Prognostic impact of neurological dysfunction assessed by modified Rankin Scale in acute myocardial infarction

Acute myocardial infarction (AMI) patients with a prior stroke face higher in-hospital risks than those with AMI alone, yet the association between neurological status-assessed via the modified Rankin Scale (mRS)-and long-term mortality in AMI patients remains understudied. This retrospective study analyzed 10,084 AMI patients, categorizing them into three groups: no prior stroke, prior ischemic stroke (IS) with mRS 0-1 (no disability), or mRS 2-5 (disability), with mortality tracked via the China National Death Registration System over a median 5.26 years. Among the cohort, 8.9% (n = 893) had prior IS, and 18.1% (n = 1,829) died, including 1,454 cardiovascular deaths. Compared to non-stroke patients, those with prior IS and mRS 0-1 exhibited elevated all-cause (hazard ratio [HR] = 1.42, 95% CI 1.20-1.67) and cardiovascular mortality (HR = 1.46, 95% CI 1.21-1.76), while the mRS 2-5 group faced significantly higher risks (all-cause: HR = 2.18, 95% CI 1.84-2.60; cardiovascular: HR = 2.10, 95% CI 1.73-2.55), all P < 0.001. Prior IS, even without residual disability, is linked to increased long-term mortality in AMI patients, with the highest risk among those with post-stroke disability. These findings emphasize the need for enhanced secondary prevention strategies to reduce mortality in this high-risk population.