Myocardial Infarction as a Complication in Acute Stroke: Results from the Austrian Stroke Unit Registry

Abstract

Background: Patients with transient ischemic attack (TIA) and stroke have an increased risk for subsequent cardiac events including myocardial infarction (MI), which might be associated with a worse clinical outcome. Rapid identification of stroke patients at higher risk for MI might foster intensified cardiac monitoring or certain therapeutic strategies. However, information regarding acute MI as a complication of stroke in the very acute phase is limited. Moreover, there are no systematic data on the occurrence of MI following intracerebral hematoma. We thus aimed to assess the frequency, clinical characteristics and short-term outcome of patients suffering from acute MI in the stroke unit setting. Methods: We analyzed 46,603 patients from 32 Austrian stroke units enrolled in the prospective Austrian Stroke Unit Registry because of TIA/acute stroke over a 6-year period (January 1, 2007 to January 13, 2013). A total of 41,619 patients (89.3%) had been treated for TIA/ischemic stroke and 4,984 (10.7%) for primary intracerebral hemorrhage (ICH). Acute MI was defined according to clinical evaluation, ECG findings and laboratory assessments. Patients with evidence for MI preceding the cerebrovascular event were not considered. Results: Overall, 421 patients (1%) with TIA/ischemic stroke and 17 patients (0.3%) with ICH suffered from MI during stroke unit treatment for a median duration of 3 days. Patients with TIA/ischemic stroke and MI were significantly older, clinically more severely affected and had more frequently vascular risk factors, atrial fibrillation and previous MI. Total anterior circulation and left hemispheric stroke syndromes were more often observed in MI patients. Patients with MI not only suffered from worse short-term outcome including a higher mortality (14.5 vs. 2%; p < 0.001) at stroke unit discharge, but also acquired more stroke complications like progressive stroke and pneumonia. Multivariate analyses identified previous MI and stroke severity at admission (according to the National Institutes of Health and Stroke Scale score) as factors independently associated with the occurrence of MI on the stroke unit. Conclusions: While quite rare in the acute phase after stroke, MI is associated with a poor short-term outcome including a higher mortality. Patients with previous MI and severe stroke syndromes appear to be at particular risk for MI as an early complication in the stroke unit setting. Further studies are needed to determine whether increased vigilance and prolonged (cardiac) monitoring or certain therapeutic approaches could improve the outcome in these high-risk patients.

Ischemic Stroke with Troponin Elevation: Patient Characteristics, Resource Utilization, and In-Hospital Outcomes

“…In addition, the more intensive lowering of blood pressure recommended for AMI may be harmful in patients with acute ischemic stroke, with current guidelines only recommending treatment for specific individuals receiving thrombolytic therapy or with other acute organ injury or marked blood pressure elevations [7] . Furthermore, clinically relevant AMI after stroke (as defined by standard criteria and clinical judgment) occurs substantially less often than troponin elevation alone, as noted in a recent analysis from a national registry [36] . This latter finding may explain why many standard AMI therapies are not associated with risk reduction in troponin-positive stroke patients, with troponin functioning more as a prognostic marker than a diagnostic test for AMI in these individuals.…”

Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

“…Recent data from the prospective Austrian Stroke Unit Registry, which included 4984 ICH patients, found that 0.3% of patients had an MI over a median duration of 3 days. 175 These patients not only experienced higher inhospital mortality but also had greater complications, including pneumonia and progressive stroke. History of prior MI and severity of deficits on admission are associated with the occurrence of MI.…”

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

“…Since data were obtained by cross-linking the hospital database with NHS primary care data, all incident MI events occurring during the follow-up period were recorded unless they occurred outside the United Kingdom and were not recorded within the NHS primary care database.Characteristic data and relevant covariates were selected based on existing literature[10][11][12] and clinical judgement. We highlight a range of potential areas to focus preventative efforts.ischaemic stroke, mortality, myocardial infarction, risk factors of Disease (ICD-10), based on patient history, ECG findings, and cardiac troponin levels (ICD I21; ST elevation [STEMI] and non-ST elevation [NSTEMI] myocardial infarction).…”