Ischemic Stroke After Acute Myocardial Infarction

J Korean Neurol Assoc > Volume 17(2); 1999 > Article

Journal of the Korean Neurological Association 1999;17(2): 201-205.

급성 심근 경색증에 합병된 허혈성 뇌졸중

김근호, 김진석ㆍ이형·임정근·이상도·박영춘

계명대학교 의과대학 신경과학교실

Ischemic Stroke After Acute Myocardial Infarction

Geun-Ho Kim, M.D., Jin-Seok Kim, M.D., Hyung Lee, M.D., Jeong-Geun Lim, M.D., Sang-Doe Yi, M.D., Young-Choon Park, M.D.

Department of Neurology, School of medicine, Keimyung university

Abstract

Background : The relationship between the anterior site of acute myocardial infarction(MI) and occurrence of stroke has become a recent subject of much debate in the relevant literature. The object of this study was to examine the incidence of ischemic stroke during the hospitalization after an acute MI and to identify predictors of MI-related stroke. Methods : We performed retrospective analysis of 452 patients with acute MI admitted to department of Neurology or Cardiology from January 1990 to August 1997. Patients with a stroke during hospitalization after acute MI were recruited for this study. Result : Thirteen cases were recorded. Seventy-seven percent (10/13) of the strokes occurred within 4 days after onset of MI. Multivariate analysis identified the following as independent predictors of stroke : History of hypertension(OR. 2.6: CI, 1.1 to 5.9), previous stroke(OR, 22.3: CI, 5.9 to 84.9) and congestive heart failure (CHF)(OR, 15.4: CI, 2.2-108.6). Transthoracic echocardiography(TTE) was performed in 349/452(77%) during hospitalization. The incidence of left ventricular thrombosis(LVT) in patients with anterior MI who received thrombolytic and anticoagulant therapy was not significantly different from that in patients with anterior MI who didn't(2.6% vs 6.1%, p=0.265). Stroke developed in only one of these patients with LVT. Thrombolytic and anticoagulant therapy were more frequently used in patients without stroke compared with stroke.(p<0.05). Conclusion : The incidence of stroke after acute MI is 2.9% and more frequent within the 4 days after MI. History of hypertension, previous stroke and congestive heart failure (CHF) were the factors independently favoring the occurrence of stroke, but there is no relation between the occurrence of stroke and anterior site of MI. Although intravenous thrombolytics followed by full anticoagulation treatment appeared to provide protection against ischemic stroke, it has no effect in the incidence of left ventricular thrombi in this study. Key Words : Acute myocardial infarction, Ischemic stroke, Left ventricular thrombosis