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Long-Term Risk of Stroke in Myocardial Infarction Survivors: Thirty-Year Population-Based Cohort Study
Jens Sundbøll1, Erzsébet Horváth-Puhó2, Morten Schmidt2
1From the Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (J.S., E.H.P., M.S., L.P., V.W.H.); Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus N, Denmark (J.S., M.S., H.E.B.); and Departments of Health Research and Policy (Epidemiology) (V.W.H., H.T.S.) and Neurology and Neurological Sciences (V.W.H.), Stanford University, Stanford, CA. jens.sundboll@clin.au.dk.
Insights
Patients with myocardial infarction (MI) face significantly higher risks of all stroke types, especially ischemic stroke, in the first year post-MI. While risks for other stroke types decrease over time, the elevated risk of ischemic stroke persists long-term.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Epidemiology
Background:
- Improved survival rates post-myocardial infarction (MI) have led to a growing population at risk for subsequent strokes.
- Understanding the specific risks of different stroke subtypes after MI is crucial for patient management.
Purpose of the Study:
- To investigate the risks of ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in patients following a myocardial infarction (MI).
- To compare these risks against those observed in the general population.
Main Methods:
- A nationwide, population-based cohort study was conducted using Danish medical registries from 1980 to 2009.
- Patients with a first-time inpatient diagnosis of MI were identified and compared to a sex- and age-matched cohort from the general population.
- Cumulative stroke risks and adjusted stroke rate ratios with 95% confidence intervals (CIs) were calculated.
Main Results:
- The study identified 258,806 MI patients and 1,244,773 controls.
- Within the first 30 days post-MI, the adjusted stroke rate ratio was significantly elevated: 30-fold for ischemic stroke, 20-fold for ICH, and 15-fold for SAH.
- While risks for ICH and SAH decreased to near-general population levels after one year, the risk for ischemic stroke remained significantly elevated (1.6-fold) up to 30 years post-MI.
Conclusions:
- Myocardial infarction (MI) serves as a significant risk factor for all stroke subtypes within the first year following the event.
- The increased risk for intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) diminishes over time, returning to baseline levels.
- However, the elevated risk for ischemic stroke persists long-term after myocardial infarction (MI).
Background And Purpose:
Improved survival after myocardial infarction (MI) has increased the number of patients at risk of post-MI stroke. We examined risks of ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in patients with MI compared with the general population.
Methods:
We conducted a nationwide population-based cohort study using Danish medical registries. During 1980 to 2009, we identified all patients with a first-time inpatient diagnosis of MI and formed a sex- and age-matched comparison cohort. We computed cumulative stroke risks and adjusted stroke rate ratios with 95% confidence intervals (CIs).
Results:
We identified 258 806 patients with an MI and 1 244 773 individuals from the general population. For patients with MI, the cumulative stroke risks after 1 to 30 years were 12.6% for ischemic stroke, 1.2% for ICH, and 0.24% for SAH. During the first 30 days after MI, the adjusted stroke rate ratio was 30-fold increased for ischemic stroke (31.9; 95% CI, 28.4-35.8), 20-fold for ICH (21.8; 95% CI, 16.6-28.5), and 15-fold for SAH (16.6; 95% CI, 8.7-32.0). The adjusted stroke rate ratio remained increased during 31 to 365 days (3-fold for ischemic stroke, 2-fold for ICH, and 1.5-fold for SAH). During the ensuing 1 to 30 years, the risks remained increased for ischemic stroke (1.6; 95% CI, 1.6-1.6) but decreased to near unity for ICH (1.1; 95% CI, 1.0-1.2) and SAH (1.1; 95% CI, 0.94-1.2).
Conclusions:
MI was a risk factor for all stroke subtypes during the first year of follow-up, but only for ischemic stroke thereafter.
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