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

Tiberiu A. Pana, Adrian D. Wood, Mamas A. Mamas, Allan B. Clark, Joao H. Bettencourt-Silva, David J. McLernon, John F. Potter, Phyo K. Myint (Corresponding Author), Norfolk and Norwich Stroke and TIA Register Steering Committee Collaborators

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Abstract

Objectives
To determine the risk factor profiles associated with post‐acute ischaemic stroke (AIS) myocardial infarction (MI) over long‐term follow‐up.

Methods
This observational study includes prospectively identified AIS patients (n = 9840) admitted to a UK regional centre between January 2003 and December 2016 (median follow‐up: 4.72 years). Predictors of post‐stroke MI during follow‐up were examined using logistic and Cox regression models for in‐hospital and post‐discharge events, respectively. MI incidence was determined using a competing risk non‐parametric estimator. The influence of post‐stroke MI on mortality was examined using Cox regressions.

Results
Mean age (SD) of study participants was 77.3 (12.2) years (48% males). Factors associated with in‐hospital MI (OR [95% CI]) were increasing blood glucose (1.80 [1.17‐2.77] per 10 mmol/L), total leucocyte count (1.25 [1.01‐1.54] per 10 × 109/L) and CRP (1.05 [1.02‐1.08] per 10 mg/L increase). Age (HR [95% CI] = 1.03 [1.01‐1.06]), coronary heart disease (1.59 [1.01‐2.50]), chronic kidney disease (2.58 [1.44‐4.63]) and cancers (1.76 [1.08‐2.89]) were associated with incident MI between discharge and one‐year follow‐up. Age (1.02 [1.00‐1.03]), diabetes (1.96 [1.38‐2.65]), congestive heart failure (2.07 [1.44‐2.99]), coronary heart disease (1.81 [1.31‐2.50]), hypertension [1.86 (1.24‐2.79)] and peripheral vascular disease (2.25 [1.40‐3.63]) were associated with incident MI between 1 and 5 years after discharge. Diabetes (2.01 [1.09‐3.72]), hypertension (3.69 [1.44‐9.45]) and peripheral vascular disease (2.46 [1.02‐5.98]) were associated with incident MI between 5 and 10 years after discharge. Cumulative MI incidence over 10 years was 5.4%. MI during all follow‐up periods (discharge‐1, 1‐5, 5‐10 years) was associated with increased risk of death (respective HR [95% CI] = 3.26 [2.51‐4.15], 1.96 [1.58‐2.42] and 1.92 [1.26‐2.93]).

Conclusions
In conclusion, prognosis is poor in post‐stroke MI. We highlight a range of potential areas to focus preventative efforts.
Original languageEnglish
Pages (from-to)219-228
Number of pages10
JournalActa Neurologica Scandinavica
Volume140
Issue number3
Early online date17 Jun 2019
DOIs
Publication statusPublished - Sep 2019

Keywords

  • myocardial infarction
  • ischemic stroke
  • mortality
  • risk factors
  • ischaemic stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

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    Pana, T. A., Wood, A. D., Mamas, M. A., Clark, A. B., Bettencourt-Silva, J. H., McLernon, D. J., Potter, J. F., Myint, P. K., & Norfolk and Norwich Stroke and TIA Register Steering Committee Collaborators (2019). Myocardial infarction after acute ischaemic stroke: incidence, mortality, and risk factors. Acta Neurologica Scandinavica, 140(3), 219-228. https://doi.org/10.1111/ane.13135