Conference Coverage

Heart attacks bring 12 weeks of higher stroke risk



Patients recently hospitalized for an acute myocardial infarction face a heightened risk for ischemic stroke during the first 12 weeks following their MI discharge, based on a sample of Medicare beneficiaries.

The period of elevated stroke risk following an MI extends beyond the 30-day window that has traditionally been considered the interval of highest risk, Alexander E. Merkler, MD, said at the International Stroke Conference, sponsored by the American Heart Association.

Dr. Alexander E. Merkler Mitchel L. Zoler/Frontline Medical News

Dr. Alexander E. Merkler

Dr. Merkler’s analysis showed that the incidence of hospitalization for an acute ischemic stroke was 2.7-fold higher than usual during the first 4 weeks following hospital discharge for an MI, then two-fold above the usual rate during weeks 5-8 following an MI discharge, and then 60% above the background stroke rate during weeks 9-12 after an MI discharge.

Beyond 12 weeks after MI discharge, the stroke incidence showed no significant difference compared with people without a recent MI history, said Dr. Merkler, a neurologist at Weill Cornell Medicine in New York.

He calculated these statistically significant elevated risk rates after adjusting for demographic measures, stroke risk factors, and the comorbidities included in the Charlson Comorbidity Index.

Herpes zoster raises risk of stroke, MI
These increased stroke rates were independent of periprocedural strokes that might have happened during MI interventions, as the analysis excluded MI patients with a history of a stroke either before or during their MI hospitalization.

To run this analysis, Dr. Merkler and his associates used data collected in a 5% sample of Medicare beneficiaries who were at least 66 years old during 2008-2015. Among these 1.7 million people were 46,182 who were hospitalized for an MI.

Several factors associated with an acute MI likely contribute to an elevated stroke risk, including stasis in the heart and generation of microthrombi, and a possibly systemic proinflammatory state, Dr. Merkler suggested.

Dr. Merkler had no disclosures.

SOURCE: Merkler AE et al., International Stroke Conference abstract 172 (Stroke. 2018 Jan; 49[Suppl 1]:A172).

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