A community-based study of stroke incidence after myocardial infarction.
BACKGROUND
The rate of stroke after myocardial infarction (MI) remains unclear.


OBJECTIVE
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.


METHODS
Community-based cohort.


METHODS
Olmsted County, Minnesota.


METHODS
Persons with incident (first-ever) MI between 1979 and 1998.


METHODS
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.


RESULTS
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]).


CONCLUSIONS
Findings may not be generalizable to different populations. The authors measured outcomes by reviewing medical records.


CONCLUSIONS
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.
Witt
Brandi J
BJ
Mayo Clinic and Olmsted Medical Center, Rochester, Minnesota 55905, USA.
Brown
Robert D
RD
Jacobsen
Steven J
SJ
Weston
Susan A
SA
Yawn
Barbara P
BP
Roger
Véronique L
VL
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009203:Myocardial Infarction / Q000150:complications*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D016019:Survival Analysis