Brandi J. Witt, MD; Robert D. Brown Jr., MD, MPH; Steven J. Jacobsen, MD, PhD; Susan A. Weston, MS; Barbara P. Yawn, MD; Véronique L. Roger, MD, MPH
Acknowledgments: The authors thank Ryan A. Meverden, BS, and Jill Killian, BS, for assistance with statistical analyses, and Kristie Shorter for secretarial support.
Grant Support: In part by grants AR30582, HL59205, and HL68765 from the Public Health Service, National Institutes of Health.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Véronique L. Roger, MD, MPH, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Current Author Addresses: Drs. Witt, Brown, Jacobsen, and Roger and Ms. Weston: Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Dr. Yawn: Olmsted Medical Center, 210 Ninth Street SE, Rochester, MN 55904.
Author Contributions: Conception and design: B.J. Witt, R.D. Brown, S.J. Jacobsen, B.P. Yawn, V.L. Roger. Analysis and interpretation of the data: B.J. Witt, R.D. Brown, S.J. Jacobsen, S.A. Weston, V.L. Roger. Drafting of the article: B.J. Witt, S.J. Jacobsen. Critical revision of the article for important intellectual content: B.J. Witt, R.D. Brown, S.A. Weston, B.P. Yawn, V.L. Roger. Final approval of the article: B.J. Witt, R.D. Brown, B.P. Yawn. Statistical expertise: S.A. Weston. Obtaining of funding: V.L. Roger. Collection and assembly of data: B.J. Witt.
The rate of stroke after myocardial infarction (MI) remains unclear.
To examine the rate of stroke after incident MI; compare it with that observed in the population of Rochester, Minnesota; determine how the rate of stroke after MI has changed over time; and examine the impact of stroke on survival after incident MI.
Olmsted County, Minnesota.
Persons with incident (first-ever) MI between 1979 and 1998.
Ischemic or hemorrhagic stroke in hospitalized and nonhospitalized patients that was identified by screening of the medical record for stroke diagnostic codes and subsequent stroke confirmation by physician review of the recorded event. Medical record review was used to ascertain baseline characteristics and death.
A total of 2160 persons with incident MI were hospitalized between 1979 and 1998 and followed for a median of 5.6 years (range, 0 to 22.2 years). The rate of stroke was 22.6 per 1000 person-months (95% CI, 16.3 to 30.6 per 1000 person-months) during the first 30 days after MI, corresponding to a 44-fold increase (standardized morbidity ratio, 44 [95% CI, 32 to 59]) risk for stroke in the population of Rochester, Minnesota. The risk for stroke remained 2 to 3 times higher than expected during the first 3 years after MI. Older age, previous stroke, and diabetes increased the risk for stroke, which did not decline over the study period. Strokes were associated with a large increase in the risk for death after MI (hazard ratio, 2.89 [CI, 2.44 to 3.43]).
Findings may not be generalizable to different populations. The authors measured outcomes by reviewing medical records.
In the community, the risk for stroke is markedly increased after MI, particularly early after MI, compared with the expected risk in population without MI. Stroke is associated with a large increase in the risk for death after MI.
After a myocardial infarction (MI), outcomes such as heart failure and recurrent MI are decreasing. What about stroke?
This cohort study from Olmsted County, Minnesota, had a 44-fold increase in stroke rate during the first month after MI compared with the stroke rate in the general community. Stroke rates in the cohort declined markedly after the first month but exceeded the rates in the general community for 3 years. Strokes after MI were associated with increased risk for death, and their rate did not decline between 1979 and 1998.
Early after MI, risk for stroke is markedly increased. This risk has not declined over time.
Table 1. Rate of Stroke after Myocardial Infarction in Olmsted County, Minnesota
Ratio of observed strokes in the myocardial infarction (MI) cohort to expected strokes in Rochester, Minnesota (standardized morbidity ratio [SMR]).
Table 2. Characteristics of Patients with Myocardial Infarction by Occurrence of Stroke
Table 3. Risk for Death after Myocardial Infarction Associated with Stroke
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
A study shows patients who have just had a heart attack are at a greater risk of also suffering a stroke withing month of their attack.
Witt BJ, Brown RD, Jacobsen SJ, et al. A Community-Based Study of Stroke Incidence after Myocardial Infarction. Ann Intern Med. 2005;143:785–792. doi: 10.7326/0003-4819-143-11-200512060-00006
Download citation file:
Published: Ann Intern Med. 2005;143(11):785-792.
Results provided by:
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use