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Clinical Features of Patients with a Myocardial Infarction During Acute Management of an Ischemic Stroke

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Abstract

Background and Aims

Ischemic stroke and myocardial infarction (MI) share some common risk factors and pathophysiological mechanisms. In addition, brain injury has been associated with abnormalities of heart function such as increased cardiac enzymes and EKG changes. However, there is little information on patients with post-stroke MI. In this study, we investigated the characteristics of ischemic stroke patients who had a MI during the acute stroke period.

Methods

One thousand three hundred fifty-seven patients with acute ischemic stroke were studied by retrospective review of the stroke registry and inpatient charts. Among these patients, 12 that developed a post-stroke MI, during acute stroke management, were included in this study. The stroke subtype, pattern of arterial stenosis, and lesional dominance were analyzed.

Results

The overall frequency of a post-stroke MI during hospitalization was 0.9% (12 of 1,357 patients initially studied). Eight of the 12 patients included had a painless MI. Significant intracranial arterial stenosis was observed in 10 patients (83%). According to the TOAST classification, seven patients (58.3%) had large artery atherosclerosis, three patients were classified as undetermined etiology and two patients were divided into the lacunar and cardioembolic group. Acute ischemia of the insular region was noted in six patients. Five patients died from their cardiac complications during the hospital stay.

Conclusion

Post-stroke MI can be a potential complication of acute ischemic stroke; these events have a high mortality. Routine EKG monitoring, during the acute stroke period, may improve patient outcome due to the possibility of a painless post-stroke MI.

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References

  1. Pasternak RC, Criqui MH, Benjamin EJ, Fowkes FG, Isselbacher EM, McCullough PA, et al. Atherosclerotic vascular disease conference: writing group I: epidemiology. Circulation. 2004;109:2605–12. doi:10.1161/01.CIR.0000128518.26834.93.

    Article  PubMed  Google Scholar 

  2. Rokey R, Rolak LA, Harati Y, Kutka N, Verani MS. Coronary artery disease in patients with cerebrovascular disease: a prospective study. Ann Neurol. 1984;16:50–3. doi:10.1002/ana.410160110.

    Article  PubMed  CAS  Google Scholar 

  3. Love BB, Grover-McKay M, Biller J, Rezai K, McKay CR. Coronary artery disease and cardiac events with asymptomatic and symptomatic cerebrovascular disease. Stroke. 1992;23:939–45.

    PubMed  CAS  Google Scholar 

  4. Hertzer NR, Young JR, Beven EG, Graor RA, O’Hara PJ, Ruschhaupt WF, et al. Coronary angiography in 506 patients with extracranial cerebrovascular disease. Arch Intern Med. 1985;145:849–52. doi:10.1001/archinte.145.5.849.

    Article  PubMed  CAS  Google Scholar 

  5. Touzé E, Varenne O, Chatellier G, Peyrard S, Rothwell PM, Mas JL. Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis. Stroke. 2005;36:2748–55. doi:10.1161/01.STR.0000190118.02275.33.

    Article  PubMed  Google Scholar 

  6. National Cholesterol Education Program (NCEP) Expert Panel on Detection. Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143–421.

    Google Scholar 

  7. Crop GJ, Manning GW. Electrocardiographic changes simulating myocardial ischemia and infarction associated with spontaneous intracranial hemorrhage. Circulation. 1960;22:25–38.

    Google Scholar 

  8. Dimant J, Grob D. Electrocardiographic changes and myocardial damage in patients with acute cerebrovascular accidents. Stroke. 1977;8:448–55.

    PubMed  CAS  Google Scholar 

  9. Goldstein DS. The electrocardiogram in stroke: relationship to pathophysiology type and comparison with prior tracings. Stroke. 1979;10:253–9.

    PubMed  CAS  Google Scholar 

  10. Greenhoot JH, Reichenbach DD. Cardiac injury and subarachnoid hemorrhage, a clinical, pathological, and physiological correlation. J Neurosurg. 1969;30:521–31.

    Article  PubMed  CAS  Google Scholar 

  11. Chalela JA, Ezzeddine MA, Davis L, Warach S. Myocardial injury in acute stroke: a troponin I study. Neurocrit Care. 2004;1:343–6. doi:10.1385/NCC:1:3:343.

    Article  PubMed  Google Scholar 

  12. Ay H, Koroshetz WJ, Benner T, Vangel MG, Melinosky C, Arsava EM, et al. Neuroanatomic correlates of stroke-related myocardial injury. Neurology. 2006;66:1325–9. doi:10.1212/01.wnl.0000206077.13705.6d.

    Article  PubMed  CAS  Google Scholar 

  13. Lee VH, Oh JK, Mulvagh SL, Widicks EF. Mechanisms in neurogenic stress cardiomyopathy after aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2006;5:243–9. doi:10.1385/NCC:5:3:243.

    Article  PubMed  Google Scholar 

  14. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24:35–41.

    PubMed  Google Scholar 

  15. The Joint European Society of Cardiology/American College of Cardiology Committee. Myocardial infarction redefined-A consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J. 2000;21:1502–13. doi:10.1053/euhj.2000.2305.

    Article  Google Scholar 

  16. Antman EM, Braunwald E. ST-segment elevation myocardial infarction. In: Fauci AS, Braunwald E, Kasper DL, et al., editors. Harrison’s internal medicine. 17th ed. NY: McGraw Hill; 2008. p. 1532–44.

    Google Scholar 

  17. Steiner T. Stroke unit design: intensive monitoring should be a routine procedure. Stroke. 2004;35:1018–9. doi:10.1161/01.STR.0000120953.78592.72.

    Article  PubMed  Google Scholar 

  18. Indredavik B. Intensive monitoring should not be the routine. Stroke. 2004;35:1019–20. doi:10.1161/01.STR.0000120954.27472.8F.

    Article  PubMed  Google Scholar 

  19. Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38:1655–711. doi:10.1161/STROKEAHA.107.181486.

    Article  PubMed  Google Scholar 

  20. Arenillas JF, Candell-Riera J, Romero-Farina G, Molina CA, Chacón P, Aguadé-Bruix S, et al. Silent myocardial ischemia in patients with symptomatic intracranial atherosclerosis: associated factors. Stroke. 2005;36:1201–6. doi:10.1161/01.STR.0000166045.12976.af.

    Article  PubMed  Google Scholar 

  21. Chimowitz MI, Poole RM, Starling MR, Schwaiger M, Gross MD. Frequency and severity of asymptomatic coronary disease in patients with different causes of stroke. Stroke. 1997;28:941–5.

    PubMed  CAS  Google Scholar 

  22. Dhamoon MS, Tai W, Boden-Albala B, Rundek T, Paik MC, Sacco RL, et al. Risk of myocardial infarction or vascular death after first ischemic stroke: the Northern Manhattan Study. Stroke. 2007;38:1752–8. doi:10.1161/STROKEAHA.106.480988.

    Article  PubMed  Google Scholar 

  23. Sander D, Klingelhofer J. Changes of circadian blood pressure patterns after hemodynamic and thromboembolic brain infarction. Stroke. 1994;25:1730–7.

    PubMed  CAS  Google Scholar 

  24. Oppenheimer SM, Gelb A, Girvin JP, Hachinski VC. Cardiovascular effects of human insular cortex stimulation. Neurology. 1992;42:1727–32.

    PubMed  CAS  Google Scholar 

  25. Oppenheimer SM, Kedem G, Martin WM. Left insular cortex lesions perturb cardiac autonomic tone in humans. Clin Auton Res. 1996;6:1–10. doi:10.1007/BF02281899.

    Article  Google Scholar 

  26. Laowattana S, Zeger SL, Lima JAC, Goodman SN, Wittstein IS, Oppenheimer SM. Left insular stroke is associated with adverse cardiac outcome. Neurology. 2006;66:477–83. doi:10.1212/01.wnl.0000202684.29640.60.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was supported by a grant of the Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea (project no. A060093).

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Authors and Affiliations

  1. Department of Neurology, The Catholic University of Korea, Kangnam St. Mary’s Hospital, 505, Banpo-dong, Seocho-gu, Seoul, 137-701, South Korea

    Seung-Jae Lee, Kwang-Soo Lee, Yeong-In Kim, Jae-Young An & Joong-Seok Kim

  2. Department of Neurology, National Cancer Center, 111, Jungbalsan-road, Ilsan dong-gu, Koyang, Kyunggi, South Korea

    Woojun Kim

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  1. Seung-Jae Lee
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Correspondence to Joong-Seok Kim.

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Lee, SJ., Lee, KS., Kim, YI. et al. Clinical Features of Patients with a Myocardial Infarction During Acute Management of an Ischemic Stroke. Neurocrit Care 9, 332–337 (2008). https://doi.org/10.1007/s12028-008-9128-1

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  • DOI: https://doi.org/10.1007/s12028-008-9128-1

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