Early Stroke following Acute Myocardial Infarction: Incidence, Predictors and Outcome in Six Middle-Eastern Countries

Abstract

Background and Objectives: Stroke is a potential complication of acute myocardial infarction (AMI). The aim of this study was to identify the incidence, risk factors predisposing to stroke and in-hospital outcome during the index admission with AMI among patients in the Middle East. Methods: For a period of 6 months in 2006 and 2007, 5,833 consecutive AMI patients were enrolled from 64 hospitals in 6 Middle East countries. Results: The incidence of in-hospital stroke following AMI was 0.85%. Most cases were ST segment elevation AMI-related and ischemic in nature. Patients with in-hospital stroke were older than patients without stroke and were more likely to be female (36 vs. 18.6%, p = 0.0033). They were also more likely to have diabetes mellitus, dyslipidemia, prior AMI, or percutaneous/surgical coronary revascularization. Patients with stroke were more likely to present with advanced Killip class II–IV, higher mean heart rate and higher serum creatinine. Independent predictors of stroke were age, prior stroke, prior coronary artery bypass surgery, anterior AMI and systolic blood pressure >190 mm Hg on presentation. Early administration of statins was independently associated with reduced stroke risk (odds ratio, OR, 0.4, 95% confidence interval, CI, 0.19–0.90, p = 0.025). Stroke was fatal in 44% of the cases and was independently associated with in-hospital mortality (adjusted OR 12.5, 95% CI 5.7–27.4, p < 0.01). Conclusion: There is a low incidence of in-hospital stroke in Middle-Eastern patients presenting with AMI but with very high fatality rates. Early statin therapy was associated with a significant reduction in stroke risk. Future work should be focused on reducing the risk and improving the outcome of this devastating complication.

Risk of Ischemic Stroke After an Acute Myocardial Infarction in Patients With Diabetes Mellitus

“…Furthermore, patients with diabetes mellitus had a higher risk of stroke but a lower proportion of STEMI. Moreover, anticoagulants during the initial period after AMI, which definitely decreases the incidence of left ventricular thrombus, have not been shown to decrease the incidence of ischemic stroke, 9,13,[31][32][33] and there was no association with reduced stroke risk in the present study. Instead, we think that an important mechanism behind ischemic stroke during the early post-AMI period could be increased inflammation and platelet reactivity.…”

“…2 DM has been associated with post-AMI stroke in some studies [6][7][8][9][10] but not in others. 4,5,[11][12][13] The major reasons for contradictory results are probably inadequate study sizes, exclusion of high-risk patients, and short follow-up durations.…”

“…Some researchers found that DM was associated with a significantly increased risk of post-AMI stroke, 6-10 whereas others did not. 4,5,[11][12][13] Acute and secondary preventive treatments for AMI have changed dramatically during the recent decade and may have influenced the risk of post-AMI stroke. In the diabetic AMI population, there are no data about changes in post-AMI stroke risk and no conclusive data published, even in general AMI population, about change in stroke risk during recent years.…”

Incidence, Trends, and Predictors of Ischemic Stroke 1 Year After an Acute Myocardial Infarction

“…4 Finally, there is also conflicting data on the identified independent predictors associated with stroke risk after AMI. 10 The primary purpose of this study was to make a solid estimate of the incidence of ischemic stroke during the first year after AMI. Second, we intended to evaluate whether the introduction of modern AMI treatment affected the risk of ischemic stroke after AMI.…”

In-hospital stroke

“…The mortality in IHS is higher than in COS, reaching up to 33% 11 . Stroke after MI or CABG is a serious complication and increases in-hospital mortality significantly 24,25 . IHS patients are less likely to be discharged home (27.7% (IHS) vs 49.9% (COS)) or to be functionally independent (31.0% (IHS) vs 50.4% (COS)) 3 and remain hospitalized for a longer time (mean 19.5 (IHS) vs 12.1 days (COS)) 12 .…”