Key result
Among myocardial infarction patients, those with a history of stroke had higher hospital mortality (18.8% vs 10.3%), with treatment-resistant chest pain being the strongest mortality determinant (OR 7.02).
Why the study?
Does a history of stroke increase hospital mortality and alter mortality risk factors in patients presenting with myocardial infarction?
Cohort (n=20,750)
Yes
Does a history of stroke increase hospital mortality and alter mortality risk factors in patients presenting with myocardial infarction?
Absolute Event Rate: 18.8% vs 10.3%
p-value: p=0.001
A history of stroke significantly increases in-hospital mortality among patients presenting with myocardial infarction, with resistant chest pain and lack of thrombolytic therapy being major mortality determinants.
Prior stroke was associated with higher MI mortality; leaves open whether it modifies acute management priorities in prospective studies.
BACKGROUND: The data and determinants of mortality due to stroke in myocardial infarction (MI) patients are unknown. This study was conducted to evaluate the differences in risk factors for hospital mortality among MI patients with and without stroke history. MATERIALS AND METHODS: This study was a retrospective, cohort study; 20,750 new patients with MI from April, 2012 to March, 2013 were followed up and their data were analyzed according to having or not having the stroke history. Stroke and MI were defined based on the World Health Organization's definition. The data were analyzed by logistic regression in STATA software. RESULTS: Of the 20,750 studied patients, 4293 had stroke history. The prevalence of stroke in the studied population was derived 20.96% (confidence interval [CI] 95%: 20.13-21.24). Of the patients, 2537 (59.1%) had ST-elevation MI (STEMI). Mortality ratio in patients with and without stroke was obtained 18.8% and 10.3%, respectively. The prevalence of risk factors in MI patients with and without a stroke is various. The adjusted odds ratio of mortality in patients with stroke history was derived 7.02 (95% CI: 5.42-9) for chest pain resistant to treatment, 2.39 (95% CI: 1.97-2.9) for STEMI, 3.02 (95% CI: 2.5-3.64) for lack of thrombolytic therapy, 2.2 (95% CI: 1.66-2.91) for heart failure, and 2.17 (95% CI: 1.6-2.9) for ventricular tachycardia. CONCLUSION: With regards to the factors associated with mortality in this study, it is particularly necessary to control the mortality in MI patients with stroke history. More emphasis should be placed on the MI patients with the previous stroke over those without in the interventions developed for prevention and treatment, and for the prevention of avoidable mortalities.
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Ahmadi et al. (2016) conducted a cohort in Myocardial infarction (n=20,750). Stroke history vs. No stroke history was evaluated on Hospital mortality (p=0.001). Among myocardial infarction patients, those with a history of stroke had higher hospital mortality (18.8% vs 10.3%), with treatment-resistant chest pain being the strongest mortality determinant (OR 7.02).
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