Myocardial infarction and stroke

Stroke is a rare but potentially devastating complication of acute myocardial infarction

• stroke occurs in approximately 1per cent of patients following percutaneous coronary intervention (PCI)
• study evidence shows (1)
  • stroke occurred in 1.3% of primary patients with PCI
    • a third of strokes were ischemic (n=23; 33%), 12% (n=8) were hemorrhagic, and the remaining 55% (n=38) were of uncertain type
    • median (25th, 75th percentile) time of stroke occurrence was 6 (3, 14) days
    • 43% of strokes occurred within 48 hours of PCI, and all hemorrhagic strokes occurred within 48 hours
    • stroke was associated with an increased risk of 90-day death (unadjusted hazard ratio [HR], 8.0; 95% confidence interval [CI], 4.8-13.5), congestive heart failure (unadjusted HR, 3.2; 95% CI, 1.3-7.8), and 30-day hospital readmission (unadjusted HR, 3.2; 95% CI, 2.0-5.1)
      
      
  • all hemorrhagic strokes occurred within 48 hours of primary PCI, whereas ischemic strokes tended to occur beyond 48 hours
  • because most of the strokes occurred >48 hours after primary PCI, not all strokes after primary PCI seem to be procedure-related and, therefore, other mechanisms might be responsible for these later events

Reference:

• Guptill JT et al. Stroke after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction: timing, characteristics, and clinical outcomes.Circ Cardiovasc Interv. 2013 Apr;6(2):176-83