Myocardial Infarction Is Associated With Increased Stroke Severity, In-Hospital Mortality, and Complications:
Hongzhou Duan1,2, Zixiao Li3,4,5,6, Hong-Qiu Gu4,6
1Department of Interventional Neuroradiology Beijing Tiantan HospitalCapital Medical University Beijing China.
Insights
Patients with ischemic stroke (IS) and a history of myocardial infarction (MI) face higher risks of severe strokes, in-hospital death, and complications. This highlights the need for tailored treatment strategies for this high-risk group.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Prior studies indicate an elevated risk of ischemic stroke (IS) following myocardial infarction (MI).
- Limited research exists on the specific characteristics, mortality, and complications of IS patients with a prior MI history.
- This study investigates whether a history of MI exacerbates stroke severity and outcomes.
Purpose of the Study:
- To compare the characteristics of ischemic stroke patients with and without a history of myocardial infarction.
- To evaluate in-hospital mortality and complication rates in these two patient groups.
- To identify potential differences in stroke severity based on prior MI status.
Main Methods:
- Analysis of consecutive in-hospital data from the China Stroke Center Alliance database (August 2015 - July 2019).
- Comparison of patient demographics, pre-admission medications, clinical characteristics, and in-hospital outcomes.
- Statistical analysis including National Institute of Health Stroke Scale (NIHSS) scores and logistic regression for mortality and complications.
Main Results:
- Out of 893,429 IS patients, 81,646 (9.1%) had a history of MI.
- Patients with prior MI were older, had less smoking, more family history, and took more pre-admission medications.
- The MI group exhibited higher NIHSS scores (4.0 vs. 3.0), a greater proportion of severe strokes (7.1% vs. 4.4%), and significantly increased in-hospital mortality (OR, 1.74).
- Higher risks of complications were observed in the MI group, including urinary tract infections, gastrointestinal bleeding, pneumonia, depression, seizures, atrial fibrillation, and cardiac/respiratory arrest.
Conclusions:
- Ischemic stroke patients with a history of myocardial infarction experience more severe strokes.
- These patients face a significantly increased risk of in-hospital mortality and a wide range of complications.
- Further research into underlying mechanisms is crucial for developing tailored stroke treatment strategies for patients with a history of MI.
Abstract:
Background Prior studies have shown an increased risk of ischemic stroke (IS) after myocardial infarction (MI); however, there are limited studies concerning the characteristics, in-hospital mortality, and complications of patients with IS with a medical history of MI. We hypothesized that patients with IS with a medical history of MI may experience more severe strokes and have a higher risk of in-hospital mortality and complications than patients with IS without a medical history of MI. Methods and Results Consecutive in-hospital data were extracted from the China Stroke Center Alliance database from August 2015 to July 2019. Patient characteristics, hospital tests, in-hospital mortality, and complications were analyzed and compared in patients with IS with or without a history of MI. Of 893 429 patients with IS, we identified 81 646 (9.1%) patients with a history of MI (MI group). Compared with patients with IS without MI, MI group patients were older, had a lower prevalence of current smoking, had a higher prevalence of a relative medical history, and took more medications before admission. Compared with the group with IS without MI, the MI group had a higher National Institute of Health Stroke Scale score after onset (4.0 versus 3.0; Hodges-Lehmann estimator, 22.5) and a higher proportion of severe strokes (National Institute of Health Stroke Scale score ≥15) (7.1% versus 4.4%; absolute standardized difference=11.6%). In the fully adjusted models, the risk of in-hospital mortality was higher in the MI group (odds ratio [OR], 1.74; 95% CI, 1.57-1.92; P<0.0001). MI group patients also had a higher risk of complications, including urinary tract infection (OR, 1.28; 95% CI, 1.2-1.36; P<0.0001), gastrointestinal bleeding (OR, 1.29; 95% CI, 1.19-1.39; P<0.0001), pneumonia (OR, 1.24; 95% CI, 1.21-1.28; P<0.0001), depression (OR, 1.33; 95% CI, 1.24-1.42; P<0.0001), seizure (OR, 1.35; 95% CI, 1.22-1.49; P<0.0001), atrial fibrillation (OR, 1.78; 95% CI, 1.71-1.86; P<0.0001), and cardiac or respiratory arrest (OR, 1.98; 95% CI, 1.78-2.2; P<0.0001). Conclusions Patients with IS with a medical history of MI have an increased risk of severe stroke, in-hospital mortality, and complications. Studies exploring the underlying mechanisms are needed to improve and tailor stroke treatment strategies.
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