Outcomes of Cardio-Cerebral Infarction Patients: A Single-Centre Retrospective Study

Abstract

Background Cardio-cerebral infarction (CCI) belongs to an area of growing interest within cerebrovascular medicine as it refers to the concurrence of acute ischaemic stroke (AIS) and acute myocardial infarction (AMI) usually within 72 hours. A scenario where both the heart and brain sustain a catastrophic ischaemic insult can be devastating. We describe the incidence, treatment, and outcomes of CCI patients from a North London Hyper-Acute Stroke Unit (HASU) over two years and propose a potential treatment algorithm for the treatment of CCI. Methodology A retrospective analysis of AIS patients admitted to a North London HASU between January 2020 to December 2021 was performed to investigate the occurrence of concurrent AIS and AMI. Patients were initially included if they had elevated troponins upon admission to the stroke unit, following which they were excluded or included based on the diagnosis and treatment of myocardial infarction (MI) within 72 hours of AIS or vice versa. We describe the clinical characteristics of admission, clinical progression, management, and outcomes of patients suffering from CCIs. Results A total of 1,921 AIS patients were analysed. Of these, 302(16%) patients had elevated troponin and 35 (1.8%) patients were treated as acute coronary syndrome. Overall, 18 (0.9%) patients had CCI. Further analysis of CCI patients showed in-hospital death occurred in seven (41%) patients. The median length of stay was six days (range = 1-44 days). Angioplasty was used to treat MI in five (29%) patients, and the rest were medically managed or died. Conclusions Although rare, CCI has an exceedingly high mortality, and therefore, recognising and choosing the appropriate therapy is vital when attempting to re-perfuse both vital organs. Collaboration between stroke physicians, neuro-interventionalists, and cardiologists with a clear CCI pathway will enable better management and outcomes for these patients.