title: In-hospital myocardial infarction following acute ischaemic stroke: an observational study.
abstract: OBJECTIVE
  Acute myocardial infarction is expected to be an important medical complication following ischaemic stroke. We sought to describe the frequency and clinical impact of in-hospital myocardial infarction following acute ischaemic stroke.
  
  
  METHODS
  Consecutive patients with acute ischaemic stroke were identified from the Registry of the Canadian Stroke Network (2003-2006). Stroke severity was measured using the Canadian Neurological Scale (CNS). Functional status at discharge was measured with the modified-Rankin Scale, and categorized into strokes with no or mild-moderate dependency (m-Rankin 0-3) and those with severe dependence or death (m-Rankin 4-6). Multivariable logistic regression was used to determine the association between myocardial infarction and clinical outcome (death or severe dependence at hospital discharge and 1 year mortality), independent of co-morbidities and in-hospital medical complications.
  
  
  RESULTS
  In total, 9180 patients with acute ischaemic stroke were included. The mean age was 72 years (SD 13.9) and 48% were female. Overall, 211 (2.3%) patients were reported to have myocardial infarction during hospitalization. At hospital discharge, 64.9% of patients with in-hospital myocardial infarction had died or were severely disabled, compared with 35.8% in the entire cohort. Mortality at 1 year after ischaemic stroke was 56.4% in patients with myocardial infarction and 21.9% in the entire cohort. On multivariable analyses, myocardial infarction was also associated with death or severe dependence at discharge (OR 2.51; 95%CI 1.75-3.59) and mortality within 1 year (HR 1.83; 95%CI 1.51-2.23). Previous history of myocardial infarction (OR 1.50; 95%CI 1.05-2.15), diabetes mellitus (OR 1.55; 95%CI 1.42-2.10), stroke severity (OR 1.13; 95% CI 1.09-1.17) and peripheral vascular disease (OR 1.61; 95%CI 1.04-2.49) were independently associated with myocardial infarction during hospitalization.
  
  
  CONCLUSIONS
  Myocardial infarction is an important medical complication after acute ischaemic stroke.
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Liao
authors.forename: M J
authors.initials: MJ
authors.lastname: O'Donnell
authors.forename: F L
authors.initials: FL
authors.lastname: Silver
authors.forename: D
authors.initials: D
authors.lastname: Thiruchelvam
authors.forename: G
authors.initials: G
authors.lastname: Saposnik
authors.forename: J
authors.initials: J
authors.lastname: Fang
authors.forename: L
authors.initials: L
authors.lastname: Gould
authors.forename: N
authors.initials: N
authors.lastname: Mohamed
authors.forename: M K
authors.initials: MK
authors.lastname: Kapral
mesh_terms: D000368:Aged; D020520:Brain Infarction / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006761:Hospitals; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome