad Shahzaib; Amatul Noor; Nadeem Ahmad; Rana Shahzaib Ali; Haris Ur Rehman; Abdullah Saif Khan; Sanwal Mehmood; Muhammad Hamza Riaz; Aimen Karamat; Sana Liaquat; Tayyab Mumtaz Khan

doi:10.7759/cureus.68692

Predictors of Ischemic Stroke After Acute Coronary Syndrome: A Retrospective Analysis

Cureus. 2024 Sep 5;16(9):e68692. doi: 10.7759/cureus.68692. eCollection 2024 Sep.

Authors

Affiliations

¹ Medicine, Mohi-ud-Din Islamic Medical College, Mirpur, PAK.
² Internal Medicine, Jinnah Hospital, Lahore, Lahore, PAK.
³ Internal Medicine, Shifa International Hospital Islamabad, Islamabad, PAK.
⁴ Internal Medicine, Tehsil Headquarter (THQ) Hospital Ahmedpur Sial, Jhang, PAK.
⁵ Medicine, Mayo Hospital, Lahore, PAK.
⁶ Cardiology, Allama Iqbal Medical College, Lahore, PAK.
⁷ Orthopaedic Surgery, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, PAK.
⁸ Internal Medicine, Rahbar Medical and Dental College, Lahore, PAK.
⁹ Internal Medicine, Allama Iqbal Medical College, Lahore, PAK.
¹⁰ Internal Medicine, Punjab Rangers Teaching Hospital, Lahore, PAK.
¹¹ Orthopaedics, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, PAK.
¹² Orthopaedic Surgery, Rawalpindi Medical University, Rawalpindi, PAK.

Abstract

Background Ischemic stroke (IS) is a fatal complication of acute coronary syndrome (ACS). Factors that speed up IS development after ACS are understudied, especially in developing countries like Pakistan. Thus, this study was designed to identify the potential risk factors of IS in patients with a preceding episode of ACS. Methodology This retrospective study was performed on 208 patients whose ACS and its consequent complications such as IS were managed in the cardiac and neurology units of Benazir Bhutto Hospital, Rawalpindi, from January 2022 to March 2023. Patients were enrolled via consecutive sampling and pre-defined inclusion and exclusion criteria. Before data collection, informed consent and ethical approval were obtained. Data were retrieved from the medical records of the patients. A self-structured proforma was applied to collect data. SPSS version 25 (IBM Corp., Armonk, NY, USA) was used for data analysis. The study variables between patients with and without IS were compared using descriptive and inferential statistics. The association between IS and its possible risk factors in patients who had previously experienced ACS was determined using multivariate logistic regression. Results Of the 208 enrolled patients, 24 (11.54%) had IS following ACS. Sedentary lifestyle (odds ratio (OR) = 3.099, 95% confidence interval (CI) = 1.025~4.219, p = 0.009), hypertension (OR = 3.060, 95% CI = 1.798~4.876, p = 0.002), diabetes mellitus (OR = 2.899, 95% CI = 1.126~4.112, p = 0.009), dyslipidemia (OR = 2.907, 95% CI = 1.332~4.254, p = 0.007), history of smoking (OR = 2.760, 95% CI = 1.234~4.122, p = 0.018), and non-adherence to ACS medication (OR = 2.966, 95% CI = 1.300~4.266, p = 0.030), were the risk factors of IS among patients with preceding ACS. Conclusions In the study population, the incidence of IS following ACS was significant. Sedentary lifestyle, hypertension, diabetes mellitus, dyslipidemia, smoking history, and non-compliance with ACS therapy all played a significant role in the development of IS in patients with prior ACS. Proper management of ACS and associated risk factors could lead to the prevention of serious complications such as IS.

Keywords: acute coronary syndrome; ischemic; predictors; retrospective; stroke.