January 1, 2023Open Access

Concomitant Acute Coronary Syndrome and Acute Ischemic Stroke: A Particular Association and a Therapeutic Dilemma

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Cardiocerebral infarction (concomitant acute coronary syndrome and acute ischemic stroke) (n=2). Intervention: Individualized management (PCI, thrombolysis).

Key Result

The management of cardiocerebral infarction, a rare concomitant occurrence of acute myocardial infarction and acute ischemic stroke, requires highly individualized treatment due to conflicting risks.

Study Design

Type

Case Report (n=2)

Multicenter

Structured PICO

Population

2 female patients (ages 46 and 62) presenting with cardiocerebral infarction (concomitant acute coronary syndrome and acute ischemic stroke).

Intervention

Individualized management including percutaneous coronary intervention (PCI) and/or intravenous thrombolysis (tenecteplase).

Outcome

Clinical outcome (recovery or mortality)

The management of cardiocerebral infarction requires highly individualized treatment strategies due to the conflicting risks of bleeding and thrombosis, with no current consensus guidelines.

Limitations

No large-scale studies
Lack of high quality evidence or clinical guidelines

Abstract

Cardiocerebral infarction (CCI), defined as the concomitant occurrence of acute myocardial infarction (AMI) and acute ischaemic stroke (AIS), has been rarely reported in the literature.The aim of this manuscript is to describe the challenges in the treatment of CCI and to highlight the different approaches in the management of this entity.We report the case of two young women admitted to our cardiology department with acute coronary syndrome concomitant with stroke at different times and whose management differed according to their ischemic and hemorrhagic risk.It is assumed that there is a possible relationship between the two conditions rather than a mere coincidence.Explanations for this association are reviewed and discussed in detail in this paper.The management of a concurrent presentation of AIS and AMI is unclear.The use of antiplatelets and anticoagulants that are integral to the management of AMI may increase the risk of haemorrhagic transformation, and the use of a thrombolytic in AIS similarly increases the risk of heart wall rupture in AMI.As there are no large-scale studies, high quality evidence or clinical guidelines, the treatment of CCI should be highly individualized.

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