Predefined potential triggers of myocardial demand ischemia were present in 42% of stroke patients with acute myocardial injury compared to 24% in matched controls (OR 2.30).
Is post-stroke acute myocardial injury associated with a higher prevalence of triggers for myocardial demand ischemia in patients with acute ischemic stroke?
Conditions triggering a myocardial oxygen demand/supply mismatch are highly prevalent in patients with acute myocardial injury detected after stroke, highlighting the importance of type 2 myocardial infarction mechanisms in this population.
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Abstract Introduction Acute myocardial injury occurs in about every fourth patient in the early phase after ischemic stroke. It may be caused by an imbalance between myocardial oxygen supply and demand, potentially leading to type 2 myocardial infarction (MI). However, little is known about the prevalence of potential triggers of such demand ischemia in acute stroke. Patients and methods Consecutive patients with and without post-stroke acute myocardial injury (elevated high-sensitivity cardiac troponin T hs-cTnT levels with a rise/fall 20%) were matched for age and sex and retrospectively screened for presence of predefined triggering conditions of myocardial demand ischemia and fulfillment of diagnostic criteria for acute MI. Results Among 508 stroke patients analyzed (median age 81 73–86 years, 52% female), predefined potential triggers of demand ischemia were present in 107/254 (42%) patients with acute myocardial injury and in 61/254 (24%) matched controls (adjusted OR 2.30, 95%CI 1.51–3.52, p 0.001). Patients with a trigger were older, more often female, had more severe strokes, and more often insular cortex involvement. The most prevalent triggers were respiratory failure, sustained hypertension, supraventricular tachyarrhythmia, and hemodynamic shock. MI criteria were fulfilled in 44/254 (17%) patients with acute myocardial injury including 27/44 (61.4%) with a trigger of demand ischemia (i.e. suspected type 2 MI). Conclusions Conditions triggering a myocardial oxygen demand/supply mismatch are highly prevalent in patients with acute myocardial injury detected after stroke, notably in those fulfilling the criteria of acute MI. Stroke-specific aspects such as stroke severity or lesion location may play a role in the development of such triggers.
Stengl et al. (Thu,) reported a other. Predefined potential triggers of myocardial demand ischemia were present in 42% of stroke patients with acute myocardial injury compared to 24% in matched controls (OR 2.30).