Risk Factors for Stroke following Acute Myocardial Infarction

Pullicino, Patrick; Xuereb, Mariosa; Aquilina, Josanne; Piedmonte, Marion

doi:10.1159/000108844

Cited by 4 publications

(2 citation statements)

References 24 publications

(34 reference statements)

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“…This increased risk may be due to the effects of hypertension on either the heart, the cerebrovascular circulation, or both. In the heart, hypertension may aggravate poor cardiac function after MI [13], increasing the likelihood of hypotension or cardiac thrombus formation [5]. In the brain, hypertension is thought to increase further the elevated stroke risk in diabetics [21].…”

Section: Discussionmentioning

confidence: 99%

Stroke following acute myocardial infarction in diabetics

Pullicino¹,

Xuereb²,

Aquilina³

et al. 1992

Journal of Internal Medicine

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To investigate the effect of diabetes on stroke after myocardial infarction (MI), we studied consecutive MI patients admitted to the coronary-care unit prospectively, and compared diabetics with non-diabetics. Seven per cent (11/148) of diabetics and 3% (8/297) of non-diabetics had a stroke within 1 month after MI (P = 0.020). Previous stroke and hypertension were significant risk factors for stroke after MI in diabetics, but there were no significant risk factors in non-diabetics. Hypertension was more frequent in diabetics with (12/14; 86%) than in diabetics without (63/134; 47%) a previous stroke (P less than 0.025). Severe hypotension was more frequent in diabetics (9/11) than in non-diabetics with stroke after MI (0/8) (P = 0.002). We conclude that hypertension is a risk factor for stroke after MI in diabetics, and that may be at risk for hypotensive stroke after MI. Stroke after MI may be more frequent in diabetics than in non-diabetics.

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Section: Discussionmentioning

confidence: 99%

Stroke following acute myocardial infarction in diabetics

Pullicino¹,

Xuereb²,

Aquilina³

et al. 1992

Journal of Internal Medicine

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show abstract

“…Secondary analyses of randomized trial data have found that increasing age, prior thromboembolism, hypertension, diabetes, and impaired left ventricular function or clinical congestive heart failure identify patients at greatest risk of stroke among patients with atrial fibrillation, 6 and similar factors apply within 1 month of acute myocardial infarction. 18 Similarly, patient age, prior stroke, hypertension, and diabetes were risk factors Reprinted with permission from reference 12.…”

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confidence: 99%

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2000

Neurology

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Article abstract-Background: Cardiac failure is associated with both stroke of presumed cardioembolic origin and a high mortality rate. Warfarin is used frequently in patients with reduced cardiac left ventricular ejection fraction (EF), although no randomized trials have confirmed that anticoagulation benefits these patients. Methods: A literature review was performed pertaining to the frequency of stroke and mortality, and the effect of antithrombotic agents on stroke and mortality rates, in patients with cardiac failure or reduced cardiac EF. We also reviewed the main features of two new proposed studies (Warfarin and Antiplatelet Therapy in Chronic Heart Failure [WATCH] and Warfarin Versus Aspirin in Reduced Cardiac Ejection Fraction [WARCEF]) comparing warfarin and antiplatelet agents in patients with low EF. Results: The risk of stroke increases with decreasing EF and the risk of mortality increases with the clinical severity of cardiac failure (New York Heart Association class). Data from heart failure treatment studies suggest that warfarin may reduce stroke and mortality in patients with reduced EF, but definitive answers are lacking. The stroke rate alone is too low to be used as a primary endpoint, but an endpoint combining stroke and death (as WARCEF and WATCH propose) should allow an assessment of the effect of antithrombotics in cardiac failure. Amalgamating the data on stroke from these two trials should yield enough statistical power to compare the effects of warfarin and aspirin on stroke as an independent secondary endpoint. Conclusion: Whether warfarin is superior to aspirin in reducing stroke and mortality in patients with low ejection fraction is an important clinical issue that warrants prospective evaluation.

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Small deep cerebral infarcts: Is there synergism between hypertension and diabetes?

Pullicino

Zammit

1993

Journal of Stroke and Cerebrovascular Diseases

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Risk Factors for Stroke following Acute Myocardial Infarction

Cited by 4 publications

References 24 publications

Stroke following acute myocardial infarction in diabetics

Stroke following acute myocardial infarction in diabetics

Access www.neurology.org now for full-text articles

Small deep cerebral infarcts: Is there synergism between hypertension and diabetes?

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