Abstract WMP51: Risk and Timing of of Ischemic Stroke Following Acute Myocardial Infarction

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Alexander E Merkler ◽  
Gino Gialdini ◽  
Santosh Murthy ◽  
Shadi Yaghi ◽  
Babak Navi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Absolute Risk ◽  
Absolute Increase ◽  
Risk Increase ◽  
Immortal Time Bias ◽  
Acute Mi ◽  
The Absolute

Background: Acute myocardial infarction (MI) has long been reported as a risk factor for ischemic stroke, but the magnitude and duration of risk remains uncertain. Methods: We performed a crossover-cohort study using inpatient and outpatient claims data from a nationally representative 5% sample of Medicare beneficiaries from 2008 through 2014. We identified all patients ≥66 years of age with a first-recorded hospitalization for acute MI. The primary outcome was ischemic stroke. All predictors and outcomes were defined using previously validated ICD-9-CM codes. To exclude stroke that may have been due to percutaneous coronary intervention, we included only cases of ischemic stroke that occurred after discharge from the MI hospitalization. We compared the risk of ischemic stroke in successive 4-week periods during the 12 weeks after MI versus the corresponding 4-week periods 1 year later. To avoid immortal time bias, we limited our cohort to patients who remained alive and insured throughout the 15 month study period. Odds ratios (OR) and absolute risk differences were calculated using the Mantel-Haenszel estimator for matched data. Results: We identified 22,798 patients with an acute MI in whom the mean age was 77.4 (±7.9) years and 50.3% were women. In the 12 weeks after discharge, 216 patients (0.95%) developed a stroke, as compared to 21 (0.09%) patients in the corresponding 12-week period 1 year later. The absolute increase in stroke risk was 0.45% (95% confidence interval [CI], 0.36-0.55%) in the first 4 weeks after acute MI compared to the 4-week time period 1 year later, corresponding to an OR of 18.2 (95% CI, 8.1-50.6). The absolute risk increase was 0.24% (95% CI, 0.16-0.31%) during weeks 5-8 (OR, 8.7; 95% CI, 4.0-22.6) and 0.17% (95% CI, 0.10-0.23%) during weeks 9-12 (OR, 5.8; 95% CI, 2.7-14.1). Conclusions: Acute MI is associated with a substantially elevated short-term risk of ischemic stroke. This risk was independent of periprocedural stroke risk in the setting of coronary reperfusion therapies.

scholarly journals Intravenous immune globulin and thromboembolic adverse events in patients with hematologic malignancy

Blood ◽  
2016 ◽  
Vol 127 (2) ◽  
pp. 200-207 ◽  
Author(s):  
Eric M. Ammann ◽  
Michael P. Jones ◽  
Brian K. Link ◽  
Ryan M. Carnahan ◽  
Scott K. Winiecki ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Thromboembolic Event ◽  
Stroke Risk ◽  
Hematologic Malignancy ◽  
Absolute Risk ◽  
Ivig Treatment ◽  
Key Points ◽  
Ischemic Stroke Risk

Key Points Acute myocardial infarction and ischemic stroke risk was 3 times higher during days 0 to 1 following IVIg treatment in patients with secondary hypogammaglobulinemia. In patients treated with IVIg for 1 year, the estimated increase in the absolute risk of a severe thromboembolic event was ∼1%.

Abstract 152: Risk of Arterial Thromboembolic Events After Intracerebral Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Santosh Murthy ◽  
Alexander Merkler ◽  
Gino Gialdini ◽  
Costantino Iadecola ◽  
Babak Navi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Absolute Risk ◽  
Optimal Strategies ◽  
Thromboembolic Events ◽  
Risk Increase ◽  
Immortal Time Bias ◽  
The Absolute ◽  
Arterial Thromboembolic Events ◽  
Matched Data

Introduction: Ischemic stroke and myocardial infarction (MI) have been reported as frequent complications after intracerebral hemorrhage (ICH), but the magnitude and duration of this risk is unclear. Methods: We performed a cohort-crossover study using inpatient and outpatient claims data from a nationally representative 5% sample of Medicare beneficiaries from 2008 through 2014. We included patients ≥66 years of age hospitalized for ICH. Our primary outcome was a composite of ischemic stroke or MI. We used validated ICD-9-CM diagnosis codes to identify predictors and outcomes. To avoid inclusion of patients with ICH as a complication of stroke or MI, we excluded ICH patients with a concurrent stroke or MI during the index ICH hospitalization. We compared the risk of stroke and MI during the 12 weeks after ICH versus the corresponding 12-week period 6 months later. To avoid immortal time bias, we limited our cohort to patients who remained alive and insured throughout the 9-month study period. Odds ratios (OR) and absolute risk differences were calculated using the Mantel-Haenszel estimator for matched data. Results: We included 1,817 ICH patients. In the 12-week period after discharge, 130 (7.1%) patients had a stroke or MI versus 13 (0.7%) in the corresponding 12-week period 6 months later. The absolute risk increase for ischemic stroke or MI was 6.4% (95% CI, 5.1-7.7%) during this period, with a corresponding OR of 10.0 (95% CI, 5.6-19.3). The absolute risk increase was 4.8% (95% CI, 3.7-5.8%) during the first 4 weeks, and 1.0% (95% CI, 0.3-1.7%) during weeks 5-8. Limitations: First, we lacked data on antithrombotic drug use, so further work is needed to distinguish how much of the heightened risk was due to the effect of ICH versus the effect of antithrombotic cessation. Second, we included only patients who survived at least 9 months; however, this would be expected to select for a less sick cohort and therefore decrease any apparent associations with these serious complications. Conclusions: There appears to be a heightened short-term risk of arterial thromboembolic events after acute ICH. This underlines the importance of studies and trials to identify optimal strategies for resuming antithrombotic medications in survivors of ICH.

Abstract T P64: Cerebral Ischemic Events Associated with Intravenous Thrombolytic Administration in International Joint Efficacy Comparison of Thrombolytics (INJECT) Trial.

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Nudrat Tasneem ◽  
Malik M Adil ◽  
M Fareed K Suri ◽  
Adnan I Qureshi
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Double Blind ◽  
Intravenous Heparin ◽  
Acute Mi ◽  
Cardiac Shock ◽  
Cerebral Ischemic ◽  
Post Hoc ◽  
Ischemic Events

Background: Platelet activation can be seen subsequent to thrombolytic administration leading to re-occlusion within coronary arteries. However, the occurrence of cerebral ischemic events secondary to thrombolytic administration is not well studied. Objective: To study the rate and outcome of patients with acute myocardial infarction [MI] who develop cerebral ischemic events within 48 hours of thrombolytic administration. Methods: A post-hoc analysis of the INJECT trial data was performed. Patients from 208 centers in nine countries (n = 6010) with acute myocardial infarction (<12 hr after symptom onset) were randomized to receive double-blind either streptokinase 1.5 MU intravenously over 60 min or reteplase two boluses of 10 MU given 30 min apart. All patients received intravenous heparin for at least 24 h. Ascertainment of ischemic stroke during hospitalization was performed throughout the study. Results: A total of 81 in-hospital strokes were observed in 6010 acute MI patients of which 47 were classified as ischemic events. A total of 29 (62%) suffered ischemic events within 48 hours of thrombolytic administration; 23 were ischemic stroke and 06 were transient ischemic attacks. The mean age (±SD) of the 29 patients was 70± (10) ; 20 were men. None of the patients had pre-existing or new onset atrial fibrillation. Underlying cardiac shock and heart failure was seen in 2 and 5 patients, respectively. IV heparin was continued for 24-72 hours in 11 patients. Survival was 66% (n=19) at 35 days and 55% (n=16) at 6 months. Conclusions: Most cerebral ischemic events occur in the immediate post-thrombolytic period and result in disproportionately low survival over 6 months.

scholarly journals Duration of Heightened Ischemic Stroke Risk After Acute Myocardial Infarction

2018 ◽  
Vol 7 (22) ◽  
Author(s):  
Alexander E. Merkler ◽  
Ivan Diaz ◽  
Xian Wu ◽  
Santosh B. Murthy ◽  
Gino Gialdini ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Ischemic Stroke Risk

Thrombolytic Therapy in the Current ERA: Myocardial Infarction and Beyond

2018 ◽  
Vol 24 (4) ◽  
pp. 414-426 ◽  
Author(s):  
Patrick Proctor ◽  
Massoud A. Leesar ◽  
Arka Chatterjee
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Coronary Intervention ◽  
Evidence Base ◽  
Primary Pci ◽  
Percutaneous Coronary

Thrombolytic therapy kick-started the era of modern cardiology but in the last few decades it has been largely supplanted by primary percutaneous coronary intervention (PCI) as the go-to treatment for acute myocardial infarction. However, these agents remain important for vast populations without access to primary PCI and acute ischemic stroke. More innovative uses have recently come up for the treatment of a variety of conditions. This article summarizes the history, evidence base and current use of thrombolytics in cardiovascular disease.

Managed care improves prognosis in acute myocardial infarction survivors. Data from the MAnaged Care for Acute Myocardial Infarction Survivors (MACAMIS) Programme

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Jankowski ◽  
R Topor-Madry ◽  
M Gasior ◽  
U Ceglowska ◽  
Z Eysymontt ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Multivariate Analysis ◽  
Managed Care ◽  
Care Programme ◽  
Wide System ◽  
Care Assessment ◽  
Acute Mi ◽  
One Year ◽  
Overall Mortality

Abstract Background Mortality following acute myocardial infarction (MI) remains high despite progress in pharmacotherapy and interventional treatment. In 2017 a nation-wide system of managed care for MI survivors comprising a continuum of acute treatment of MI, staged revascularization, cardiac rehabilitation, cardiac electrotherapy and cardiac ambulatory care within one year following MI was implemented in Poland. The managed care programme (MCP) includes also the quality of care assessment based on clinical measures (e.g. cardiovascular risk factors control) as well as on the rate of minor and major cardiovascular events. The goal of the analysis was to assess the overall mortality of MI survivors participating and not participating in the MCP. Methods The database of survivors of acute MI discharged from hospital from October 1, 2017 to December 31, 2018 was analyzed. Patients who died within 10 days after discharge were excluded from the analysis. The primary end-point was defined as death from any cause. Propensity-Score Matching (PSM) using nearest neighbor matching was used to form comparable groups of patients participating and not participating in the MCP. The Cox proportional hazard regression analysis was used to assess the relation between MCP and the overall mortality. Results MCP was implemented in the first stage in 48 hospitals spread around the country (about 34% of all hospitals treating acute MI patients in Poland). Out of 87739 analyzed patients (age: 68.1±11.9 years; 55581 men and 32158 women) 34064 were hospitalized in hospitals with MCP implemented. Altogether 10404 patients (11.9% of the whole cohort; 30.5% of those hospitalized in hospitals with MCP implemented) participated in MCP. They were matched with 10404 patients not participating in the MCP. During 324.8±140.5 days of follow-up 7413 patients died. One-year mortality was lower in patients participating in the MCP both when we analyzed the whole cohort (4.4% vs. 9.5%; p&lt;0.001) as well as when we limited the analysis to the PSM groups (4.4% vs. 6.5%; p&lt;0.001, figure 1). MCP was related to the overall mortality in univariate (HR 0.43 [0.39–0.48]) as well as in multivariate analysis (0.64 [0.57–0.71]) in the whole cohort as well as in the PSM cohort (HR 0.63 [0.56–0.72] and 0.64 [0.56–0.72] for the univariate and multivariate analysis respectively). When we limited the analysis to hospitals in which MCP was implemented one-year mortality was 4.3% vs. 6.3% (p&lt;0.001) whereas univariate HR was 0.51 (0.44–0.60) and multivariate HR 0.52 (0.44–0.61). Conclusion The implemented in Poland nation-wide system of managed care for MI survivors is related to improved survival. Therefore, the Ministry of Health plans to implement the programme in all cardiac centers in Poland. Funding Acknowledgement Type of funding source: None

scholarly journals Mortality of major cardiovascular emergencies among patients admitted to hospitals on weekends as compared with weekdays in Taiwan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chao-Lun Lai ◽  
Raymond Nien-Chen Kuo ◽  
Ting-Chuan Wang ◽  
K. Arnold Chan
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Ischemic Stroke ◽  
Aortic Aneurysm ◽  
Hospital Mortality ◽  
Weekend Effect ◽  
Claims Database ◽  
Ruptured Aortic Aneurysm ◽  
Incident Cases

Abstract Background Several studies have found a so-called weekend effect that patients admitted at the weekends had worse clinical outcomes than patients admitted at the weekdays. We performed this retrospective cohort study to explore the weekend effect in four major cardiovascular emergencies in Taiwan. Methods The Taiwan National Health Insurance (NHI) claims database between 2005 and 2015 was used. We extracted 3811 incident cases of ruptured aortic aneurysm, 184,769 incident cases of acute myocardial infarction, 492,127 incident cases of ischemic stroke, and 15,033 incident cases of pulmonary embolism from 9,529,049 patients having at least one record of hospitalization in the NHI claims database within 2006 ~ 2014. Patients were classified as weekends or weekdays admission groups. Dates of in-hospital mortality and one-year mortality were obtained from the Taiwan National Death Registry. Results We found no difference in in-hospital mortality between weekend group and weekday group in patients with ruptured aortic aneurysm (45.4% vs 45.3%, adjusted odds ratio [OR] 1.01, 95% confidence interval [CI] 0.87–1.17, p = 0.93), patients with acute myocardial infarction (15.8% vs 16.2%, adjusted OR 0.98, 95% CI 0.95–1.00, p = 0.10), patients with ischemic stroke (4.1% vs 4.2%, adjusted OR 0.99, 95% CI 0.96–1.03, p = 0.71), and patients with pulmonary embolism (14.6% vs 14.6%, adjusted OR 1.02, 95% CI 0.92–1.15, p = 0.66). The results remained for 1 year in all the four major cardiovascular emergencies. Conclusions We found no difference in either short-term or long-term mortality between patients admitted on weekends and patients admitted on weekdays in four major cardiovascular emergencies in Taiwan.

scholarly journals Daylight saving time does not seem to be associated with number of percutaneous coronary interventions for acute myocardial infarction in the Netherlands

2021 ◽  
Author(s):  
L. Derks ◽  
◽  
S. Houterman ◽  
G. S. C. Geuzebroek ◽  
P. van der Harst ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
The Netherlands ◽  
Incidence Rate ◽  
Hospital Admissions ◽  
Control Period ◽  
Daylight Saving Time ◽  
Daylight Saving ◽  
Percutaneous Coronary ◽  
Acute Mi

Abstract Background In multiple studies, the potential relationship between daylight saving time (DST) and the occurrence of acute myocardial infarction (MI) has been investigated, with mixed results. Using the Dutch Percutaneous Coronary Intervention (PCI) registry facilitated by the Netherlands Heart Registration, we investigated whether the transitions to and from DST interact with the incidence rate of PCI for acute MI. Methods We assessed changes in hospital admissions for patients with ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) undergoing PCI between 1 January 2015 and 31 December 2018. We compared the incidence rate of PCI procedures during the first 3 or 7 days after the transition with that during a control period (2 weeks before transition plus second week after transition). Incidence rate ratio (IRR) was calculated using Poisson regression. Potential gender differences were also investigated. Results A total of 80,970 PCI procedures for STEMI or NSTEMI were performed. No difference in incidence rate a week after the transition to DST in spring was observed for STEMI (IRR 0.95, 95% confidence interval (CI) 0.87–1.03) or NSTEMI (IRR 1.04, 95% CI 0.96–1.12). After the transition from DST in autumn, the IRR was also comparable with the control period (STEMI: 1.03, 95% CI 0.95–1.12, and NSTEMI: 0.98, 95% CI 0.91–1.06). Observing the first 3 days after each transition yielded similar results. Gender-specific results were comparable. Conclusion Based on data from a large, nationwide registry, there was no correlation between the transition to or from DST and a change in the incidence rate of PCI for acute MI.

scholarly journals Use of Circulating MicroRNAs to Diagnose Acute Myocardial Infarction

2012 ◽  
Vol 58 (3) ◽  
pp. 559-567 ◽  
Author(s):  
Yvan Devaux ◽  
Mélanie Vausort ◽  
Emeline Goretti ◽  
Petr V Nazarov ◽  
Francisco Azuaje ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Troponin T ◽  
Correct Diagnosis ◽  
Patient Treatment ◽  
Healthy Controls ◽  
Clinical Model ◽  
Acute Mi ◽  
St Elevation

Abstract BACKGROUND Rapid and correct diagnosis of acute myocardial infarction (MI) has an important impact on patient treatment and prognosis. We compared the diagnostic performance of high-sensitivity cardiac troponin T (hs-cTnT) and cardiac enriched microRNAs (miRNAs) in patients with MI. METHODS Circulating concentrations of cardiac-enriched miR-208b and miR-499 were measured by quantitative PCR in a case-control study of 510 MI patients referred for primary mechanical reperfusion and 87 healthy controls. RESULTS miRNA-208b and miR-499 were highly increased in MI patients (&gt;105-fold, P &lt; 0.001) and nearly undetectable in healthy controls. Patients with ST-elevation MI (n= 397) had higher miRNA concentrations than patients with non–ST-elevation MI (n = 113) (P &lt; 0.001). Both miRNAs correlated with peak concentrations of creatine kinase and cTnT (P &lt; 10−9). miRNAs and hs-cTnT were already detectable in the plasma 1 h after onset of chest pain. In patients who presented &lt;3 h after onset of pain, miR-499 was positive in 93% of patients and hs-cTnT in 88% of patients (P= 0.78). Overall, miR-499 and hs-cTnT provided comparable diagnostic value with areas under the ROC curves of 0.97. The reclassification index of miR-499 to a clinical model including several risk factors and hs-cTnT was not significant (P = 0.15). CONCLUSION Circulating miRNAs are powerful markers of acute MI. Their usefulness in the establishment of a rapid and accurate diagnosis of acute MI remains to be determined in unselected populations of patients with acute chest pain.

scholarly journals Red meat intake is positively associated with non-fatal acute myocardial infarction in the Costa Rica Heart Study

2017 ◽  
Vol 118 (4) ◽  
pp. 303-311 ◽  
Author(s):  
Dongqing Wang ◽  
Hannia Campos ◽  
Ana Baylin
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Costa Rica ◽  
Meat Consumption ◽  
Red Meat ◽  
Health Concern ◽  
Meat Intake ◽  
Acute Mi ◽  
Red Meat Intake ◽  
Processed Red Meat

AbstractThe adverse effect of red meat consumption on the risk for CVD is a major population health concern, especially in developing Hispanic/Latino countries in which there are clear trends towards increased consumption. This population-based case–control study examined the associations between total, processed and unprocessed red meat intakes and non-fatal acute myocardial infarction (MI) in Costa Rica. The study included 2131 survivors of a first non-fatal acute MI and 2131 controls individually matched by age, sex and area of residence. Dietary intake was assessed with a FFQ. OR were estimated by using conditional logistic regression. Higher intakes of total and processed red meat were associated with increased odds of acute MI. The OR were 1·31 (95 % CI 1·04, 1·65) and 1·29 (95 % CI 1·01, 1·65) for the highest quintiles of total red meat (median: 110·8 g or 1 serving/d) and processed red meat intake (median: 36·1 g or 5 servings/week), respectively. There were increasing trends in the odds of acute MI with higher total (Ptrend=0·01) and processed (Ptrend=0·02) red meat intakes. Unprocessed red meat intake was not associated with increased odds of acute MI. Substitutions of 50 g of alternative foods (fish, milk, chicken without skin and chicken without fat) for 50 g of total, processed and unprocessed red meat were associated with lower odds of acute MI. The positive association between red meat intake and acute MI in Costa Rica highlights the importance of reducing red meat consumption in middle-income Hispanic/Latino populations.

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