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Twenty-Five-Year (1986-2011) Trends in the Incidence and Death Rates of Stroke Complicating Acute Myocardial Infarction

      Abstract

      Background

      The occurrence of a stroke after an acute myocardial infarction is associated with increased morbidity and mortality rates. However, limited data are available, particularly from a population-based perspective, about recent trends in the incidence and mortality rates associated with stroke complicating an acute myocardial infarction.
      The purpose of this study was to examine 25-year trends (1986-2011) in the incidence and in-hospital mortality rates of initial episodes of stroke complicating acute myocardial infarction.

      Methods

      The study population consisted of 11,436 adults hospitalized with acute myocardial infarction at all 11 medical centers in central Massachusetts on a biennial basis between 1986 and 2011.

      Results

      In this study cohort, 159 patients (1.4%) experienced an acute first-ever stroke during hospitalization for acute myocardial infarction. The proportion of patients with acute myocardial infarction who developed a stroke increased through the 1990s but decreased slightly thereafter. Compared with patients who did not experience a stroke, those who experienced a stroke were significantly older, were more likely to be female, had a previous acute myocardial infarction, had a significant burden of comorbidities, and were more likely to have died (32.1% vs 10.8%) during their index hospitalization. Patients who developed a first stroke in the most recent study years (2003-2011) were more likely to have died during hospitalization than those hospitalized during earlier study years.

      Conclusions

      Although the incidence rates of acute stroke complicating acute myocardial infarction remained relatively stable during the years under study, the in-hospital mortality rates of those experiencing a stroke have not decreased.

      Keywords

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      References

        • Witt BJ
        • Ballman KV
        • Brown RD
        • Meverden RA
        • Jacobsen SJ
        • Roger VL
        The incidence of stroke after myocardial infarction: a meta-analysis.
        Am J Med. 2006; 119 (e1-9): 354
        • Tanne D
        • Gottlieb S
        • Hod H
        • Reicher-Reiss H
        • Boyko V
        • Behar S
        Incidence and mortality from early stroke associated with acute myocardial infarction in the prethrombolytic and thrombolytic eras. Secondary Prevention Reinfarction Israeli Nifedipine Trial (SPRINT) and Israeli Thrombolytic Survey Groups.
        J Am Coll Cardiol. 1997; 30: 1484-1490
        • Budaj A
        • Flasinska K
        • Gore JM
        • et al.
        Magnitude of and risk factors for in-hospital and postdischarge stroke in patients with acute coronary syndromes.
        Circulation. 2005; 111: 3242-3247
        • Goldberg RJ
        • Gore JM
        • Alpert JS
        • Dalen JE
        Recent changes in attack and survival rates of acute myocardial infarction (1975 through 1981): the Worcester Heart Attack Study.
        JAMA. 1986; 255: 2774-2779
        • Mooe T
        • Eriksson P
        • Stegmayr B
        Ischemic stroke after acute myocardial infarction.
        Stroke. 1997; 28: 762-767
        • Chen H-Y
        • Gore JM
        • Lapane KL
        • et al.
        A 35-year perspective (1975-2009) into the long-term prognosis and hospital management of patients discharged from the hospital after a first acute myocardial infarction.
        Am J Cardiol. 2015; 116: 24-29
        • Chen HY
        • McManus DD
        • Saczynski JS
        • et al.
        Characteristics, treatment practices, and in-hospital outcomes of older adults hospitalized with acute myocardial infarction.
        J Am Geriatr Soc. 2014; 62: 1451-1459
        • Tisminetzky M
        • Coukos JA
        • McManus DD
        • et al.
        Decade-long trends in the magnitude, treatment, and outcomes of patients aged 30 to 54 years hospitalized with ST-segment elevation and non-ST-segment elevation myocardial infarction.
        Am J Cardiol. 2014; 113: 1606-1610
        • Nguyen HL
        • Saczynski JS
        • Gore JM
        • et al.
        Long-term trends in short-term outcomes in acute myocardial infarction.
        Am J Med. 2011; 124: 939-946
        • Behar S
        • Tanne D
        • Abinader E
        • et al.
        Cerebrovascular accident complicating acute myocardial infarction: incidence, clinical significance and short- and long-term mortality rates. The SPRINT Study Group.
        Am J Med. 1991; 91: 45-50
        • Tanne D
        • Goldbourt U
        • Zion M
        • et al.
        Frequency and prognosis of stroke/TIA among 4808 survivors of acute myocardial infarction. The SPRINT Study Group.
        Stroke. 1993; 24: 1490-1495
        • Witt BJ
        • Brown RD
        • Jacobsen SJ
        • et al.
        A community-based study of stroke incidence after myocardial infarction.
        Ann Intern Med. 2005; 143: 785-792
        • Goldberg RJ
        • Gore JM
        • Alpert JS
        • Dalen JE
        Incidence and case fatality rates of acute myocardial infarction (1975-1984): the Worcester Heart Attack Study.
        Am Heart J. 1988; 115: 761-767
        • Goldberg RJ
        • Yarzebski J
        • Lessard D
        • Gore JM
        A two-decades (1975 to 1995) long experience in the incidence, in-hospital and long-term case–fatality rates of acute myocardial infarction: a community-wide perspective.
        J Am Coll Cardiol. 1999; 33: 1533-1539
        • Goldberg RJ
        • Gorak EJ
        • Yarzebski Y
        • et al.
        A communitywide perspective of sex differences and temporal trends in the incidence and survival rates after acute myocardial infarction and out-of-hospital deaths caused by coronary heart disease.
        Circulation. 1993; 87: 1947-1953
        • Saczynski JS
        • Spencer FA
        • Gore JM
        • et al.
        Twenty-year trends in the incidence of stroke complicating acute myocardial infarction: Worcester Heart Attack Study.
        Arch Intern Med. 2008; 168: 2104-2110
        • Spencer FA
        • Gore JM
        • Yarzebski Y
        • et al.
        Trends (1986 to 1999) in the incidence and outcomes of in-hospital stroke complicating acute myocardial infarction (the Worcester Heart Attack Study).
        Am J Cardiol. 2003; 92: 383-388
        • Goldberg RJ
        • Yarzebski J
        • Lessard D
        • Wu J
        • Gore JM
        Recent trends in the incidence rates of and death rates from atrial fibrillation complicating initial acute myocardial infarction: a community-wide perspective.
        Am Heart J. 2002; 143: 519-527
        • Spencer FA
        • Meyer TE
        • Goldberg RJ
        • et al.
        Twenty year trends (1975-1995) in the incidence, in-hospital and long-term death rates associated with heart failure complicating acute myocardial infarction: a community-wide perspective.
        J Am Coll Cardiol. 1999; 34: 1378-1387
        • Goldberg RJ
        • Samad NA
        • Yarzebski J
        • et al.
        Temporal trends in cardiogenic shock complicating acute myocardial infarction.
        N Engl J Med. 1999; 340: 1162-1168
        • Maggioni AP
        • Franzosi MG
        • Farina ML
        • et al.
        Cerebrovascular events after myocardial infarction: analysis of the GISSI trial. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI).
        BMJ. 1991; 302: 1428-1431
        • Longstreth Jr, WT
        • Litwin PE
        • Weaver WD
        Myocardial infarction, thrombolytic therapy, and stroke. A community-based study. The MITI Project Group.
        Stroke. 1993; 24: 587-590
      1. ISIS-3: a randomised comparison of streptokinase vs tissue plasminogen activator vs anistreplase and of aspirin plus heparin vs aspirin alone among 41,299 cases of suspected acute myocardial infarction. ISIS-3 (Third International Study of Infarct Survival) Collaborative Group.
        Lancet. 1992; 339: 753-770
        • Thompson PL
        • Robinson JS
        Stroke after acute myocardial infarction: relation to infarct size.
        Br Med J. 1978; 2: 457-459
        • Saczynski JS
        • Spencer FA
        • Gore JM
        • et al.
        Twenty-year trends in the incidence of stroke complicating acute myocardial infarction: Worcester Heart Attack Study.
        Arch Intern Med. 2008; 168: 2104-2110
        • The GUSTO Investigators
        An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction.
        N Engl J Med. 1993; 329: 673-682
        • Angeja BG
        • Rundle AC
        • Gurwitz JH
        • Gore JM
        • Barron HV
        Death or nonfatal stroke in patients with acute myocardial infarction treated with tissue plasminogen activator.
        Am J Cardiol. 2001; 87: 627-630
        • de Boer MJ
        • Ottervanger JP
        • van 't Hof AW
        • et al.
        Reperfusion therapy in elderly patients with acute myocardial infarction: a randomized comparison of primary angioplasty and thrombolytic therapy.
        J Am Coll Cardiol. 2002; 39: 1723-1728
        • Allen CL
        • Bayraktutan U
        Risk factors for ischaemic stroke.
        Int J Stroke. 2008; 3: 105-116
        • Sacco RL
        Risk factors and outcomes for ischemic stroke.
        Neurology. 1995; 45: S10-S14
        • Wasser J
        • Goldberg RJ
        • Spencer FA
        • Yarzebski Y
        • Gore JM
        Multidecade-long trends (1986-2005) in the utilization of coronary reperfusion and revascularization treatment strategies in patients hospitalized with acute myocardial infarction: a community-wide perspective.
        Coron Artery Dis. 2009; 20: 71-80
        • Fornasini M
        • Yarzebski J
        • Chiriboga D
        • et al.
        Contemporary trends in evidence-based treatment for acute myocardial infarction.
        Am J Med. 2010; 123: 166-172
        • Wienbergen H
        • Schiele R
        • Gitt AK
        • et al.
        Incidence, risk factors, and clinical outcome of stroke after acute myocardial infarction in clinical practice.
        Am J Cardiol. 2001; 87: 782-785
        • Mahaffey KW
        • Granger CB
        • Sloan MA
        • et al.
        Risk factors for in-hospital nonhemorrhagic stroke in patients with acute myocardial infarction treated with thrombolysis.
        Circulation. 1998; 97: 757-764
        • Puletti M
        • Morocutti C
        • Tronca M
        • et al.
        Cerebrovascular accidents in acute myocardial infarction.
        Ital J Neurol Sci. 1987; 8: 245-248
        • Bodenheimer MM
        • Sauer D
        • Shareef B
        • et al.
        Relation between myocardial infarct location and stroke.
        J Am Coll Cardiol. 1994; 24: 61-66
        • Fulton RM
        • Duckett K
        Plasma-fibrinogen and thromboemboli after myocardial infarction.
        Lancet. 1976; 2: 1161-1164
        • Gustafsson C
        • Blombäck M
        • Britton M
        • Hamsten A
        • Svensson J
        Coagulation factors and the increased risk of stroke in nonvalvular atrial fibrillation.
        Stroke. 1990; 21: 47-51
        • Ng P-W
        • Chan WK
        • Kwan PK
        Risk of stroke after acute myocardial infarction among Chinese.
        Chin Med J (Engl). 2001; 114: 210-211
        • Gore JM
        • Granger CB
        • Simoons ML
        • et al.
        Stroke after thrombolysis: mortality and functional outcomes in the GUSTO-I trial. global use of strategies to open occluded coronary arteries.
        Circulation. 1995; 92: 2811-2818