Hemorrhagic stroke the first 30days after an acute myocardial infarction: Incidence, time trends and predictors of risk

Binsell‐Gerdin, Emil; Graipe, Anna; Ögren, Joachim; Jernberg, Tomas; Mooe, Thomas

doi:10.1016/j.ijcard.2014.07.032

Cited by 17 publications

(11 citation statements)

References 27 publications

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“…5,6,8 Hemorrhagic stroke (HS) after AMI is less frequent and such events decreased by 50% between 1998 and 2008, with a 30-day incidence between 0.06% and 0.22%. 9 Despite these studies, which mixed ST-elevation and non-ST-elevation MI, one can expect that the falling prevalence of HS is partly explained by the shift in reperfusion strategies from thrombolysis to percutaneous coronary intervention. 9 Giugliano et al 10 reported 30-day mortality of 65.4% after intracranial hemorrhage, rising to 71.8% at 1 year.…”

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“…9 Despite these studies, which mixed ST-elevation and non-ST-elevation MI, one can expect that the falling prevalence of HS is partly explained by the shift in reperfusion strategies from thrombolysis to percutaneous coronary intervention. 9 Giugliano et al 10 reported 30-day mortality of 65.4% after intracranial hemorrhage, rising to 71.8% at 1 year. Independent predictors of HS have already been described.…”

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confidence: 99%

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Frequency and Predictors of Stroke After Acute Myocardial Infarction

Hachet

Guenancia

Stamboul

et al. 2014

Stroke

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Background and Purpose-Stroke is a serious complication after acute myocardial infarction (AMI) and is closely associated with decreased survival. This study aimed to investigate the frequency, characteristics, and factors associated with in-hospital and postdischarge stroke in patients with AMI. Methods-Eight thousand four hundred eighty-five consecutive patients admitted to a cardiology intensive care unit for AMI, between January 2001 and July 2010. Stroke/transient ischemic attack were collected during 1-year follow-up. Results-One hundred twenty-three in-hospital strokes were recorded: 65 (52.8%) occurred on the first day after admission for AMI, and 108 (87%) within the first 5 days. One hundred six patients (86.2%-incidence rate 1.25%) experienced inhospital ischemic stroke, and 14 patients (11.4%-incidence rate 0.16%) were diagnosed with an in-hospital hemorrhagic stroke. In-hospital ischemic stroke subtypes according to the Trial of Org 10 172 in Acute Stroke Treatment (TOAST) classification showed that only 2 types of stroke were identified more frequently. As expected, the leading subtype of in-hospital ischemic stroke was cardioembolic stroke (n=64, 60%), the second was stroke of undetermined pathogenesis (n=38, 36%). After multivariable backward regression analysis, female sex, previous transient ischemic attack (TIA)/ stroke, new-onset atrial fibrillation, left ventricular ejection fraction (odds ratio per point of left ventricular ejection fraction), and C-reactive protein were independently associated with in-hospital ischemic stroke. When antiplatelet and anticoagulation therapy within the first 48 hours was introduced into the multivariable model, we found that implementing these treatments (≥1) was an independent protective factor of in-hospital stroke. In-hospital hemorrhagic stroke was dramatically increased (5-fold) when thrombolysis was prescribed as the reperfusion treatment. However, the different parenteral anticoagulants were not predictors of risk in univariable analysis. Finally, only 45 postdischarge strokes were recorded. Postdischarge stroke subtypes showed a more heterogeneous distribution of mechanisms. The annual rate of stroke post-AMI remained stable throughout the 10-year study period. Conclusions-The present study describes specific predictors of in-hospital and postdischarge stroke in patients with AMI. It showed a marked increase in the risk of death, both during hospitalization and in the year after AMI. After hospital discharge, stroke remains a rare event and is mostly associated with high cardiovascular risk. (Stroke. 2014;45:3514-3520.)

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confidence: 99%

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Frequency and Predictors of Stroke After Acute Myocardial Infarction

Hachet

Guenancia

Stamboul

et al. 2014

Stroke

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“…Intracranial hemorrhage (ICH) is a rare but catastrophic complication in patients with acute myocardial infarction (AMI) [1,2]. However, in the contemporary era, primary percutaneous coronary intervention (PCI) is being increasingly used over thrombolytic therapy for early revascularization, resulting in a decline in the incidence and burden of ICH after AMI [3][4][5][6]. Due to the uncommon occurrence of this complication in recent times, studies evaluating these patients are limited by the small number of ICH events [3].…”

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confidence: 99%

“…However, in the contemporary era, primary percutaneous coronary intervention (PCI) is being increasingly used over thrombolytic therapy for early revascularization, resulting in a decline in the incidence and burden of ICH after AMI [3][4][5][6]. Due to the uncommon occurrence of this complication in recent times, studies evaluating these patients are limited by the small number of ICH events [3]. Prior studies have often combined ICH patients with those with acute ischemic stroke, which limits individual assessments [5,6].…”

Section: Introductionmentioning

confidence: 99%

Intracranial Hemorrhage Complicating Acute Myocardial Infarction: An 18-Year National Study of Temporal Trends, Predictors, and Outcomes

Patlolla

Sundaragiri

Cheungpasitporn

et al. 2020

JCM

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Background: There is a paucity of contemporary data on the burden of intracranial hemorrhage (ICH) complicating acute myocardial infarction (AMI). This study sought to evaluate the temporal trends, predictors, and outcomes of ICH in AMI. Methods: The National Inpatient Sample (2000–2017) was used to identify adult (>18 years) AMI admissions with ICH. In-hospital mortality, hospitalization costs, length of stay, and measure of functional ability were the outcomes of interest. The discharge destination along with use of tracheostomy and percutaneous endoscopic gastrostomy were used to estimate functional burden. Results: Of a total 11,622,528 AMI admissions, 23,422 (0.2%) had concomitant ICH. Compared to those without, the ICH cohort was on average older, female, of non-White race, had greater comorbidities, and had higher rates of arrhythmias (all p < 0.001). Female sex, non-White race, ST-segment elevation AMI presentation, use of fibrinolytics, mechanical circulatory support, and invasive mechanical ventilation were identified as individual predictors of ICH. The AMI admissions with ICH received less frequent coronary angiography (46.9% vs. 63.8%), percutaneous coronary intervention (22.7% vs. 41.8%), and coronary artery bypass grafting (5.4% vs. 9.2%), as compared to those without (p < 0.001). ICH was associated with a significantly higher in-hospital mortality (41.4% vs. 6.1%; adjusted OR 5.65 (95% CI 5.47–5.84); p < 0.001), longer hospital length of stay, higher hospitalization costs, and greater use of percutaneous endoscopic gastrostomy (all p < 0.001). Among ICH survivors (N = 13, 689), 81.3% had a poor functional outcome at discharge. Conclusions: ICH causes a substantial burden in AMI due to associated higher in-hospital mortality and poor functional outcomes.

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“…In many countries, there has been a shift in approach from thrombolysis to primary percutaneous coronary intervention (PCI), an increase in the use of parenteral anticoagulants, and more‐aggressive treatment of elderly patients. These changes have affected the short‐term occurrence of ICH . However, data remain limited regarding any change in the postdischarge risk of ICH over time and long term.…”

Section: Introductionmentioning

confidence: 99%

Incidence, Time Trends, and Predictors of Intracranial Hemorrhage During Long‐Term Follow‐up After Acute Myocardial Infarction

Graipe

Binsell‐Gerdin

Söderström

et al. 2015

JAHA

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BackgroundTo address the lack of knowledge regarding the long‐term risk of intracranial hemorrhage (ICH) after acute myocardial infarction (AMI), the aims of this study were to: (1) investigate the incidence, time trends, and predictors of ICH in a large population within 1 year of discharge after AMI; (2) investigate the comparative 1‐year risk of ICH in AMI patients and a reference group; and (3) study the impact of previous ischemic stroke on ICH risk in patients treated with various antithrombotic therapies.Methods and ResultsData about patients whose first AMI occurred between 1998 and 2010 were collected from the Swedish Register of Information and Knowledge about Swedish Heart‐Intensive‐Care Admissions (RIKS‐HIA). Patients with an ICH after discharge were identified in the National Patient Register. Risk was compared against a matched reference population. Of 187 386 patients, 590 had an ICH within 1 year. The 1‐year cumulative incidence (0.35%) was approximately twice that of the reference group, and it did not change significantly over time. Advanced age, previous ischemic or hemorrhagic stroke, and reduced glomerular filtration rate were associated with increased ICH risk, whereas female sex was associated with a decreased risk. Previous ischemic stroke did not increase risk of ICH associated with single or dual antiplatelet therapy, but increased risk with anticoagulant therapy.ConclusionThe 1‐year incidence of ICH after AMI remained stable, at ≈0.35%, over the study period. Advanced age, decreased renal function, and previous ischemic or hemorrhagic stroke are predictive of increased ICH risk.

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Hemorrhagic stroke the first 30days after an acute myocardial infarction: Incidence, time trends and predictors of risk

Cited by 17 publications

References 27 publications

Frequency and Predictors of Stroke After Acute Myocardial Infarction

Frequency and Predictors of Stroke After Acute Myocardial Infarction

Intracranial Hemorrhage Complicating Acute Myocardial Infarction: An 18-Year National Study of Temporal Trends, Predictors, and Outcomes

Incidence, Time Trends, and Predictors of Intracranial Hemorrhage During Long‐Term Follow‐up After Acute Myocardial Infarction

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