Acute ST-segment elevation myocardial infarction and prior stroke: an analysis from the Magnesium in Coronaries (MAGIC) trial.
BACKGROUND
Patients with prior stroke represent a substantial proportion of patients presenting with acute ST-segment elevation myocardial infarction (STEMI). However, the impact of prior stroke on prognosis has not been rigorously examined in the reperfusion era.


METHODS
The baseline characteristics, treatments, and clinical outcomes of patients with prior stroke enrolled in the Magnesium in Coronaries (MAGIC) trial were evaluated and compared to those of patients without prior stroke.


RESULTS
MAGIC enrolled 6213 patients with STEMI, of whom 558 (9.0%) had prior stroke. Patients with prior stroke were more likely to have a history of hypertension (88.0% vs 70.3%), diabetes (19.9% vs 14.5%), myocardial infarction (38.2% vs 25.1%), and congestive heart failure (15.6% vs 9.7%). The mean Thrombolysis in Myocardial Infarction Risk Score was higher in patients with prior stroke compared to those without prior stroke (4.37 vs 3.93, P < .0001). Patients with prior stroke were less likely to receive reperfusion therapy, even among those considered eligible at presentation (66.3% vs 80.6%, P < .0001). Compared to patients without prior stroke, inhospital stroke (3.0% vs 1.0%, P < .0001), severe congestive heart failure (23.3% vs 18.2%, P = .003), and 30-day mortality (21.0% vs 14.7%, P < .0001) were higher among patients with prior stroke. On multivariable analysis, prior stroke was independently associated with a significantly higher risk of death at 30 days (odds ratio 1.44, P = .0023).


CONCLUSIONS
Patients with prior stroke who present with STEMI are at very high risk for short-term morbidity and mortality. Aggressive treatment of these patients appears warranted.
Cooper
Howard A
HA
Washington Hospital Center, Washington, DC 20010, USA. howard.a.cooper@medstar.net <howard.a.cooper@medstar.net>
Domanski
Michael J
MJ
Rosenberg
Yves
Y
Norman
James
J
Scott
Judith H
JH
Assmann
Susan F
SF
McKinlay
Sonja M
SM
Hochman
Judith S
JS
Antman
Elliott M
EM
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002986:Clinical Trials as Topic; D000075202:Contraindications; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008278:Magnesium Sulfate / Q000627:therapeutic use; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000150:complications*; D015912:Thrombolytic Therapy
D008278:Magnesium Sulfate