In-hospital myocardial infarction following acute ischaemic stroke: an observational study
J Liao1, M J O'Donnell, F L Silver
1McMaster University, Hamilton, ON, Canada.
Insights
Myocardial infarction is a significant complication following acute ischemic stroke, increasing the risk of death or severe disability. Early identification and management are crucial for improving patient outcomes after stroke.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Acute myocardial infarction is a recognized, yet understudied, complication of ischemic stroke.
- Understanding the frequency and impact of in-hospital myocardial infarction post-stroke is critical for patient care.
Purpose of the Study:
- To determine the incidence of myocardial infarction in patients hospitalized with acute ischemic stroke.
- To evaluate the clinical impact of in-hospital myocardial infarction on patient outcomes, including disability and mortality.
Main Methods:
- Analysis of 9180 patients from the Canadian Stroke Network Registry (2003-2006).
- Assessment of stroke severity using the Canadian Neurological Scale (CNS).
- Evaluation of functional status with the modified-Rankin Scale (m-RS) and 1-year mortality using multivariable logistic regression.
Main Results:
- 2.3% of ischemic stroke patients experienced myocardial infarction during hospitalization.
- In-hospital myocardial infarction significantly increased the odds of death or severe disability at discharge (OR 2.51) and 1-year mortality (HR 1.83).
- Factors associated with in-hospital myocardial infarction included prior myocardial infarction, diabetes mellitus, stroke severity, and peripheral vascular disease.
Conclusions:
- Myocardial infarction is a critical and frequent medical complication following acute ischemic stroke.
- In-hospital myocardial infarction is independently associated with worse clinical outcomes.
- These findings underscore the need for vigilant monitoring and management of cardiac complications in stroke patients.
Background And Purpose:
Acute myocardial infarction is expected to be an important medical complication following ischaemic stroke. We sought to describe the frequency and clinical impact of in-hospital myocardial infarction following acute ischaemic stroke.
Methods:
Consecutive patients with acute ischaemic stroke were identified from the Registry of the Canadian Stroke Network (2003-2006). Stroke severity was measured using the Canadian Neurological Scale (CNS). Functional status at discharge was measured with the modified-Rankin Scale, and categorized into strokes with no or mild-moderate dependency (m-Rankin 0-3) and those with severe dependence or death (m-Rankin 4-6). Multivariable logistic regression was used to determine the association between myocardial infarction and clinical outcome (death or severe dependence at hospital discharge and 1 year mortality), independent of co-morbidities and in-hospital medical complications.
Results:
In total, 9180 patients with acute ischaemic stroke were included. The mean age was 72 years (SD 13.9) and 48% were female. Overall, 211 (2.3%) patients were reported to have myocardial infarction during hospitalization. At hospital discharge, 64.9% of patients with in-hospital myocardial infarction had died or were severely disabled, compared with 35.8% in the entire cohort. Mortality at 1 year after ischaemic stroke was 56.4% in patients with myocardial infarction and 21.9% in the entire cohort. On multivariable analyses, myocardial infarction was also associated with death or severe dependence at discharge (OR 2.51; 95%CI 1.75-3.59) and mortality within 1 year (HR 1.83; 95%CI 1.51-2.23). Previous history of myocardial infarction (OR 1.50; 95%CI 1.05-2.15), diabetes mellitus (OR 1.55; 95%CI 1.42-2.10), stroke severity (OR 1.13; 95% CI 1.09-1.17) and peripheral vascular disease (OR 1.61; 95%CI 1.04-2.49) were independently associated with myocardial infarction during hospitalization.
Conclusions:
Myocardial infarction is an important medical complication after acute ischaemic stroke.
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