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(Stroke. 1999;30:997-1001.)
© 1999 American Heart Association, Inc.

Original Contributions

Ischemic Stroke

Impact of a Recent Myocardial Infarction

Thomas Mooe, MD, PhD; Bert-Ove Olofsson, MD, PhD; Birgitta Stegmayr, PhD Peter Eriksson, MD, PhD

From the Heart Center (T.M., P.E.) and Institute of Internal Medicine (B-O.O., B.S.), Norrland University Hospital, Umeå, Sweden.

Correspondence to Thomas Mooe, MD, PhD, Hjärtdivisionen, Område Medicin, Östersunds sjukhus, S-83183 Östersund, Sweden. E-mail thomas.mooe{at}medicin.umu.se

Background and Purpose—The risk of ischemic stroke is increased after a myocardial infarction. We quantified the stroke risk and evaluated ischemic stroke characteristics after an acute myocardial infarction.

Methods—A case-control study including patients with first-ever stroke was undertaken. Cases (n=103) were recorded prospectively in the population-based Northern Sweden World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study. Two controls per case with a stroke but without a recent myocardial infarction were matched for age, sex, and year of stroke onset.

Results—The sudden onset of neurological symptoms (76.7% versus 54.9%, P<0.001), impairment of consciousness (35.0% versus 18.4%, P<0.01), and a progression in neurological deficits (19.4% versus 8.7%, P<0.01) were more common in cases, while the onset of stroke during sleep was rarer in cases (6.8% versus 21.4%, P<0.01). In cases and controls, the clinical subclasses of stroke were as follows: total anterior circulation infarcts, 51.5% versus 37.9% (P<0.05); partial anterior circulation infarcts, 28.2% versus 26.7% (P=NS); lacunar infarcts, 4.8% versus 27.2% (P<0.001); and posterior circulation infarcts, 15.5% versus 8.2% (P=0.051). During the first 28 days after myocardial infarction, the daily rate of stroke declined rapidly from 9 to 1 stroke per 10 000 myocardial infarction patients compared with an age-adjusted average daily stroke rate of 0.14 per 10 000 in the MONICA population.

Conclusions—We conclude that the clinical characteristics of the stroke differ between patients with and without a recent myocardial infarction. The risk of a first-ever ischemic stroke is highest during the first few days after a myocardial infarction, but it then declines rapidly, and the absolute number of stroke events is low.

Key Words: case-control studies • myocardial infarction • stroke, ischemic

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