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Recent Myocardial Infarction is Associated With Increased Risk in Older Adults With Acute Ischemic Stroke Receiving Thrombolytic Therapy.

Publication ,  Journal Article
Inohara, T; Liang, L; Kosinski, AS; Smith, EE; Schwamm, LH; Hernandez, AF; Bhatt, DL; Fonarow, GC; Peterson, ED; Xian, Y
Published in: J Am Heart Assoc
August 6, 2019

Background Intravenous recombinant tissue-type plasminogen activator (rtPA) remains the only medical therapy to improve outcomes for acute ischemic stroke (AIS), but the safety of rtPA in AIS patients with a history of recent myocardial infarction (MI) remains controversial. Methods and Results We sought to determine whether the presence of recent MI would alter the risk of mortality and rtPA-related complications. Multivariate logistic regression models were used to compare in-hospital outcomes between rtPA-treated AIS patients with recent MI within 3 months and those with no history of MI from the Get With The Guidelines-Stroke hospitals between February 2009 and December 2015. Among 40 396 AIS patients aged ≥65 years treated with rtPA, 241 (0.6%) had recent MI, of which 19.5% were ST-segment-elevation myocardial infarction. Patients with recent MI had more severe stroke than those without (median National Institutes of Health Stroke Scale [interquartile range]: 13.0 [7.0-20.0] versus 11.0 [6.0-18.0]). Recent MI was associated with an increased risk of mortality compared with no history of MI (17.4% versus 9.0%; adjusted odds ratio 1.60 [95% CI, 1.10-2.33]; P=0.014), but no statistically significant differences in rtPA-related complications (13.5% versus 9.4%; adjusted odds ratio 1.28 [0.88-1.86]; P=0.19). Recent ST-segment-elevation myocardial infarction was associated with higher risk of death and rtPA-related complications, but non-ST-segment-elevation myocardial infarction was not. Conclusions Among older AIS patients treated with rtPA, recent MI was associated with an increased risk of in-hospital mortality. Further investigations are necessary to determine whether the benefit of rtPA outweighs its risk among AIS patients with recent MI.

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

August 6, 2019

Volume

8

Issue

15

Start / End Page

e012450

Location

England

Related Subject Headings

  • Tissue Plasminogen Activator
  • Time Factors
  • Thrombolytic Therapy
  • Stroke
  • Risk Assessment
  • Retrospective Studies
  • Myocardial Infarction
  • Male
  • Humans
  • Hospital Mortality
 

Citation

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Inohara, T., Liang, L., Kosinski, A. S., Smith, E. E., Schwamm, L. H., Hernandez, A. F., … Xian, Y. (2019). Recent Myocardial Infarction is Associated With Increased Risk in Older Adults With Acute Ischemic Stroke Receiving Thrombolytic Therapy. J Am Heart Assoc, 8(15), e012450. https://doi.org/10.1161/JAHA.119.012450
Inohara, Taku, Li Liang, Andrzej S. Kosinski, Eric E. Smith, Lee H. Schwamm, Adrian F. Hernandez, Deepak L. Bhatt, Gregg C. Fonarow, Eric D. Peterson, and Ying Xian. “Recent Myocardial Infarction is Associated With Increased Risk in Older Adults With Acute Ischemic Stroke Receiving Thrombolytic Therapy.J Am Heart Assoc 8, no. 15 (August 6, 2019): e012450. https://doi.org/10.1161/JAHA.119.012450.
Inohara T, Liang L, Kosinski AS, Smith EE, Schwamm LH, Hernandez AF, et al. Recent Myocardial Infarction is Associated With Increased Risk in Older Adults With Acute Ischemic Stroke Receiving Thrombolytic Therapy. J Am Heart Assoc. 2019 Aug 6;8(15):e012450.
Inohara, Taku, et al. “Recent Myocardial Infarction is Associated With Increased Risk in Older Adults With Acute Ischemic Stroke Receiving Thrombolytic Therapy.J Am Heart Assoc, vol. 8, no. 15, Aug. 2019, p. e012450. Pubmed, doi:10.1161/JAHA.119.012450.
Inohara T, Liang L, Kosinski AS, Smith EE, Schwamm LH, Hernandez AF, Bhatt DL, Fonarow GC, Peterson ED, Xian Y. Recent Myocardial Infarction is Associated With Increased Risk in Older Adults With Acute Ischemic Stroke Receiving Thrombolytic Therapy. J Am Heart Assoc. 2019 Aug 6;8(15):e012450.
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

August 6, 2019

Volume

8

Issue

15

Start / End Page

e012450

Location

England

Related Subject Headings

  • Tissue Plasminogen Activator
  • Time Factors
  • Thrombolytic Therapy
  • Stroke
  • Risk Assessment
  • Retrospective Studies
  • Myocardial Infarction
  • Male
  • Humans
  • Hospital Mortality