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

Research output: Contribution to journalArticle

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

Fingerprint

Stroke
Myocardial Infarction
Mortality
Incidence
Peripheral Vascular Diseases
Coronary Disease
Hypertension
Chronic Renal Insufficiency
Leukocyte Count
Proportional Hazards Models
Observational Studies
Blood Glucose
Heart Failure
Logistic Models
Neoplasms

Keywords

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

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Pana, T. A., Wood, A. D., Mamas, M. A., Clark, A. B., Bettencourt-Silva, J. H., McLernon, D. J., ... 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

Myocardial infarction after acute ischaemic stroke : incidence, mortality, and risk factors. / Pana, Tiberiu A.; Wood, Adrian D.; Mamas, Mamas A.; Clark, Allan B.; Bettencourt-Silva, Joao H.; McLernon, David J.; Potter, John F.; Myint, Phyo K. (Corresponding Author); Norfolk and Norwich Stroke and TIA Register Steering Committee Collaborators.

In: Acta Neurologica Scandinavica, Vol. 140, No. 3, 09.2019, p. 219-228.

Research output: Contribution to journalArticle

Pana, TA, Wood, AD, Mamas, MA, Clark, AB, Bettencourt-Silva, JH, McLernon, DJ, Potter, JF, Myint, PK & 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, vol. 140, no. 3, pp. 219-228. https://doi.org/10.1111/ane.13135
Pana, Tiberiu A. ; Wood, Adrian D. ; Mamas, Mamas A. ; Clark, Allan B. ; Bettencourt-Silva, Joao H. ; McLernon, David J. ; Potter, John F. ; Myint, Phyo K. ; Norfolk and Norwich Stroke and TIA Register Steering Committee Collaborators. / Myocardial infarction after acute ischaemic stroke : incidence, mortality, and risk factors. In: Acta Neurologica Scandinavica. 2019 ; Vol. 140, No. 3. pp. 219-228.
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title = "Myocardial infarction after acute ischaemic stroke: incidence, mortality, and risk factors",
abstract = "ObjectivesTo determine the risk factor profiles associated with post‐acute ischaemic stroke (AIS) myocardial infarction (MI) over long‐term follow‐up.MethodsThis 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.ResultsMean 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]).ConclusionsIn conclusion, prognosis is poor in post‐stroke MI. We highlight a range of potential areas to focus preventative efforts.",
keywords = "myocardial infarction, ischemic stroke, mortality, risk factors, ischaemic stroke",
author = "Pana, {Tiberiu A.} and Wood, {Adrian D.} and Mamas, {Mamas A.} and Clark, {Allan B.} and Bettencourt-Silva, {Joao H.} and McLernon, {David J.} and Potter, {John F.} and Myint, {Phyo K.} and {Norfolk and Norwich Stroke and TIA Register Steering Committee Collaborators}",
note = "The following individuals should be indexed on PubMed as collaborators: Norfolk and Norwich Stroke Registry Steering Committee Collaborators: Anthony K Metcalfe, Kristian M Bowles. We would also like to thank the data team of the Norfolk and Norwich University Hospital Stroke Services. We also thank Prof Kristian Bowles and Dr Anthony K Metcalfe (co-Principal Investigators of the stroke register) and our lay steering committee members and independent chair Prof Alastair Forbes (Chief of Research & Innovation, Norfolk and Norwich University Hospital). SOURCES OF FUNDING TAP received the Gwyn Seymour Aberdeen Summer Research Scholarship (ASRS) to carry out the research [grant number EA6414]. ADW was funded by the Special Educational Scholarship award by the Department of Medicine for the Elderly, NHS Grampian [grant number ES798]. NNUH Stroke Register is maintained by the NNUH Stroke Services.",
year = "2019",
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doi = "10.1111/ane.13135",
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TY - JOUR

T1 - Myocardial infarction after acute ischaemic stroke

T2 - incidence, mortality, and risk factors

AU - Pana, Tiberiu A.

AU - Wood, Adrian D.

AU - Mamas, Mamas A.

AU - Clark, Allan B.

AU - Bettencourt-Silva, Joao H.

AU - McLernon, David J.

AU - Potter, John F.

AU - Myint, Phyo K.

AU - Norfolk and Norwich Stroke and TIA Register Steering Committee Collaborators

N1 - The following individuals should be indexed on PubMed as collaborators: Norfolk and Norwich Stroke Registry Steering Committee Collaborators: Anthony K Metcalfe, Kristian M Bowles. We would also like to thank the data team of the Norfolk and Norwich University Hospital Stroke Services. We also thank Prof Kristian Bowles and Dr Anthony K Metcalfe (co-Principal Investigators of the stroke register) and our lay steering committee members and independent chair Prof Alastair Forbes (Chief of Research & Innovation, Norfolk and Norwich University Hospital). SOURCES OF FUNDING TAP received the Gwyn Seymour Aberdeen Summer Research Scholarship (ASRS) to carry out the research [grant number EA6414]. ADW was funded by the Special Educational Scholarship award by the Department of Medicine for the Elderly, NHS Grampian [grant number ES798]. NNUH Stroke Register is maintained by the NNUH Stroke Services.

PY - 2019/9

Y1 - 2019/9

N2 - ObjectivesTo determine the risk factor profiles associated with post‐acute ischaemic stroke (AIS) myocardial infarction (MI) over long‐term follow‐up.MethodsThis 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.ResultsMean 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]).ConclusionsIn conclusion, prognosis is poor in post‐stroke MI. We highlight a range of potential areas to focus preventative efforts.

AB - ObjectivesTo determine the risk factor profiles associated with post‐acute ischaemic stroke (AIS) myocardial infarction (MI) over long‐term follow‐up.MethodsThis 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.ResultsMean 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]).ConclusionsIn conclusion, prognosis is poor in post‐stroke MI. We highlight a range of potential areas to focus preventative efforts.

KW - myocardial infarction

KW - ischemic stroke

KW - mortality

KW - risk factors

KW - ischaemic stroke

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