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Relation between myocardial infarct location and stroke.
- Source :
-
Journal of the American College of Cardiology [J Am Coll Cardiol] 1994 Jul; Vol. 24 (1), pp. 61-6. - Publication Year :
- 1994
-
Abstract
- Objectives: We sought to compare the likelihood of stroke in patients with anterior versus nonanterior myocardial infarction.<br />Background: The association between anterior infarction and left ventricular thrombus has led to the assumption that embolization from thrombi is an important cause of stroke in patients with anterior infarction. We hypothesized that if anterior infarction is a cause of left ventricular thrombi, the number of strokes should be disproportionately higher in patients with anterior than nonanterior infarction.<br />Methods: We performed a retrospective analysis of 2,466 patients randomized from day 3 to day 15 after infarction as part of a multicenter placebo-controlled study of diltiazem to prevent cardiac death or myocardial infarction. Any acute focal cerebral disorder resulting in localizing findings characterized as a stroke or transient ischemic attack was considered an event.<br />Results: Of 91 events during a follow-up period of 12 to 52 months, 23 (3.2%) occurred in 724 patients with an anterior and 68 (3.9%) in 1,742 patients with a nonanterior myocardial infarction (relative risk 0.81; 95% confidence interval 0.51 to 1.30). Power analysis revealed that the negativity of the study was not the result of inadequate sample size. Life table analysis showed no difference in cumulative event rate (p = 0.42) according to site of infarction. Cox regression analysis showed that of 10 clinical covariates, only systolic blood pressure was predictive of stroke (p < 0.001). The use of warfarin did not contribute to the model. Finally, the addition of site of infarction (anterior vs. nonanterior) did not contribute significantly to the Cox model.<br />Conclusions: Although there is a significant incidence of stroke after acute myocardial infarction, there is no relation between the occurrence of stroke and site of infarction. These data do not support the presumed causal relation between anterior myocardial infarction, thrombus and stroke.
- Subjects :
- Adult
Aged
Cerebrovascular Disorders epidemiology
Diltiazem therapeutic use
Female
Follow-Up Studies
Humans
Incidence
Ischemic Attack, Transient epidemiology
Ischemic Attack, Transient etiology
Male
Middle Aged
Myocardial Infarction drug therapy
Myocardial Infarction epidemiology
Prognosis
Retrospective Studies
Risk Factors
Statistics as Topic methods
Time Factors
Cerebrovascular Disorders etiology
Myocardial Infarction complications
Subjects
Details
- Language :
- English
- ISSN :
- 0735-1097
- Volume :
- 24
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 7980764
- Full Text :
- https://doi.org/10.1016/0735-1097(94)90542-8