Acute ST-segment elevation myocardial infarction and prior stroke: an analysis from the Magnesium in Coronaries
Howard A Cooper1, Michael J Domanski, Yves Rosenberg
1Washington Hospital Center, Washington, DC 20010, USA. howard.a.cooper@medstar.net <howard.a.cooper@medstar.net>
Insights
Patients with a history of stroke presenting with ST-segment elevation myocardial infarction (STEMI) face significantly higher short-term mortality risks. These high-risk patients require more aggressive and timely treatment strategies for improved outcomes.
Area of Science:
- Cardiology
- Neurology
- Clinical Research
Background:
- A significant portion of ST-segment elevation myocardial infarction (STEMI) patients have a history of stroke.
- The prognostic impact of prior stroke in the current reperfusion therapy era for STEMI is not well-established.
Purpose of the Study:
- To evaluate the clinical outcomes and characteristics of STEMI patients with a history of stroke.
- To compare the prognosis of STEMI patients with and without prior stroke in the reperfusion era.
Main Methods:
- Analysis of baseline characteristics, treatments, and outcomes from the Magnesium in Coronaries (MAGIC) trial.
- Comparison of STEMI patients with prior stroke (n=558) versus those without (n=5655).
Main Results:
- Patients with prior stroke had higher rates of comorbidities (hypertension, diabetes, prior myocardial infarction, heart failure) and a higher Thrombolysis in Myocardial Infarction Risk Score.
- Despite eligibility, patients with prior stroke were less likely to receive reperfusion therapy (66.3% vs 80.6%).
- Prior stroke was associated with increased in-hospital stroke, severe heart failure, and significantly higher 30-day mortality (21.0% vs 14.7%).
Conclusions:
- STEMI patients with a history of stroke exhibit a substantially elevated risk of short-term morbidity and mortality.
- Aggressive and timely therapeutic interventions are strongly indicated for STEMI patients with prior stroke.
Background:
Patients with prior stroke represent a substantial proportion of patients presenting with acute ST-segment elevation myocardial infarction (STEMI). However, the impact of prior stroke on prognosis has not been rigorously examined in the reperfusion era.
Methods:
The baseline characteristics, treatments, and clinical outcomes of patients with prior stroke enrolled in the Magnesium in Coronaries (MAGIC) trial were evaluated and compared to those of patients without prior stroke.
Results:
MAGIC enrolled 6213 patients with STEMI, of whom 558 (9.0%) had prior stroke. Patients with prior stroke were more likely to have a history of hypertension (88.0% vs 70.3%), diabetes (19.9% vs 14.5%), myocardial infarction (38.2% vs 25.1%), and congestive heart failure (15.6% vs 9.7%). The mean Thrombolysis in Myocardial Infarction Risk Score was higher in patients with prior stroke compared to those without prior stroke (4.37 vs 3.93, P < .0001). Patients with prior stroke were less likely to receive reperfusion therapy, even among those considered eligible at presentation (66.3% vs 80.6%, P < .0001). Compared to patients without prior stroke, inhospital stroke (3.0% vs 1.0%, P < .0001), severe congestive heart failure (23.3% vs 18.2%, P = .003), and 30-day mortality (21.0% vs 14.7%, P < .0001) were higher among patients with prior stroke. On multivariable analysis, prior stroke was independently associated with a significantly higher risk of death at 30 days (odds ratio 1.44, P = .0023).
Conclusions:
Patients with prior stroke who present with STEMI are at very high risk for short-term morbidity and mortality. Aggressive treatment of these patients appears warranted.
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