Incidence and Prevention of Ischemic Stroke following Myocardial Infarction: Review of Current Literature

Dutta, Monisha; Hanna, Elias B.; Das, Pranab; Steinhubl, Steven R.

doi:10.1159/000094847

Cited by 29 publications

(30 citation statements)

References 107 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The risk of developing stroke is highest in the first 4 weeks after AMI [1], especially the first few days. The risk decreases gradually thereafter [2].…”

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

View full text Add to dashboard Cite

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.

show abstract

“…The risk of developing stroke is highest in the first 4 weeks after AMI [1], especially the first few days. The risk decreases gradually thereafter [2].…”

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

View full text Add to dashboard Cite

show abstract

“…1 Sustaining an ischemic stroke after an AMI also confers a significantly increased mortality risk. [2][3][4] Despite the seriousness of this phenomenon, our knowledge is limited on the incidence, predictors, and trends over time of post-AMI ischemic stroke. Several investigators have studied the risk of stroke after AMI.…”

mentioning

confidence: 99%

Incidence, Trends, and Predictors of Ischemic Stroke 1 Year After an Acute Myocardial Infarction

Ulvenstam

Kajermo

Modica

et al. 2014

Stroke

View full text Add to dashboard Cite

show abstract

“…Cerebral emboli often coexist with intraoperative hypoperfusion, which impairs the clearance of microemboli and may be responsible of bilateral watershed infarcts after CABG. Cerebral hypoperfusion may be exacerbated by the coexistence of carotid artery stenosis, which is another important risk factor for intraoperative stroke [37].…”

Section: Pathogenesis Of Stroke After Myocardial Revascularizationmentioning

confidence: 99%

Coronary Artery Bypass and Stroke: Incidence, Etiology, Pathogenesis, and Surgical Strategies to Prevent Neurological Complications

Gennari¹,

Polvani²,

Generali³

et al. 2017

Coronary Artery Bypass Graft Surgery

View full text Add to dashboard Cite

Current data suggest that cardiac bypass surgery is the single largest cause of iatrogenic stroke. Among the strategies to decrease or eliminate aortic manipulation, there is the use of of-pump coronary artery bypass grafting (CABG) through an aortic "no touch" technique, which reduces signiicantly the stroke rate. However, this of-pump aortic "no touch" technique is not always applicable, and, when saphenous vein and/or free arterial aortocoronary grafts are used, there is still risk of neurological injury due to tangential aortic clamp applied during the proximal anastomosis sewing. We aim to analyze the current incidence, etiology, and physiopathology of the neurological complications after coronary artery bypass surgery. We describe the methods and techniques that provide reduction in the occurrence of neurological complications. CABG with multiple clamp technique failed to ind a beter outcome in terms of neuropsychological deicit in the OPCABG group. By the way, patients undergoing CABG with single clamping seems to have beter outcomes, suggesting that the cross-clamping technique used and minimal aortic manipulation could have had a role in reducing neurocognitive impairment. Moreover, surprisingly, CPB seemed to be a neuroprotective factor, and this aspect could be linked to the mild hypothermia used during on-pump surgery.Keywords: coronary artery bypass, stroke, cardiac surgery, aortic cross clamp, neurologic impairment IntroductionIn 1978 the World Health Organization deined a stroke as a focal or global neurologic deicit due to cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours [1].© 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Strokes are classiied by etiology into ischemic strokes (85%) and hemorrhagic strokes (15%). Ischemic strokes result from a critical reduction in blood low and are categorized as embolic, thrombotic, hemodynamic, or hypotensive [2]. Cerebrovascular accidents (CVAs) remain one of the most common complications after surgical myocardial revascularization despite the increased quality of treatment. Cerebral injuries are associated with substantial increases in mortality, morbidity, length of hospitalization, and an impaired quality of life [3].Ischemic stroke occurs in 1.5-5.2% of patients. Percentage varies across studies and depends on study design, patient risk proile, operative techniques, and the length of study followup. Although advances in surgical and medical management have occurred across the last 10 years, the risk of stroke after coronary artery bypass grafting (CABG) has not signiicantly declined likely because of the progressive aging of the CABG population [4].The etiology of postoperative stroke is multifactorial. Previous studies showed that the risk factors for postop...

show abstract

Incidence and Prevention of Ischemic Stroke following Myocardial Infarction: Review of Current Literature

Cited by 29 publications

References 107 publications

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

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

Incidence, Trends, and Predictors of Ischemic Stroke 1 Year After an Acute Myocardial Infarction

Coronary Artery Bypass and Stroke: Incidence, Etiology, Pathogenesis, and Surgical Strategies to Prevent Neurological Complications

Contact Info

Product

Resources

About