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.
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 language | English |
|---|---|
| Pages (from-to) | 219-228 |
| Number of pages | 10 |
| Journal | Acta Neurologica Scandinavica |
| Volume | 140 |
| Issue number | 3 |
| Early online date | 17 Jun 2019 |
| DOIs | |
| Publication status | Published - Sept 2019 |
Bibliographical 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.
Keywords
- myocardial infarction
- ischemic stroke
- mortality
- risk factors
- ischaemic stroke
Access to Document
- Accepted Manuscript
This is the peer reviewed version of the following article: Pana, TA, Wood, AD, Mamas, MA, et al. Myocardial infarction after acute ischaemic stroke: Incidence, mortality and risk factors. Acta Neurol Scand. 2019; 140: 219– 228., which has been published in final form at https://doi.org/10.1111/ane.13135. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.