Acute myocardial infarction and heart failure in acute stroke patients: frequency and influence on clinical outcome

In patients admitted for acute stroke, the clinical burden of acute myocardial infarction (AMI) and acute heart failure (AHF) is unclear. In these patients we evaluated: (1) the prevalence of AMI and AHF; (2) the effect of AMI and/or AHF on mortality at 3 months; (3) the risk factors for AMI and/or AHF. Consecutive patients admitted for acute stroke were prospectively assessed for the occurrence of AMI and AHF during the hospital stay. Mortality at 3 months was also assessed. Multiple logistic regression analysis was used to identify independent predictors for cardiovascular events and death. Eight hundred fourteen patients were included in the study, 685 of which had an ischemic stroke (84.2%). Fifty-three patients (6.5%) had an AMI and/or an AHF (13 AMI alone, 28 AHF alone and 12 AMI and AHF); all these events occurred in patients with ischemic stroke. At 3 months, 151 patients had died (18.8%). Among patients who had an AMI and/or AHF, 60.4% died as compared with 119 of the 750 patients who did not have these events (15.9%) (p < 0.0001). At logistic regression analysis, AMI and/or AHF were associated with increased mortality at 3 months (p = 0.001). History of angina (p = 0.003), AMI in the 3 months before admission (p < 0.0001), hyperglycemia (p = 0.047), and high NIHSS on admission (p < 0.0001) were associated with in hospital AMI and/or AHF. In acute stroke patients, AMI and AHF are common and associated with increased mortality at 3 months. Whether a timely and more careful management of these complications may improve clinical outcome should be further explored.