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Background: Cerebral and cardiovascular events can occur simultaneously in a given patient or in differential timing. There are no comparative studies on the impact of stroke timing difference on the risk and outcome of coronary events.Objective: To describe the association of cerebrovascular and cardiac events and the impact of the order of occurrence of these events on patients’ outcomes.Design: Retrospective longitudinal cohort studySetting: Single tertiary center from 2010 through 2015Patients: All patients with who underwent coronary angiogram or had a primary admitting diagnosis of stroke.Methods: The two separate databases were crossed matched to identify patients with both diagnoses, and then temporal relationships were identified on both directions (stroke before or after cardiac event). Cardiac events include any suspected acute coronary events that triggered referral for coronary angiogram.Outcome Measures: A composite of death, recurrent stroke and re-hospitalization within 30 days.Results: Among 6300 cardiac patients and 500 stroke patients, 16 patients were identified with both diagnoses. The mean age was 56.9±18.5 years, and 37.5% were females. The most common vascular risk factors were hypertension (94%) diabetes (81%), atrial fibrillation (25%), and renal impairment (6%). When classified based on stroke timing, a quarter (n=4) of patients had stroke pre cardiac event and 75% (n=12) had stroke post cardiac event. The composite endpoint of death, recurrent stroke and re-hospitalization within 30 days was higher in the stroke pre cardiac event group (p=0.0001) This was primarily driven by increased risk of recurrent stroke in the stroke pre vs. post cardiac event: odds ratio 2.4 (1.2-4.7) vs. 0.4 (0.2-0.8), respectively. The mean time from stroke to cardiac event was 89.5 days compared to 40.5 months from cardiac event to stroke.Conclusions: In this cohort, we observed low co-incidence of stroke with symptomatic coronary disease. Stroke preceding cardiac events carried worse prognosis than its occurrence after a cardiac event. This could imply different vulnerability of the cerebral and coronary vascular beds. Optimization of medical treatment after stroke will reduce future cerebrovascular and coronary events.