0061: Frequency and predictors of stroke after acute myocardial infarction: specific aspects between in-hospital and postdischarge events

Abstract

Stroke is a serious complication after acute myocardial infarction (AMI) and is closely associated with poor prognosis. This study aimed to investigate the frequency, the characteristics and factors associated with in-hospital and postdischarge stroke in patients with AMI. 8485 consecutive patients admitted in intensive care unit (ICU) between January 2001 and June 2010 were included. Among other major adverse cardiac events (MACE), both stroke and transient ischemic attack (TIA) were collected during one-year follow-up. 168 (1.98%) strokes were recorded during the first year of follow-up after AMI. In-hospital strokes (IHS) occurred in 123 patients (1.4%), and 87% of them in the first five days after admission in ICU. After multivariate logistic regression analysis, IHS was independently associated with female sex (OR: 1.73, 95% CI: 1.19-2.51, p=0.004), previous stroke/TIA (OR: 2.21, 95% CI: 1.28-3.83, p=0.004), LVEF (OR: 0.96, 95% CI: 0.95-0.98, p<0.001), new onset atrial fibrillation (AF) (OR: 1.99, 95% CI: 1.25-3.16, p=0.004) and C-reactive protein (CRP) (OR 1.006, 95% CI: 1,003-1,009, p<0.001). Patients developing an in-hospital stroke had an increased risk of death at one year after adjustment to other prognostic factors (OR: 1.82, 95% CI: 1.05-3.15, p=0.031). Among surviving patients (n=7808), postdischarge stroke (PDS) occurred in 45 patients (0.64%) within one-year follow-up after AMI. After multivariate logistic regression analysis, PDS was independently associated with age (OR: 1.04, 95% CI: 1.01-1.07, p=0.003), previous stroke/TIA (OR: 3.69, 95% CI: 1.83-7.43, p<0.001) and systemic hypertension (OR: 2.77, 95% CI: 1.26-6.08, p=0.011). During the entire study period of ten years, the annual rate of stroke post-AMI remained stable. The present study describes specific predictors of in-hospital and postdischarge stroke in patients with AMI, with a marked increase in the risk of death, both during hospitalization and the year after AMI. After hospital discharge, stroke remains a rare event and mostly associated with a high cardiovascular risk.