Cerebrovascular accident complicating acute myocardial infarction: Incidence, clinical significance, and short-long-term mortality rates

Behar, Solomon; Tanné, David; Abinader, Edward G.; Agmon, Jacob; Barzilai, Jacob; Friedman, Yaacov; Kaplinsky, Elieser; Kauli, N; Kishon, Yehezkiel; Palant, A; Peled, Benjamin; Reisin, Leonardo; Schlesinger, Z; Zahavi, Izhar; Zion, Monty M.; Goldbourt, Uri

doi:10.1016/0002-9343(91)90072-6

Cited by 55 publications

(31 citation statements)

References 12 publications

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“…7,8,27 All 3 patients with stroke had HITS. In addition to the established risk factors for stroke in AMI, including anterior lesions, mural thrombus, impaired LV function, and atrial fibrillation, HITS may be also be an independent risk factor for clinical embolic events.…”

Section: Discussionmentioning

confidence: 99%

“…Thirty-three percent of these cases occur within 24 hours and Ϸ70% within the first week. 7,8 There are various causes for systemic embolism, including mural thrombus usually associated with anterior wall infarction, cardiac arrhythmias (especially AF), and impaired left ventricular ejection fraction (LVEF). 9,10 Many asymptomatic patients with potential sources of cardiac embolism have signs of cerebral embolism on brainimaging studies.…”

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confidence: 99%

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Cerebral Microembolism in Acute Myocardial Infarction

Nadareishvili

Choudary

Joyner

et al. 1999

Stroke

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Background and Purpose-This study was undertaken to determine the frequency of cerebral microemboli (high-intensity transient signals; HITS) detected by transcranial Doppler (TCD) in patients with acute myocardial infarction (AMI) and to relate them to the various putative risk factors and clinical embolic events. Methods-We investigated 112 consecutive patients within 72 hours of admission to an acute coronary care unit using TCD to monitor for cerebral microemboli. Twelve patients were excluded because of failure of ultrasound insonation. All patients had 2-dimensional echocardiograms within the study period. Results-HITS were detected in 17% of patients, with significantly higher frequency in patients with reduced (Ͻ65%) left ventricular (LV) ejection fraction (Pϭ0.019), akinetic LV segments (Pϭ0.002), and LV thrombus (Pϭ0.015). A marginally significant (Pϭ0.059) increase of HITS was found in patients with anterior AMI. Stroke was significantly more frequent in patients with cerebral microemboli (Pϭ0.01). Conclusions-HITS were detected in 17% of patients in spite of adequate antithrombotic therapy and were increased in patients with reduced LV function, akinetic myocardial segments, and LV thrombus. They were present in all 3 patients with stroke and may represent a predictor of clinical embolic events. (Stroke. 1999;30:2679-2682.)

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Cerebral Microembolism in Acute Myocardial Infarction

Nadareishvili

Choudary

Joyner

et al. 1999

Stroke

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“…The INTERSTROKE study [7] that enrolled 3,000 patients with first stroke in 22 countries has recently reported risk factors for stroke which include hypertension, smoking, abdominal obesity, diabetes, stress and depression; however, there is little agreement in the literature about predictors of stroke after AMI with the exception of older age and prior stroke [4,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40]. For example, hypertension [14,15,22,33,34] and diabetes [22,27,32,33,36,37] were shown in some, but not all, studies to be predictors of stroke.…”

Section: Introductionmentioning

confidence: 99%

Early Stroke following Acute Myocardial Infarction: Incidence, Predictors and Outcome in Six Middle-Eastern Countries

Albaker

Zubaid²,

Alsheikh‐Ali³

et al. 2011

Cerebrovasc Dis

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Background and Objectives: Stroke is a potential complication of acute myocardial infarction (AMI). The aim of this study was to identify the incidence, risk factors predisposing to stroke and in-hospital outcome during the index admission with AMI among patients in the Middle East. Methods: For a period of 6 months in 2006 and 2007, 5,833 consecutive AMI patients were enrolled from 64 hospitals in 6 Middle East countries. Results: The incidence of in-hospital stroke following AMI was 0.85%. Most cases were ST segment elevation AMI-related and ischemic in nature. Patients with in-hospital stroke were older than patients without stroke and were more likely to be female (36 vs. 18.6%, p = 0.0033). They were also more likely to have diabetes mellitus, dyslipidemia, prior AMI, or percutaneous/surgical coronary revascularization. Patients with stroke were more likely to present with advanced Killip class II–IV, higher mean heart rate and higher serum creatinine. Independent predictors of stroke were age, prior stroke, prior coronary artery bypass surgery, anterior AMI and systolic blood pressure >190 mm Hg on presentation. Early administration of statins was independently associated with reduced stroke risk (odds ratio, OR, 0.4, 95% confidence interval, CI, 0.19–0.90, p = 0.025). Stroke was fatal in 44% of the cases and was independently associated with in-hospital mortality (adjusted OR 12.5, 95% CI 5.7–27.4, p < 0.01). Conclusion: There is a low incidence of in-hospital stroke in Middle-Eastern patients presenting with AMI but with very high fatality rates. Early statin therapy was associated with a significant reduction in stroke risk. Future work should be focused on reducing the risk and improving the outcome of this devastating complication.

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“…Several publications have outlined the incidence and clinical significance of stroke occurring during AMI in the prethrombolyticl-4 and thrombolytic eras.5-13 The frequency of this complication has apparently not increased with the advent of thrombolytic treatment but nevertheless remains an important cause of morbidity and mortality in patients with AMI. Data on the incidence and prognostic significance of stroke in survivors from AMI, however, are very scarce and limited to select subgroups of patients.14- 17 The purposes of the present study were (1) to assess the incidence of stroke or transient ischemic attack (TIA) after hospital discharge in a large unselected population of survivors from AMI, (2) to identify the characteristics of MI patients at risk, and (3) to assess the impact on mortality of stroke/TIA occurring after AMI.…”

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confidence: 99%