Risk Factors for Acute Cardioembolic Brain Stroke in Acute Myocardial Infarction

ABSTRACT

BACKGROUND AND OBJECTIVES: An ischemic brain stroke following acute myocardial infarction (AMI) has a poor clinical prognosis, which primarily results from a thromboembolism. We determined the risk factors of acute cardioembolic brain stroke events that developed concurrently with, or soon after, the onset of AMI. SUBJECTS AND METHODS: We evaluated 38 AMI patients, who developed subsequent acute cardioembolic brain stroke during their index admission, by comparing their clinical and angiographic characteristics with those of 1,443 consecutive patients that had not experienced a brain stroke. Strokes that occurred between the onset of the AMI and patient discharge were analyzed. The incidences of cardiovascular risk factors, and the clinical and angiographic characteristics, of patients admitted to Ewha Womans University Mokdong Hospital, with a diagnosis of AMI over a 10-year period, were compared. RESULTS: In the univariate analysis, the frequencies of atrial fibrillation (21% vs. 4%, p=0.011) and hypertension (71% vs. 48%, p=0.030), and a left ventricular ejection fraction <40% (52% vs. 33%, p=0.039) were significantly higher in patients that had had an acute cardioembolic brain stroke. In a logistical regression analysis, atrial fibrillation was found to be a significant contributor to the subsequent development of an acute cardioembolic brain stroke in the AMI patients (p=0.023, beta=2.025, odds ratio=7.6). Mean follow-up period, which was mainly determined as the time to death after the AMI, was shorter in the acute cardioembolic brain stroke patients (8.5 month vs. 24.3 month, p=0.002). The death rate during the mean follow-up period was much higher in these patients (50% vs. 29%). CONCLUSION: We found that the presence of atrial fibrillation at the time of admission for an AMI was associated with an increased risk of a subsequent acute cardioembolic brain stroke.