***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND PURPOSE Modern treatment may have influenced the risk of stroke after myocardial infa rct ion ( MI ) . The purpose of this study was to examine the incidence of ischemic stroke during the first month after an acute MI in an unselected population , to identify predictors of MI-related stroke , and to investigate the secular trend in MI-related stroke incidence . METHODS In this case-control study , from a population of approximately 310000 25- to 74-year-old inhabitants , case subjects with a stroke within 1 month after an MI were prospect ively recorded in the population -based Northern Sweden MONICA ( Monitoring of Trends and Determinants in Cardiovascular Disease ) study from 1985 to 1994 . The same number of control subjects with an MI but without a stroke were matched for age , sex , and year when MI occurred . RESULTS One hundred twenty-four case subjects were recorded . Fifty-one percent ( 63/124 ) of the strokes occurred within 5 days after onset of MI . The odds ratios ( ORs ) of an MI-related stroke were for a history of hypertension 1.7 ( 95 % confidence interval [ CI ] , 1.0 to 3.2 ) , previous stroke 2.4 ( CI , 1.0 to 6.1 ) , chronic atrial fibrillation 3.0 ( CI , 1.1 to 9.2 ) , onset of atrial fibrillation during the hospital stay 3.5 ( CI , 1.4 to 10.1 ) , ST-segment elevation 2.4 ( CI , 1.4 to 4.6 ) , and anterior infa rct ion 1.5 ( CI , 0.9 to 2.6 ) . In a conditional multiple logistic regression model , previous stroke ( OR , 2.8 ; CI , 1.1 to 7.6 ) , chronic atrial fibrillation ( OR , 3.8 ; CI , 1.3 to 11.0 ) , new-onset atrial fibrillation ( OR , 4.6 ; CI , 1.6 to 12.8 ) , and ST-segment elevation ( OR , 3.4 ; CI , 1.6 to 7.4 ) were independent predictors of stroke . MIs preceding stroke were larger and in 51 % were located anteriorly . There was a decrease in the incidence and event rate of MI-related stroke during the study period ( P < .01 and P < .05 , respectively ) . CONCLUSIONS The risk of stroke is highest the first 5 days after MI . Only approximately half of the strokes occurring the first month after an MI are preceded by an anterior MI . The most important predictors of MI-related stroke are atrial fibrillation ( chronic or new onset ) , ST elevation , and a history of a previous stroke . There is a long-term trend toward a lower incidence of MI-related stroke . These findings have important implication s concerning both the pathophysiology and prevention of MI-related stroke BACKGROUND Nonhemorrhagic stroke occurs in 0.1 % to 1.3 % of patients with acute myocardial infa rct ion who are treated with thrombolysis , with substantial associated mortality and morbidity . Little is known about the risk factors for its occurrence . METHODS AND RESULTS We studied the 247 patients with nonhemorrhagic stroke who were r and omly assigned to one of four thrombolytic regimens within 6 hours of symptom onset in the GUSTO-I trial . We assessed the univariable and multivariable baseline risk factors for nonhemorrhagic stroke and created a scoring nomogram from the baseline multivariable modeling . We used time-dependent Cox modeling to determine multivariable in-hospital predictors of nonhemorrhagic stroke . Baseline and in-hospital predictors were then combined to determine the overall predictors of nonhemorrhagic stroke . Of the 247 patients , 42 ( 17 % ) died and another 98 ( 40 % ) were disabled by 30-day follow-up . Older age was the most important baseline clinical predictor of nonhemorrhagic stroke , followed by higher heart rate , history of stroke or transient ischemic attack , diabetes , previous angina , and history of hypertension . These factors remained statistically significant predictors in the combined model , along with worse Killip class , coronary angiography , bypass surgery , and atrial fibrillation/flutter . CONCLUSIONS Nonhemorrhagic stroke is a serious event in patients with acute myocardial infa rct ion who are treated with thrombolytic , antithrombin , and antiplatelet therapy . We developed a simple nomogram that can predict the risk of nonhemorrhagic stroke on the basis of baseline clinical characteristics . Prophylactic anticoagulation may be an important treatment strategy for patients with high probability for nonhemorrhagic stroke , but further study is needed Background — Patients with acute coronary syndromes and history of stroke or transient ischemic attack ( TIA ) have an increased rate of recurrent cardiac events and intracranial hemorrhages . Methods and Results — We evaluated treatment effects of ticagrelor versus clopidogrel in patients with acute coronary syndrome with and without a history of prior stroke or TIA in the PLATelet inhibition and patient Outcomes ( PLATO ) trial . Of the 18 624 r and omized patients , 1152 ( 6.2 % ) had a history of stroke or TIA . Such patients had higher rates of myocardial infa rct ion ( 11.5 % versus 6.0 % ) , death ( 10.5 % versus 4.9 % ) , stroke ( 3.4 % versus 1.2 % ) , and intracranial bleeding ( 0.8 % versus 0.2 % ) than patients without prior stroke or TIA . Among patients with a history of stroke or TIA , the reduction of the primary composite outcome and total mortality at 1 year with ticagrelor versus clopidogrel was consistent with the overall trial results : 19.0 % versus 20.8 % ( hazard ratio , 0.87 ; 95 % confidence interval , 0.66–1.13 ; interaction P=0.84 ) and 7.9 % versus 13.0 % ( hazard ratio , 0.62 ; 95 % confidence interval , 0.42–0.91 ) . The overall PLATO-defined bleeding rates were similar : 14.6 % versus 14.9 % ( hazard ratio , 0.99 ; 95 % confidence interval , 0.71–1.37 ) , and intracranial bleeding occurred infrequently ( 4 versus 4 cases , respectively ) . Conclusions — Patients with acute coronary syndrome with a prior history of ischemic stroke or TIA had higher rates of clinical outcomes than patients without prior stroke or TIA . However , the efficacy and bleeding results of ticagrelor in these high-risk patients were consistent with the overall trial population , with a favorable clinical net benefit and associated impact on mortality . Clinical Trial Registration — URL : http://www.clinicatrials.gov . Unique identifier : NCT00391872 Background and Purpose Stroke complicating acute myocardial infa rct ion is associated with substantial morbidity and mortality . The purpose of this study was to assess the incidence , predictors , and impact on mortality of stroke/transient ischemic attacks occurring after hospital discharge in a large unselected population of acute myocardial infa rct ion survivors . Methods During a secondary prevention study with nifedipine ( SPRINT ) , demographic , anamnestic , and clinical data were collected for 5839 consecutive acute myocardial infa rct ion patients admitted to 13 coronary care units in Israel . Hospital survivors ( n=4808 ) were followed for a year after their discharge . Mortality was assessed for a mean follow-up of 5.5 years ( range , 4.5 to 7 years ) . Results One percent ( 48/4808 ) of hospital survivors from acute myocardial infa rct ion experienced a stroke/transient ischemic attack in the year after acute myocardial infa rct ion . Thirty-one percent ( 15 of 48 ) of events occurred in the first month after hospital discharge . Incidence was higher among older patients ( > 70 years ; 1.9 % ) , those with anterior site of myocardial infa rct ion ( 1.35 % ) , a previous history of myocardial infa rct ion ( 1.8 % ) , hypertension ( 1.4 % ) , stroke in the past ( 4.1 % ) , and chronic atrial fibrillation ( 9 % ) . Multivariate analysis identified the following as independent predictors of stroke/ transient ischemic attacks occurring in the year after hospital discharge : chronic atrial fibrillation , older age , history of previous myocardial infa rct ion , anterior myocardial infa rct ion site , serum glutamic oxaloacetic transaminase levels more than four times above upper normal limits , and stroke in the past . The age-adjusted 1-year and long-term mortality rates ( 4.5 to 7 years ; mean , 5.5 years ) were significantly higher in patients with ( 31 % and 62 % ) than in those without stroke/transient ischemic attacks ( 9 % and 31 % , respectively ; P < .01 ) . Conclusions Stroke/transient ischemic attack is a relatively rare ( 1 % ) complication in the year after hospital discharge from acute myocardial infa rct ion , though more frequent in the first month . Chronic atrial fibrillation , older age , anterior myocardial infa rct ion site , serum glutamic oxaloacetic transaminase levels more than four times above upper normal limits , past myocardial infa rct ion , and stroke identify high-risk patients . Patients suffering from subsequent stroke/transient ischemic attacks experienced higher mortality than counterparts who remained free from this complication CONTEXT Patients with unstable angina/non-ST-segment elevation myocardial infa rct ion ( MI ) ( UA/NSTEMI ) present with a wide spectrum of risk for death and cardiac ischemic events . OBJECTIVE To develop a simple risk score that has broad applicability , is easily calculated at patient presentation , does not require a computer , and identifies patients with different responses to treatments for UA/NSTEMI . DESIGN , SETTING , AND PATIENTS Two phase 3 , international , r and omized , double-blind trials ( the Thrombolysis in Myocardial Infa rct ion [ TIMI ] 11B trial [ August 1996-March 1998 ] and the Efficacy and Safety of Subcutaneous Enoxaparin in Unstable Angina and Non-Q-Wave MI trial [ ESSENCE ; October 1994-May 1996 ] ) . A total of 1957 patients with UA/NSTEMI were assigned to receive unfractionated heparin ( test cohort )  and 1953 to receive enoxaparin in TIMI 11B ; 1564 and 1607 were assigned respectively in ESSENCE . The 3 validation cohorts were the unfractionated heparin group from ESSENCE and both enoxaparin groups . MAIN OUTCOME MEASURES The TIMI risk score was derived in the test cohort by selection of independent prognostic variables using multivariate logistic regression , assignment of value of 1 when a factor was present and 0 when it was absent , and summing the number of factors present to categorize patients into risk strata . Relative differences in response to therapeutic interventions were determined by comparing the slopes of the rates of events with increasing score in treatment groups and by testing for an interaction between risk score and treatment . Outcomes were TIMI risk score for developing at least 1 component of the primary end point ( all-cause mortality , new or recurrent MI , or severe recurrent ischemia requiring urgent revascularization ) through 14 days after r and omization . RESULTS The 7 TIMI risk score predictor variables were age 65 years or older , at least 3 risk factors for coronary artery disease , prior coronary stenosis of 50 % or more ,  ST-segment deviation on electrocardiogram at presentation  , at least 2 anginal events in prior 24 hours , use of aspirin in prior 7 days , and elevated serum cardiac markers . Event rates increased significantly as the TIMI risk score increased in the test cohort in TIMI 11B : 4.7 % for a score of 0/1 ; 8.3 % for 2 ; 13 . 2 % for 3 ; 19.9 % for 4 ; 26.2 % for 5 ; and 40.9 % for 6/7 ( P<.001 by chi(2 ) for trend ) . The pattern of increasing event rates with increasing TIMI risk score was confirmed in all 3 validation groups ( P<.001 ) . The slope of the increase in event rates with increasing numbers of risk factors was significantly lower in the enoxaparin groups in both TIMI 11B ( P = .01 ) and ESSENCE ( P = .03 ) and there was a significant interaction between TIMI risk score and treatment ( P = . 02 ) . CONCLUSIONS In patients with UA/NSTEMI , the TIMI risk score is a simple prognostication scheme that categorizes a patient 's risk of death and ischemic events and provides a basis for therapeutic decision making . JAMA . 2000;284:835 - Objective To develop a clinical risk prediction tool for estimating the cumulative six month risk of death and death or myocardial infa rct ion to facilitate triage and management of patients with acute coronary syndrome . Design Prospect i ve multinational observational study in which we used multivariable regression to develop a final predictive 
    Output:
    
All other factors were positively associated with stroke , although with lower odds ratios .
Conclusions : All risk factors included in the CHA2DS2-VASc score are associated with stroke/ transient ischemic attack in patients with recent acute coronary syndrome , and retain similar odds ratios to what already seen in atrial fibrillation .