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Coronary artery disease, myocardial infarction, and brain embolism
D C Hess1, I A D'Cruz, R J Adams
1Neurology Service, Veterans Affairs Medical Center, Augusta, Georgia.
Insights
In-hospital stroke complicates about 1% of acute myocardial infarctions, with risk factors including large infarcts and prior stroke. Certain thrombolytic therapies increase stroke risk due to cerebral hemorrhages.
Area of Science:
- Cardiology
- Neurology
- Thrombolytic Therapy
Background:
- In-hospital stroke occurs in approximately 1% of acute myocardial infarction (AMI) cases.
- Risk factors for stroke include large infarcts, anterior wall involvement, prior stroke history, and advanced age.
- Left ventricular thrombi, often associated with anterior wall AMI, may be reduced by anticoagulation.
Purpose of the Study:
- To review the incidence and risk factors of in-hospital stroke following AMI.
- To evaluate the impact of thrombolytic therapies on stroke risk.
- To discuss the role of anticoagulation in managing left ventricular thrombi and preventing embolization.
Main Methods:
- Literature review of studies on stroke complicating AMI.
- Analysis of risk factors for ischemic stroke in AMI patients.
- Comparison of stroke rates associated with different thrombolytic agents.
Main Results:
- The overall incidence of stroke post-AMI is around 1%, largely unaffected by thrombolytic therapy.
- Specific thrombolytic agents like t-PA and APSAC increase stroke risk due to cerebral hemorrhages compared to streptokinase.
- Left ventricular aneurysms have a low embolization risk and do not necessitate anticoagulation.
Conclusions:
- Stroke in AMI patients is influenced by factors such as infarct size, location, and patient history.
- The choice of thrombolytic therapy can significantly impact the risk of hemorrhagic stroke.
- Anticoagulation may be beneficial for left ventricular thrombi but is not indicated for left ventricular aneurysms.
Abstract:
The incidence of in-hospital stroke complicating acute myocardial infarction is approximately 1%. This rate is largely unaffected by thrombolytic therapy. Large myocardial infarctions, anterior wall involvement, prior stroke, and increasing age are risk factors for ischemic stroke. Left ventricular thrombi commonly occur with anterior wall infarctions. There is some evidence that anticoagulation reduces their incidence and uncontrolled studies suggest that anticoagulation may reduce the risk of embolization. Left ventricular aneurysms have a low rate of embolization and do not require systemic anticoagulation. Treatment of acute myocardial infarction with t-PA and anisoylated plasminogen streptokinase activator complex are associated with a higher risk of stroke than treatment with streptokinase; this excess risk is attributable to an increased rate of cerebral hemorrhages.