NEW STROKE RISK SCORE FOR PATIENTS WITH CORONARY ARTERY DISEASE

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Objective: The study aimed to analyze the possible association of clinical factors with the development of strokes in patients after acute coronary syndrome (ACS). Design and method: 1843 ACS pts from the 4 PCI centers were included in ORACLE II (ObseRvation after Acute Coronary syndrome for deveLopment of trEatment options) observational multicenter study (NCT04068909 ClinicalTrials.gov) in 2014–2017 years. Mean age 64,9 years, 1149 (61,9%) man. The primary end-point was all-cause death. Ischemic stroke was one of the secondary end-points. We collected data about unfavorable outcomes on 25, 90, 180 and 360 days after hospital discharge. We also control blood pressure (BP) on the day of discharge and at all follow-up visits. Visit-to-visit BP variability was expressed as the CV (%) of mean BP across all visits during the follow-up. Results: We fixed 42 stokes during the follow-up (2,3%). 25 strokes were fatal. Patients with stroke during the follow up were older (70,9 ± 11,88 and 64,7 ± 12,72, p = 0,01), had higher blood pressure visit to visit variability (CV 25,3 ± 4,25 and 12.7 ± 3,67%, p = 0,019). These patients more frequently had arterial hypertension (100% and 88%, p = 0,017) and lower rate of achievement target blood pressure (35,7% and 62,7%). Patients with stroke had higher rate of atrial fibrillation (38,1% and 16,9%), heart failure (83,3% and 49,6%), peripheral atherosclerosis (47,6% and 25,4%), CKD (64,3% and 36,7%), IGT (17,1% vs 7,1%). Stroke patients were less likely to receive anticoagulant therapy (2,0% vs 5,8%, p = 0,003) and were less likely to receive PCI during index hospitalization (31,1% vs 50,5%, p = 0,01). These patients also had lower level of HDL (1,00 ± 0,266 vs 1,18 ± 0,503, p = 0,039). According to results of linear regression analysis we make simple stroke risk score: BP CV low than 12% (-1), atrial fibrillation (+3), heart failure (+2), IGT (+2), CKD (+1), HDL more than 1 mmol/l (-1), PCI (-1), anticoagulants treatment (-3). Score higher than 4 is associated with high store risk. Area under the ROC curve for this risk score was 0,780. Conclusions: BP variability and HDL levels, GFR, PCI, heart failure, atrial fibrillation, and anticoagulant treatment were associated with the risk of ischemic stroke.