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Merkler AE, Alakbarli J, Barbar T, Baradaran H, Adejumo O, Navi BB, Kamel H, Kim J, Okin PM, Gupta A, Weinsaft JW. Associations between the size and location of myocardial infarction and cerebral infarction. J Neurol Sci 2020; 419:117182. [PMID: 33099172 DOI: 10.1016/j.jns.2020.117182] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/18/2020] [Accepted: 10/10/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Myocardial infarction (MI) is a known cause of cerebral infarction. We assessed whether the size and location of MI is associated with the risk of cerebral infarction. METHODS AND RESULTS We performed a cross-sectional study of adults who underwent both brain MRI and delayed-enhancement cardiac MRI (DE-CMR) within 365 days of each other at Weill Cornell Medicine between 2014 and 2017 and had evidence of MI on DE-CMR. We used multiple logistic regression to evaluate associations between MI size and any cerebral infarction, apical MI location and any cerebral infarction, and MI size/location and cortical versus subcortical cerebral infarction. Models were adjusted for demographics, and the total number of vascular risk factors. Among 234 patients who underwent both DE-CMR and brain MRI within 365 days, 76 had evidence for MI on DE-CMR. Among these 76 patients, 51 (67.1%) had evidence of cerebral infarction. The size of MI (global MI burden) was not associated with any cerebral infarction (OR per 5% increase in MI size, 1.12; 95% CI, 0.85-1.47), but was associated with cortical cerebral infarction (OR per 5% increase in MI size, 1.30; 95% CI, 1.00.-1.68). Similarly, apical MI location was not associated with any cerebral infarction (OR 2.63, 95% CI, 0.78-8.87), but was associated with cortical cerebral infarction (OR, 3.67; 95% CI, 1.19-11.33). CONCLUSION Among patients with MI on cardiac MRI, both size and apical location of MI were associated with cortical cerebral infarction. Our results may help stratify cardioembolic risk and inform antithrombotic treatment algorithms among patients with MI.
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Affiliation(s)
- Alexander E Merkler
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA; Clinical and Translational Neuroscience Unit, Weill Cornell Medical College, New York, NY, USA.
| | - Javid Alakbarli
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Tarek Barbar
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Hediyeh Baradaran
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | | | - Babak B Navi
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA; Clinical and Translational Neuroscience Unit, Weill Cornell Medical College, New York, NY, USA
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medical College, New York, NY, USA; Clinical and Translational Neuroscience Unit, Weill Cornell Medical College, New York, NY, USA
| | - Jiwon Kim
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Peter M Okin
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
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Hachet O, Guenancia C, Stamboul K, Daubail B, Richard C, Béjot Y, Yameogo V, Gudjoncik A, Cottin Y, Giroud M, Lorgis L. Frequency and Predictors of Stroke After Acute Myocardial Infarction. Stroke 2014; 45:3514-20. [DOI: 10.1161/strokeaha.114.006707] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Stroke is a serious complication after acute myocardial infarction (AMI) and is closely associated with decreased survival. This study aimed to investigate the frequency, characteristics, and factors associated with in-hospital and postdischarge stroke in patients with AMI.
Methods—
Eight thousand four hundred eighty-five consecutive patients admitted to a cardiology intensive care unit for AMI, between January 2001 and July 2010. Stroke/transient ischemic attack were collected during 1-year follow-up.
Results—
One hundred twenty-three in-hospital strokes were recorded: 65 (52.8%) occurred on the first day after admission for AMI, and 108 (87%) within the first 5 days. One hundred six patients (86.2%-incidence rate 1.25%) experienced in-hospital ischemic stroke, and 14 patients (11.4%-incidence rate 0.16%) were diagnosed with an in-hospital hemorrhagic stroke. In-hospital ischemic stroke subtypes according to the Trial of Org 10 172 in Acute Stroke Treatment (TOAST) classification showed that only 2 types of stroke were identified more frequently. As expected, the leading subtype of in-hospital ischemic stroke was cardioembolic stroke (n=64, 60%), the second was stroke of undetermined pathogenesis (n=38, 36%). After multivariable backward regression analysis, female sex, previous transient ischemic attack (TIA)/stroke, new-onset atrial fibrillation, left ventricular ejection fraction (odds ratio per point of left ventricular ejection fraction), and C-reactive protein were independently associated with in-hospital ischemic stroke. When antiplatelet and anticoagulation therapy within the first 48 hours was introduced into the multivariable model, we found that implementing these treatments (≥1) was an independent protective factor of in-hospital stroke. In-hospital hemorrhagic stroke was dramatically increased (5-fold) when thrombolysis was prescribed as the reperfusion treatment. However, the different parenteral anticoagulants were not predictors of risk in univariable analysis. Finally, only 45 postdischarge strokes were recorded. Postdischarge stroke subtypes showed a more heterogeneous distribution of mechanisms. The annual rate of stroke post-AMI remained stable throughout the 10-year study period.
Conclusions—
The present study describes specific predictors of in-hospital and postdischarge stroke in patients with AMI. It showed a marked increase in the risk of death, both during hospitalization and in the year after AMI. After hospital discharge, stroke remains a rare event and is mostly associated with high cardiovascular risk.
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Affiliation(s)
- Olivier Hachet
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Charles Guenancia
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Karim Stamboul
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Benoit Daubail
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Carole Richard
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Yannick Béjot
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Valentin Yameogo
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Aurélie Gudjoncik
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Yves Cottin
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Maurice Giroud
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Luc Lorgis
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
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