There are not many studies on incidence of acute stroke and acute MI on the same admission. The aim of this study was to retrospectively analyze the concurrence of these two diverse pathologies which share similar risk factors.
After IRB permission, medical charts for patients admitted with a diagnosis of acute MI and acute stroke from January 1st 2001 to December 31st 2006 were reviewed. Patients with positive findings on CT/ MRI brain were categorized to have an acute stroke; similarly patients with abnormal EKGs and cardiac markers with/ without symptoms were evaluated for possible acute MI.
Of 2000 admissions for acute stroke during the study period, 37 patients had an ICD-9 diagnosis of acute MI as well. 21 (56.7%) of these, had acute stroke and acute MI on the same admission. 9 (24.32%) developed acute stroke (embolic), following cerebral or carotid angiogram/ cardiac catheterization/ CABG. 85.71% patients were hypertensive. All 21 (100%) patients had abnormal cardiac enzymes and EKG changes suggestive of acute coronary syndrome. There was an equal incidence of dyslipidemia and atrial fibrillation –57.14% each. Ischemic stroke was more commonly associated overall; intracranial hemorrhage was noted in 2 patients who were not thrombolysed or anti-coagulated.
Optimizing care for neuro-cardiac disease is an important strategy. Not all patients with acute MI and acute stroke present with symptoms of both. Recognizing subtle signs and correlating risk factors for individual cases is vital. Patients with multiple CVAs, watershed infarcts and massive anterior wall MI did worse, owing to several co-morbidities such as multi-organ failure, nosocomial infections and sepsis.
Incidence of acute CVA and acute MI in the same admission is low. More studies are needed to identify the population at risk of developing both.
Ganesh Asaithambi, No Financial Disclosure Information; No Product/Research Disclosure Information