Risk of ischemic stroke after an acute myocardial infarction in patients with diabetes mellitus.
BACKGROUND
Incidence, any trend over time, and predictors of ischemic stroke after an acute myocardial infarction (AMI) in diabetic patients are unknown.


METHODS AND RESULTS
Data for 173,233 unselected patients with an AMI, including 33,503 patients with diabetes mellitus, were taken from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA) during 1998 to 2008. Ischemic stroke events were recorded during 1 year of follow-up. Patients with diabetes mellitus more often had a history of cardiovascular disease, received less reperfusion therapy, and were treated with acetylsalicylic acid, P2Y12 inhibitors, and statins to a lesser extent compared with patients without diabetes mellitus. However, the use of evidence-based therapies increased markedly in both groups during the study period. The incidence of ischemic stroke during the first year after AMI decreased from 7.1% to 4.7% in patients with diabetes mellitus and from 4.2% to 3.7% in patients without diabetes mellitus. Risk reduction was significantly larger in the diabetic subgroup. Reperfusion therapy, acetylsalicylic acid, P2Y12 inhibitors, and statins were independently associated with the reduced stroke risk.


CONCLUSIONS
Ischemic stroke is a fairly common complication after an AMI in patients with diabetes mellitus, but the risk of stroke has decreased during recent years. The increased use of evidence-based therapies contributes importantly to this risk reduction, but there is still room for improvement.
['Jakobsson|Stina|S|', 'Bergström|Lisa|L|', 'Björklund|Fredrik|F|', 'Jernberg|Tomas|T|', 'Söderström|Lars|L|', 'Mooe|Thomas|T|']
D000368:Aged D000369:Aged, 80 and over D001241:Aspirin D048909:Diabetes Complications D005260:Female D005500:Follow-Up Studies D006801:Humans D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors D015994:Incidence D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D015425:Myocardial Reperfusion D058921:Purinergic P2Y Receptor Antagonists D012042:Registries D012189:Retrospective Studies D012307:Risk Factors D020521:Stroke D015996:Survival Rate D013548:Sweden
stroke myocardial infarction diabetes mellitus