Incidence and Outcomes of Myocardial Infarction in Patients Admitted With Acute Ischemic Stroke

Alqahtani, Fahad; Aljohani, Sami; Tarabishy, Abdul; Busu, Tatiana; Adcock, Amelia; Alkhouli, Mohamad

doi:10.1161/strokeaha.117.018408

Cited by 63 publications

(46 citation statements)

References 15 publications

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“…Cardiac death and serious cardiac events are reported in 4% and 19% of patients, respectively, within the first 3 months after an AIS [35]. Cardiac arrhythmias [18], Takotsubo cardiomyopathy [7], myocardial infarction [36], autonomic dysfunction [37], and paroxysmal hypertension [38] are the most common clinical features (Table S1, Additional file 1). Additionally, the localization of the stroke area involved is a fundamental predictor of possible cardiac consequences (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Acute and chronic cardiac dysfunction after AIS Acute cardiac dysfunction after AIS Both ischemic and arrhythmic electrocardiographic changes are common after AIS within the first 24 h [18]. Additionally, acute myocardial infarction or myocardial infarction-like abnormalities are very common after AIS [36] and are associated with an increased risk of unfavorable functional neurological outcomes and major cardiovascular events [38].…”

Section: Acute and Chronic Cardiac Dysfunction Pre-aismentioning

confidence: 99%

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Brain–heart interaction after acute ischemic stroke

et al. 2020

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Early detection of cardiovascular dysfunctions directly caused by acute ischemic stroke (AIS) has become paramount. Researchers now generally agree on the existence of a bidirectional interaction between the brain and the heart. In support of this theory, AIS patients are extremely vulnerable to severe cardiac complications. Sympathetic hyperactivity, hypothalamic-pituitary-adrenal axis, the immune and inflammatory responses, and gut dysbiosis have been identified as the main pathological mechanisms involved in brain-heart axis dysregulation after AIS. Moreover, evidence has confirmed that the main causes of mortality after AIS include heart attack, congestive heart failure, hemodynamic instability, left ventricular systolic dysfunction, diastolic dysfunction, arrhythmias, electrocardiographic anomalies, and cardiac arrest, all of which are more or less associated with poor outcomes and death. Therefore, intensive care unit admission with continuous hemodynamic monitoring has been proposed as the standard of care for AIS patients at high risk for developing cardiovascular complications. Recent trials have also investigated possible therapies to prevent secondary cardiovascular accidents after AIS. Labetalol, nicardipine, and nitroprusside have been recommended for the control of hypertension during AIS, while beta blockers have been suggested both for preventing chronic remodeling and for treating arrhythmias. Additionally, electrolytic imbalances should be considered, and abnormal rhythms must be treated. Nevertheless, therapeutic targets remain challenging, and further investigations might be essential to complete this complex multi-disciplinary puzzle. This review aims to highlight the pathophysiological mechanisms implicated in the interaction between the brain and the heart and their clinical consequences in AIS patients, as well as to provide specific recommendations for cardiovascular management after AIS.

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Section: Discussionmentioning

confidence: 99%

Section: Acute and Chronic Cardiac Dysfunction Pre-aismentioning

confidence: 99%

Brain–heart interaction after acute ischemic stroke

et al. 2020

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“…This is usually due to atherosclerosis or thrombosis in the arteries supplying blood to the brain, leading to luminal stenosis or even occlusion, resulting in focal acute insufficient blood supply [ 1 , 2 ]. ACI is currently an extremely common neurological disease worldwide, with a high incidence in the elderly [ 3 ]. According to statistics, the incidence of ACI is as high as 20.6% [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

[Retracted] Effects of Arteriovenous Thrombolysis Combined with Mechanical Thrombectomy on Efficacy and Neurological Function of Acute Cerebral Infarct Patients

Ding

Tang

et al. 2020

BioMed Research International

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Objective. To investigate the effects of arteriovenous thrombolysis combined with mechanical thrombectomy on clinical efficacy, neurological function, and the changes of nerve injury markers of acute cerebral infarct (ACI) patients. Methods. A total of 143 cases with ACI admitted to our hospital from June 2017 to June 2019 were elected as research subjects. Among them, 69 cases of patients who received treatment of arteriovenous thrombolysis were considered as group A, and 74 cases of patients who received treatment of arteriovenous thrombolysis combined with mechanical thrombectomy were considered as group B. NIHSS score, clinical efficacy, vascular recanalization, adverse reactions, hemodynamics, neurological injury indexes, duration of coma, length of hospital stay, and prognosis of patients in the two groups were compared. Results. After treatment, the NIHSS score of group A was higher than that of group B (P<0.05), the clinical efficacy of group B was better than that of group A, and the incidence of adverse reactions was lower than that of group A (P<0.05). There was no difference in vascular recanalization rate, duration of coma, and prognosis between the two groups (P>0.05). Length of hospital stay, maximum peak velocity after treatment (Vs), and mean flow rate (Vm) of group A were lower than those of group B, while vascular resistance index (RI), pulsatility index (PI), serum glutamic acid (Glu), neuron-specific enolase (NES), and S100β protein detected by enzyme-linked immunosorbent assay (ELISA) of group A were higher than those of group B (P<0.05). Conclusion. Arteriovenous thrombolysis combined with mechanical thrombectomy has a significant effect on ACI, with high safety and quick effect. In addition, it has a stronger effect on improving and protecting the neurological function of patients, which is worth promoting in clinical practice.

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“…5 The most recent systematic review calculated that the yearly risk of post-stroke MI is 1.67%. 8 Furthermore, it may be the case that the risk factors for post-AIS MI may differ significantly from those in the general population. In fact, the aforementioned figures are comparable to those of incident ACS in the general population.…”

Section: Introductionmentioning

confidence: 99%

“…It has been shown in a recent study that MI-associated hospital mortality is significantly higher in AIS patients than in non-AIS controls: 21.44% vs 7.1%, respectively. 8 Furthermore, it may be the case that the risk factors for post-AIS MI may differ significantly from those in the general population.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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 postdischarge 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 × 10 9 /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

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Incidence and Outcomes of Myocardial Infarction in Patients Admitted With Acute Ischemic Stroke

Cited by 63 publications

References 15 publications

Brain–heart interaction after acute ischemic stroke

Brain–heart interaction after acute ischemic stroke

[Retracted] Effects of Arteriovenous Thrombolysis Combined with Mechanical Thrombectomy on Efficacy and Neurological Function of Acute Cerebral Infarct Patients

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

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