In-hospital myocardial infarction following acute ischaemic stroke: an observational study

Background and Purpose — Acute myocardial infarction is expected to be an important medical complication following ischaemic stroke. We sought to describe the frequency and clinical impact of in-hospital myocardial infarction following acute ischaemic stroke.

Methods — Consecutive patients with acute ischaemic stroke were identified from the Registry of the Canadian Stroke Network (2003–2006). Stroke severity was measured using the Canadian Neurological Scale (CNS). Functional status at discharge was measured with the modified-Rankin Scale, and categorized into strokes with no or mild-moderate dependency (m-Rankin 0–3) and those with severe dependence or death (m-Rankin 4–6). Multivariable logistic regression was used to determine the association between myocardial infarction and clinical outcome (death or severe dependence at hospital discharge and 1 year mortality), independent of co-morbidities and in-hospital medical complications.

Results — In total, 9180 patients with acute ischaemic stroke were included. The mean age was 72 years (SD 13.9) and 48% were female. Overall, 211 (2.3%) patients were reported to have myocardial infarction during hospitalization. At hospital discharge, 64.9% of patients with in-hospital myocardial infarction had died or were severely disabled, compared with 35.8% in the entire cohort. Mortality at 1 year after ischaemic stroke was 56.4% in patients with myocardial infarction and 21.9% in the entire cohort. On multivariable analyses, myocardial infarction was also associated with death or severe dependence at discharge (OR 2.51; 95%CI 1.75–3.59) and mortality within 1 year (HR 1.83; 95%CI 1.51–2.23). Previous history of myocardial infarction (OR 1.50; 95%CI 1.05–2.15), diabetes mellitus (OR 1.55; 95%CI 1.42–2.10), stroke severity (OR 1.13; 95% CI 1.09–1.17) and peripheral vascular disease (OR 1.61; 95%CI 1.04–2.49) were independently associated with myocardial infarction during hospitalization.

Conclusions — Myocardial infarction is an important medical complication after acute ischaemic stroke.