Key result
A history of myocardial infarction in post-stroke patients with atrial fibrillation was associated with higher 4-year all-cause mortality compared to no prior MI (56.6% vs 37.6%, p=0.0001).
Why the study?
To evaluate clinical characteristics, medical treatment, and outcomes in patients with prior acute cerebrovascular accident and atrial fibrillation, according to the presence or absence of a history of myocardial infarction.
Does a history of myocardial infarction worsen clinical outcomes in post-stroke patients with atrial fibrillation?
Cohort (n=516)
Yes
Does a history of myocardial infarction worsen clinical outcomes in post-stroke patients with atrial fibrillation?
Post-stroke patients with atrial fibrillation and a history of myocardial infarction represent a very high-risk group with significantly increased mortality, highlighting a critical need for improved secondary prophylaxis and guideline-directed medical therapy.
AIM . Within the framework of outpatient and hospital registers of REGION (REGIster of patients who have undergone acute cerebrovascular accident) to carry out a comparative assessment of demographic and clinical-anamnestical characteristics, medical treatment and outcomes in clinical practice in patients with a combination of undergone acute cerebrovascular accident (ACVA) and atrial fibrillation (AF) in the presence or absence of myocardial infarction (MI) in the medical history. MATERIAL AND METHODS . Outpatient registers REGION (Ryazan) and hospital register REGION (Moscow) included 1886 patients who have undergone ACVA (age 70.6 ± 12.5 years, 41.9% of men), of them 516 (27.4%) people with AF. Comparison groups included 152 (8.1%) patients with a combination of ACVA, AF and MI in medical history (ACVA + AF + MI group) and 364 (19.3%) patients with ACVA, AF without MI (ACVA + AF without MI group). The presence of cardiovascular diseases (CVD), concomitant diseases, drug therapy and outcomes were analyzed. RESULTS. In the group of ACVA + AF + MI patients, compared to the ACVA + AF without MI group, the share of patients with AH (100% and 97.2%), IHD (100% and 87.1%), CHD (68.4% and 57.1%), repeated ACVA (36.9% and 23.9%), diabetes mellitus in women (39.5% and 20.4%) was statistically significantly higher. In the comparison groups, the share of smokers (13.3% and 15.5%), patients with burdened heredity of early development of CVDs (2.1% and 1.1%) and hypercholesterolemia (41.1% and 50.0%) did not differ significantly, however, in the group of ACVA + AF + MI, in comparison with the group of ACVA + AF without MI, there was a higher risk on the CHA2DS2-VASc scale (5.26 ± 1.32 and 4.09 ± 1.44; p < 0.001) and HAS-BLED scale (1.91 ± 0.76 and 1.62 ± 0.79; p < 0.01). Patients with AF of REGION register, both with and without MI, had insufficient frequency of proper medical prescriptions for CVDs (46.6% and 38.9% on average), especially prescription of anticoagulants (19.1% and 21.4%), statins in case of IHD (33.6% and 27.4%) and beta-adrenoblockers in case of CHD (39.4% and 35.6%). During the four-year period of observation, in comparison with post-stroke patients without a history of MI, the mortality rate for all causes was 1.5 times higher (56.6% and 37.6%, p = 0.0001), the incidence of non-fatal MI was higher (2.0% and 0.3%, p = 0.04). CONCLUSION. Patients with a combination of ACVA, AF and MI history are a very high risk group for adverse outcomes observed on an outpatient stage. For these patients it is very important to improve the quality of drug therapy and the effectiveness of secondary prophylaxis.
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Okshina et al. (2020) conducted a cohort in Post-stroke with atrial fibrillation (n=516). History of myocardial infarction vs. No history of myocardial infarction was evaluated on All-cause mortality (p=0.0001). A history of myocardial infarction in post-stroke patients with atrial fibrillation was associated with higher 4-year all-cause mortality compared to no prior MI (56.6% vs 37.6%, p=0.0001).
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