title: Early stroke following acute myocardial infarction: incidence, predictors and outcome in six Middle-Eastern countries.
abstract: OBJECTIVE
  Stroke is a potential complication of acute myocardial infarction (AMI). The aim of this study was to identify the incidence, risk factors predisposing to stroke and in-hospital outcome during the index admission with AMI among patients in the Middle East.
  
  
  METHODS
  For a period of 6 months in 2006 and 2007, 5,833 consecutive AMI patients were enrolled from 64 hospitals in 6 Middle East countries.
  
  
  RESULTS
  The incidence of in-hospital stroke following AMI was 0.85%. Most cases were ST segment elevation AMI-related and ischemic in nature. Patients with in-hospital stroke were older than patients without stroke and were more likely to be female (36 vs. 18.6%, p = 0.0033). They were also more likely to have diabetes mellitus, dyslipidemia, prior AMI, or percutaneous/surgical coronary revascularization. Patients with stroke were more likely to present with advanced Killip class II-IV, higher mean heart rate and higher serum creatinine. Independent predictors of stroke were age, prior stroke, prior coronary artery bypass surgery, anterior AMI and systolic blood pressure >190 mm Hg on presentation. Early administration of statins was independently associated with reduced stroke risk (odds ratio, OR, 0.4, 95% confidence interval, CI, 0.19-0.90, p = 0.025). Stroke was fatal in 44% of the cases and was independently associated with in-hospital mortality (adjusted OR 12.5, 95% CI 5.7-27.4, p < 0.01).
  
  
  CONCLUSIONS
  There is a low incidence of in-hospital stroke in Middle-Eastern patients presenting with AMI but with very high fatality rates. Early statin therapy was associated with a significant reduction in stroke risk. Future work should be focused on reducing the risk and improving the outcome of this devastating complication.
authors: Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait, Kuwait.
authors: Osamah
authors: O
authors: Albaker
authors: Mohammad
authors: M
authors: Zubaid
authors: Alawi A
authors: AA
authors: Alsheikh-Ali
authors: Wafa
authors: W
authors: Rashed
authors: Muath
authors: M
authors: Alanbaei
authors: Wael
authors: W
authors: Almahmeed
authors: Sulaiman Z
authors: SZ
authors: Al-Shereiqi
authors: Kadhim
authors: K
authors: Sulaiman
authors: Awad
authors: A
authors: Al Qahtani
authors: Jassim
authors: J
authors: Al Suwaidi
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000150:complications; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D009203:Myocardial Infarction / Q000150:complications*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors