Simultaneous cardio-cerebral infarction: a meta-analysis
T P Ng1, C Wong2, E L E Leong3
1Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 10, 119228, Singapore.
Insights
Cardio-cerebral infarction (CCI) is a rare condition with high mortality. This meta-analysis summarizes 44 cases, highlighting varied treatments like PCI and thrombectomy, and emphasizes the need for optimal strategies.
Area of Science:
- Cardiology
- Neurology
- Critical Care Medicine
Background:
- Cardio-cerebral infarction (CCI) involves simultaneous acute ischemic stroke and myocardial infarction.
- CCI has a low reported incidence (0.0009%) but presents significant treatment challenges due to the time-critical nature of both conditions.
- Published data on standardized treatment protocols for CCI are limited.
Purpose of the Study:
- To systematically review and summarize reported cases of cardio-cerebral infarction (CCI) in the medical literature.
- To identify and analyze the diagnostic and treatment modalities employed in CCI cases.
- To provide insights into the outcomes and mortality associated with CCI.
Main Methods:
- A meta-analysis was conducted.
- Literature search of four databases (PubMed, Embase, Scopus, Google Scholar) up to August 25, 2020.
- Independent review and data extraction by three authors from case reports and series.
Main Results:
- 44 CCI cases were identified from 37 publications.
- Treatments included percutaneous coronary intervention (PCI) with/without stent (52.3%), cerebral thrombectomy (22.7%), and coronary thrombectomy (18.2%).
- Medications comprised thrombolytics (45.5%), anticoagulants (22.7%), antiplatelets (18.2%), and combined anticoagulants/antiplatelets (25.0%). Mortality was 22.7%, with most deaths cardiac-related. Median days to death was 2.0, and median modified Rankin Score was 2.0.
Conclusions:
- Cardio-cerebral infarction (CCI) is associated with significant morbidity and mortality.
- Current treatment strategies for CCI are diverse, reflecting the complexity of managing simultaneous cardiac and neurological emergencies.
- Further research is essential to establish optimal diagnostic and therapeutic protocols for CCI patients.
Background/Introduction:
Cardio-cerebral infarction (CCI), which involves the simultaneous occurrence of acute ischaemic stroke and acute myocardial infarction, has a reported incidence of 0.0009%. Treatment of CCI presents a dilemma to physicians as both conditions are time critical. Despite the need for standardized treatment protocols, published data are sparse.
Aim:
We aimed to summarize the reported cardio-cerebral infarction cases in the literature.
Design:
Meta-analysis.
Methods:
Four databases, Pubmed, Embase, Scopus and Google Scholar were searched until 25 August 2020. A title and abstract sieve, full-text review and extraction of data were conducted independently by three authors.
Results:
A total of 44 cases of CCI were identified from 37 case reports and series; 15 patients (34.1%) were treated using percutaneous coronary intervention (PCI) with stent, 8 patients (18.2%) were treated with a PCI without stent, 10 patients (22.7%) were treated via a cerebral vessel thrombectomy and 8 patients (18.2%) were treated via a thrombectomy of a coronary vessel. For medications, 20 patients (45.5%) were treated with thrombolytics, 10 patients (22.7%) were treated with anticoagulants, 8 patients (18.2%) were treated with antiplatelets and 11 patients (25.0%) were treated with anticoagulants and antiplatelets. Of 44 patients, 10 patients died, and 9 of those were due to cardiac causes. Among the 44 patients, days to death was observed to be a median of 2.0 days (interquartile range (IQR): 1.5, 4.0). The modified Rankin Score was measured in nine patients, with a median score of 2.0 (IQR: 1.0, 2.5) being reported.
Discussion/Conclusion:
The condition of CCI has substantial morbidity and mortality, and further studies are needed to examine the optimal diagnostic and treatment strategies of these patients.
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