title: Hemorrhagic stroke the first 30 days after an acute myocardial infarction: incidence, time trends and predictors of risk.
abstract: OBJECTIVE
  Hemorrhagic stroke is a rare but serious complication after an acute myocardial infarction (AMI). The aims of our study were to establish the incidence, time trends and predictors of risk for hemorrhagic stroke within 30 days after an AMI in 1998-2008.
  
  
  METHODS
  We collected data from the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA). All patients with a myocardial infarction 1998-2008 were included, n=173,233. The data was merged with the National Patient Register in order to identify patients suffering a hemorrhagic stroke. To identify predictors of risk we used Cox models.
  
  
  RESULTS
  Overall the incidence decreased from 0.2% (n=94) in 1998-2000 to 0.1% (n=41) in 2007-2008. In patients with ST-elevation myocardial infarction the corresponding incidences were 0.4% (n=76) in 1998-2000 and 0.2% (n=21) in 2007-2008, and after fibrin specific thrombolytic treatment 0.6% and 1.1%, respectively, with a peak of 1.4% during 2003-2004. In total 375 patients (0.22%) suffered a hemorrhagic stroke within 30 days of the AMI. The preferred method of reperfusion changed from thrombolysis to percutaneous coronary intervention (PCI). Older age (hazard ratio (HR) >65-≤ 75 vs ≤ 65 years 1.84, 95% confidence interval (CI) 1.38-2.45), thrombolysis (HR 6.84, 95% CI 5.51-8.48), history of hemorrhagic stroke (HR 12.52, CI 8.36-18.78) and prior hypertension (HR 1.52, CI 1.23-1.86) independently predicted hemorrhagic stroke within 30 days.
  
  
  CONCLUSIONS
  The rate of hemorrhagic stroke within 30 days of an AMI has decreased by 50% between 1998 and 2008. The main reason is the shift in reperfusion method from thrombolysis to PCI.
authors: Department of Public Health and Clinical Medicine, Östersund, Umeå University, Sweden. Electronic address: binsell-gerdin@hotmail.com.
authors: Emil
authors: E
authors: Binsell-Gerdin
authors: Department of Internal Medicine, Section of Cardiology, Östersund Hospital, Sweden; Department of Public Health and Clinical Medicine, Östersund, Umeå University, Sweden. Electronic address: anna.graipe@jll.se.
authors: Anna
authors: A
authors: Graipe
authors: Department of Internal Medicine, Section of Cerebrovascular Diseases, Östersund Hospital, Sweden; Department of Public Health and Clinical Medicine, Östersund, Umeå University, Sweden. Electronic address: joachim.ogren@jll.se.
authors: Joachim
authors: J
authors: Ögren
authors: Department of Medicine, Section of Cardiology, Huddinge, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. Electronic address: tomas.jernberg@ki.se.
authors: Tomas
authors: T
authors: Jernberg
authors: Department of Public Health and Clinical Medicine, Östersund, Umeå University, Sweden. Electronic address: thomas.mooe@medicin.umu.se.
authors: Thomas
authors: T
authors: Mooe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors
keywords: Hemorrhagic stroke; Myocardial infarction; Predictor; Time trend