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Cerebral microbleeds and acute myocardial infarction: Screening and disease progression
Abbass Alaa El Din1, Hugo Debeaumarche1, Pierre Thouant2
1University Hospital Center Dijon Bourgogne, Cardiology Department, Dijon, France.
Introduction:
Cerebral microbleeds (CMB) are associated with intracerebral haemorrhage. Therefore they may represent a concern if anticoagulant and/or antiplatelet therapy is needed. The aim of this study was to determine the prevalence of CMB in patients with acute myocardial infarction (AMI), and to follow their progression at 3 months under dual antiplatelet therapy (DAPT).
Methods:
This prospective study included patients aged over 60 hospitalized in intensive cardiac care unit in our city for AMI. These patients underwent a first brain Magnetic resonance imaging (MRI) within 72 h of admission, that was repeated 3 months.
Results:
108 patients were included between November 2016 and December 2018. The prevalence of CMB was 21.3%, with a female predominance of 65.2% vs 32.1% (p = 0.004). Diabetes is significantly associated with the presence of CMB, 45.5% vs 21.2% (p = 0.021). Patients with at least one acute CMB had higher haemorrhagic risk as evaluated with CRUSADE score (40.5 ± 13.6 vs 31.2 ± 14.8 (p = 0.004).Multivariate analysis showed that only female sex was associated with the presence of a CMB on the initial MRI. On repeated MRI, an increase in CMB was observed in 6% of patients.Our results suggest that discharge treatment with anticoagulant in combination with antiplatelet therapy may be an independent predictor of early progression of CMB.
Conclusion:
Our study confirms the high prevalence of CMB in patients over 60 years with AMI. The association of anticoagulant with DAPT, 3 months after stenting, may be an independent factor of CMB progression.
Insights
Cerebral microbleeds (CMB) are common in older acute myocardial infarction (AMI) patients. Anticoagulant plus dual antiplatelet therapy may increase CMB progression.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Cerebral microbleeds (CMB) are linked to intracerebral hemorrhage, posing risks for patients needing anticoagulant or antiplatelet therapy.
- Understanding CMB prevalence in acute myocardial infarction (AMI) is crucial for managing treatment strategies.
Purpose of the Study:
- To determine the prevalence of CMB in patients over 60 with AMI.
- To assess the progression of CMB at 3 months in patients treated with dual antiplatelet therapy (DAPT).
Main Methods:
- Prospective study of patients >60 years hospitalized for AMI.
- Brain MRI performed within 72 hours of admission and repeated at 3 months.
Main Results:
- Prevalence of CMB was 21.3%, with female predominance and significant association with diabetes.
- Female sex was the only independent predictor of initial CMB presence.
- A 6% increase in CMB was observed at 3 months, with anticoagulant plus DAPT potentially predicting progression.
Conclusions:
- Confirms high CMB prevalence in older AMI patients.
- Combination anticoagulant and DAPT therapy may be an independent factor in CMB progression 3 months post-stenting.
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