Myocardial infarction after acute ischaemic stroke: Incidence, mortality and risk factors

Pana, Tiberiu A; Wood, Andy; Mamas, Mamas A.; Clark, Allan; Bettencourt‐Silva, Joao H.; McLernon, David J.; Potter, John F.; Myint, Phyo Kyaw; Norfolk,; Stroke, Norwich

doi:10.1111/ane.13135

Cited by 15 publications

(9 citation statements)

References 30 publications

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“…Time to recurrent stroke was constructed using an exponential distribution ( 29 ), while a Gompertz distribution following a previously published study was tested in the sensitivity analysis ( 30 ). Time to MI was constructed using an exponential distribution derived from a registry that prospectively recorded incidence of MI post stroke ( N = 9,840) during the period of 2003–2016 (median follow-up: 4.7 years) ( 31 ).…”

Section: Methodsmentioning

confidence: 99%

Real-World Cost-Effectiveness of Late Time Window Thrombectomy for Patients With Ischemic Stroke

et al. 2021

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Background: To compare the cost-effectiveness of providing endovascular thrombectomy (EVT) for patients with ischemic stroke in the >4.5 h time window between patient groups who met and did not meet the perfusion imaging trial criteria.Methods: A discrete event simulation (DES) model was developed to simulate the long-term outcome post EVT in patients meeting or not meeting the extended time window clinical trial perfusion imaging criteria at presentation, vs. medical treatment alone (including intravenous thrombolysis). The effectiveness of thrombectomy in patients meeting the landmark trial criteria (DEFUSE 3 and DAWN) was derived from a prospective cohort study of Australian patients who received EVT for ischemic stroke, between 2015 and 2019, in the extended time window (>4.5 h).Results: Endovascular thrombectomy was shown to be a cost-effective treatment for patients satisfying the clinical trial criteria in our prospective cohort [incremental cost-effectiveness ratio (ICER) of $11,608/quality-adjusted life year (QALY) for DEFUSE 3-postive or $34,416/QALY for DAWN-positive]. However, offering EVT to patients outside of clinical trial criteria was associated with reduced benefit (−1.02 QALY for DEFUSE 3; −1.43 QALY for DAWN) and higher long-term patient costs ($8,955 for DEFUSE 3; $9,271 for DAWN), thereby making it unlikely to be cost-effective in Australia.Conclusions: Treating patients not meeting the DAWN or DEFUSE 3 clinical trial criteria in the extended time window for EVT was associated with less gain in QALYs and higher cost. Caution should be exercised when considering this procedure for patients not satisfying the trial perfusion imaging criteria for EVT.

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Section: Methodsmentioning

confidence: 99%

Real-World Cost-Effectiveness of Late Time Window Thrombectomy for Patients With Ischemic Stroke

et al. 2021

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“…Urine: 1: <100mL; 2: ≥100mL and <400mL; 3: ≥400mL and <2500mL; 4: >2500mL. of the association between the hypermagnesemia and high risk of mortality could also be neuromuscular dysfunction, respiratory depression, hypotonia, areflexia, coma and malignant cardiac arrhythmias resulting from hypermagnesemia.- 15,16 In addition, low bicarbonate concentration, reflecting underlying metabolic acidosis, has been proven to cause impaired myocardial contractility, and the expression of inflammatory factors in endothelial cells in animal models. [17][18][19] These mechanisms can cause poor prognosis in AMI patients but still need clinical validation.…”

Section: Discussionmentioning

confidence: 99%

A Nomogram for Predicting Hospital Mortality in Intensive Care Unit Patients with Acute Myocardial Infarction

Tan¹,

Xu²,

Shi³

2021

IJGM

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Background This study aims to construct and validate an early-stage nomogram for predicting hospital mortality of ICU patients with acute myocardial infarction (AMI), to help clinicians determine the appropriate intervention. Methods The primary cohort of 2704 patients diagnosed with acute myocardial infarction in admission records from eICU-Collaborative Research Database (eICU-CRD) v2.0. Univariate logistic regression analysis and multivariate logistic regression analysis were enrolled for the construction of the predictive nomogram. Demographic factors, history of clinical cardiovascular disease, vital signs, the use of vasopressors, urine output, and serum variables in the first 24 hours were included in this analysis. The nomogram was evaluated by performance traits including Harrell’s concordance index (C-index) and area under the receiver operating characteristic (AUC) analysis, calibration curve, and decision curve analysis (DCA). The nomogram was validated in a different cohort containing 1026 subjects collected from MIMIC-III Database v1.4. Finally, in order to compare the performance with other classic prediction models, AUC analysis, calibration curve, DCA and accuracy analysis (net reclassification improvement (NRI)) were conducted for three ICU scores in validated cohort. Results The nomogram revealed 14 predictors of the first 24 hours derived from univariate and multivariable analyses, including age, history of peripheral vascular disease, atrial fibrillation, cardiogenic shock and cardiac arrest, the use of norepinephrine, urine output, white blood cell (WBC), hemoglobin (Hb), red blood cell (RBC), red cell distribution width (RDW), glucose, bicarbonate and magnesium. The C-index of this nomogram was 0.834 (95% CI 0.812 to 0.856). Then, the result of AUC analysis, the DCA and calibration curve indicated that our nomogram was feasible for clinical prediction. The predictive ability and clinical use of the nomogram were verified in the validated cohort. The AUC analysis of ICU scores showed that the AUC of these score systems was ranged from 0.811 to 0.860 (the AUC of nomogram: 0.885). Moreover, our nomogram also showed a better performance in calibration curve and DCA NRI. Conclusion The study presents a prediction nomogram incorporating 14 variables that could help identify AMI patients admitted in ICU who might have a high risk of hospital mortality in the first hospitalized 24 hours. This nomogram showed a better performance than normal ICU score systems.

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“…And in the Rochester Epidemiology Project, the mean annual incidence of MI was 0.95%. 21 However, in recent multicentre studies conducted in Japan, 4 South Korea 5 and the UK, 6 the risk of MI at 1 year was between 0.09% and 0.54%, which was much lower. Moreover, in nondisabled patients with TIA and minor stroke in TIAregistry.…”

Section: Open Accessmentioning

confidence: 95%

“…3 Given the potential heterogeneity among individual studies existed in systematic review, this result should be cautiously interpreted. Furthermore, several multicentre studies conducted in the UK, Japan and South Korea after 2007 [4][5][6] showed that 1-year incidence of MI after ischaemic stroke decreased to less than 1%, which is more noteworthy.…”

Section: Introductionmentioning

confidence: 99%

Trends and predictors of myocardial infarction or vascular death after ischaemic stroke or TIA in China, 2007–2018: insights from China National Stroke Registries

et al. 2020

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BackgroundAlthough stroke management, primary and secondary preventions have been improved in China last decades, the trends and predictors of major vascular events after ischaemic stroke or transient ischaemic attack (TIA) at national scale are less known.MethodsData were obtained from the three phases of China National Stroke Registry (CNSR), including CNSR-Ⅰ (years 2007–2008), CNSR-Ⅱ (years 2012–2013) and CNSR-III (years 2015–2018). For comparison, patients who were diagnosed as ischaemic stroke or TIA were included. Kaplan-Meier estimates of myocardial infarction (MI) or vascular death were calculated at 1 year. Independent predictors were further assessed with a Cox proportional hazards regression.ResultsFrom 2007 to 2018, a total of 50 284 patients with ischaemic stroke or TIA were enrolled in this study. A declining trend was found in 1-year MI or vascular death (p for trend <0.001), while recurrent stroke depicted a U-shape curve with a nadir in 2012–2013 cohort. A similar trend was also observed in patients who were admitted to 26 hospitals in all three CNSRs. In 2015–2018 cohort, only 251 (1.7%; 95% CI 1.5% to 1.9%) MI or vascular death had occurred at 1 year. Older age, previous stroke or TIA, history of coronary artery disease and the National Institutes of Health Stroke Scale >6 were associated with both an increased risk of MI or vascular death and recurrent stroke. While early antiplatelet therapy and lipid-lowering agents at discharge predicted a reduced risk.ConclusionA declining trend and current low incidence of MI or vascular death, rather than recurrent stroke, after ischaemic stroke or TIA were observed in China. Traditional factors were found as independent predictors. These findings suggested there is still much room to improve for stroke management.

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Myocardial infarction after acute ischaemic stroke: Incidence, mortality and risk factors

Cited by 15 publications

References 30 publications

Real-World Cost-Effectiveness of Late Time Window Thrombectomy for Patients With Ischemic Stroke

Real-World Cost-Effectiveness of Late Time Window Thrombectomy for Patients With Ischemic Stroke

A Nomogram for Predicting Hospital Mortality in Intensive Care Unit Patients with Acute Myocardial Infarction

Trends and predictors of myocardial infarction or vascular death after ischaemic stroke or TIA in China, 2007–2018: insights from China National Stroke Registries

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