Key result
Prior ischemic stroke in acute MI linked to ~2.6-fold higher 18-month MACE risk.
Why the study?
Acute myocardial infarction after ischemic stroke leads to worse outcomes, but few studies have explored the associated coronary plaque features.
Does a prior history of ischemic stroke increase the prevalence of high-risk coronary plaque features and cardiovascular events in patients with acute myocardial infarction?
Cohort (n=386)
Single-blind
No
Does a prior history of ischemic stroke increase the prevalence of high-risk coronary plaque features and cardiovascular events in patients with acute myocardial infarction?
In patients presenting with acute myocardial infarction, a history of prior ischemic stroke is associated with a significantly higher prevalence of high-risk, vulnerable coronary plaque features and a nearly threefold increased risk of subsequent 18-month adverse cardiovascular events.
May warrant closer post-AMI surveillance in patients with prior stroke; leaves open whether targeted interventions improve outcomes.
Background Acute myocardial infarction (AMI) occurring after ischemic cerebral stroke leads to substantially worse short- and long-term outcomes, as indicated by emerging evidence. Few studies explore possible plaque features. Methods From September 2019 to December 2021, 1050 AMI patients were enrolled. The individuals were divided into two groups based on whether they had suffered an ischemic stroke before percutaneous coronary intervention (PCI). Patients from both groups underwent 1:1 propensity score matching (PSM) with a caliper width of 0.02. Ultimately, the final study cohort comprised 386 patients. Results Regarding culprit lesions, patients in the stroke group exhibited a greater prevalence of thin-cap fibroatheromas (TCFA, 70.0% vs. 55.4%, p = 0.003), macrophage accumulation (52.3% vs. 39.4%, p = 0.011), a longer lipid core length (15.3 ± 7.4 mm vs. 13.5 ± 6.4 mm, p = 0.013), and a higher lipid index (3,465.0 ± 2,135.8 vs. 2,946.4 ± 1,784.4, p = 0.011), compared to non-stroke patients. Concerning non-culprit plaques, prior stroke was significantly associated with a higher prevalence of TCFA (OR 2.08, 95% CI 1.15–3.74, p = 0.014). The clinical follow-up results revealed a significantly higher incidence of major adverse cardiovascular events in the stroke group (8.9% vs. 4.2%, p = 0.009, HR 2.61, 95% CI 1.28–5.34), along with a greater frequency of recurrent stroke (4.2% vs. 1.6%, p = 0.019, HR 3.78, 95% CI 1.23–9.30) and a higher cardiac mortality rate (5.8% vs. 1.6%, p = 0.011, HR 3.55, 95% CI 1.33–9.47) than the non-stroke group. Conclusion In stroke patients, coronary multivessel disease is common and characterized by high-risk plaque features and increased cardiovascular event susceptibility, with prior ischemic stroke being associated with a higher prevalence of these OCT-defined high-risk features.
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Wang et al. (2026) conducted a cohort in Acute myocardial infarction (AMI) (n=386). Previous ischemic stroke vs. No previous ischemic stroke was evaluated on Major adverse cardiovascular events (MACE) at 18 months (HR 2.61, 95% CI 1.28-5.34, p=0.009). Previous ischemic stroke in patients with acute myocardial infarction was associated with a significantly higher 18-month incidence of major adverse cardiovascular events (HR 2.61).
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