Semin Neurol 2021; 41(04): 331-339
DOI: 10.1055/s-0041-1726333
Review Article

Acute Ischemic Stroke Associated with Myocardial Infarction: Challenges and Management

1   Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
,
Shawna Cutting
1   Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
2   The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, Rhode Island
,
Karen Furie
1   Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
2   The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, Rhode Island
› Author Affiliations

Abstract

Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) may co-occur simultaneously or in close temporal succession, with occurrence of one ischemic vascular event increasing a patient's risk for the other. Both employ time-sensitive treatments, and both benefit from expert consultation. Patients are at increased risk of stroke for up to 3 months following AMI, and aggressive treatment of AMI, including use of reperfusion therapy, decreases the risk of AIS. For patients presenting with AIS in the setting of a recent MI, treatment with alteplase, an intravenous tissue plasminogen activator, can be given, provided anterior wall myocardial involvement has been carefully evaluated. It is important for clinicians to recognize that troponin elevations can occur in the setting of AIS as well as other clinical scenarios and that this may have implications for short- and long-term mortality.



Publication History

Article published online:
13 April 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Brammås A, Jakobsson S, Ulvenstam A, Mooe T. Mortality after ischemic stroke in patients with acute myocardial infarction: predictors and trends over time in Sweden. Stroke 2013; 44 (11) 3050-3055
  • 2 Witt BJ, Ballman KV, Brown Jr RD, Meverden RA, Jacobsen SJ, Roger VL. The incidence of stroke after myocardial infarction: a meta-analysis. Am J Med 2006; 119 (04) 354.e1-354.e9
  • 3 Chin PL, Kaminski J, Rout M. Myocardial infarction coincident with cerebrovascular accidents in the elderly. Age Ageing 1977; 6 (01) 29-37
  • 4 Thompson PL, Robinson JS. Stroke after acute myocardial infarction: relation to infarct size. BMJ 1978; 2 (6135): 457-459
  • 5 Omar HR, Fathy A, Rashad R, Helal E. Concomitant acute right ventricular infarction and ischemic cerebrovascular stroke; possible explanations. Int Arch Med 2010; 3: 25
  • 6 Kijpaisalratana N, Chutinet A, Suwanwela NC. Hyperacute simultaneous cardiocerebral infarction: Rescuing the brain or the heart first?. Front Neurol 2017; 8: 664
  • 7 Adams Jr HP, Bendixen BH, Kappelle LJ. et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24 (01) 35-41
  • 8 Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ. An evidence-based causative classification system for acute ischemic stroke. Ann Neurol 2005; 58 (05) 688-697
  • 9 Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. New approach to stroke subtyping: the A-S-C-O (phenotypic) classification of stroke. Cerebrovasc Dis 2009; 27 (05) 502-508
  • 10 Merkler AE, Diaz I, Wu X. et al. Duration of heightened ischemic stroke risk after acute myocardial infarction. J Am Heart Assoc 2018; 7 (22) e010782
  • 11 Powers WJ, Rabinstein AA, Ackerson T. et al; American Heart Association Stroke Council. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49 (03) e46-e110
  • 12 Maggioni AP, Franzosi MG, Santoro E, White H, Van de Werf F, Tognoni G. The risk of stroke in patients with acute myocardial infarction after thrombolytic and antithrombotic treatment. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico II (GISSI-2), and The International Study Group. N Engl J Med 1992; 327 (01) 1-6
  • 13 Behar S, Tanne D, Abinader E. et al; The SPRINT Study Group. Cerebrovascular accident complicating acute myocardial infarction: incidence, clinical significance and short- and long-term mortality rates. Am J Med 1991; 91 (01) 45-50
  • 14 Ulvenstam A, Kajermo U, Modica A, Jernberg T, Söderström L, Mooe T. Incidence, trends, and predictors of ischemic stroke 1 year after an acute myocardial infarction. Stroke 2014; 45 (11) 3263-3268
  • 15 Loh E, Sutton MS, Wun CC. et al. Ventricular dysfunction and the risk of stroke after myocardial infarction. N Engl J Med 1997; 336 (04) 251-257
  • 16 Komrad MS, Coffey CE, Coffey KS, McKinnis R, Massey EW, Califf RM. Myocardial infarction and stroke. Neurology 1984; 34 (11) 1403-1409
  • 17 Kajermo U, Ulvenstam A, Modica A, Jernberg T, Mooe T. Incidence, trends, and predictors of ischemic stroke 30 days after an acute myocardial infarction. Stroke 2014; 45 (05) 1324-1330
  • 18 Luo J, Li H, Qin X. et al. Increased risk of ischemic stroke associated with new-onset atrial fibrillation complicating acute coronary syndrome: a systematic review and meta-analysis. Int J Cardiol 2018; 265: 125-131
  • 19 Tanne D, Gottlieb S, Hod H, Reicher-Reiss H, Boyko V, Behar S. Secondary Prevention Reinfarction Israeli Nifedipine Trial (SPRINT) and Israeli Thrombolytic Survey Groups. Incidence and mortality from early stroke associated with acute myocardial infarction in the prethrombolytic and thrombolytic eras. J Am Coll Cardiol 1997; 30 (06) 1484-1490
  • 20 Longstreth Jr WT, Litwin PE, Weaver WD. The MITI Project Group. Myocardial infarction, thrombolytic therapy, and stroke. A community-based study. Stroke 1993; 24 (04) 587-590
  • 21 Hariri E, Tisminetzky M, Lessard D, Yarzebski J, Gore J, Goldberg R. Twenty-five-year (1986-2011) trends in the incidence and death rates of stroke complicating acute myocardial infarction. Am J Med 2018; 131 (09) 1086-1094
  • 22 Binsell-Gerdin E, Graipe A, Ögren J, Jernberg T, Mooe T. Hemorrhagic stroke the first 30 days after an acute myocardial infarction: incidence, time trends and predictors of risk. Int J Cardiol 2014; 176 (01) 133-138
  • 23 Wasser J, Goldberg RJ, Spencer FA, Yarzebski J, Gore JM. Multidecade-long trends (1986-2005) in the utilization of coronary reperfusion and revascularization treatment strategies in patients hospitalized with acute myocardial infarction: a community-wide perspective. Coron Artery Dis 2009; 20 (01) 71-80
  • 24 Al Suwaidi J, Al Habib K, Asaad N. et al. Immediate and one-year outcome of patients presenting with acute coronary syndrome complicated by stroke: findings from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2). BMC Cardiovasc Disord 2012; 12: 64
  • 25 Putaala J, Nieminen T. Stroke risk period after acute myocardial infarction revised. J Am Heart Assoc 2018; 7 (22) e011200
  • 26 Coles AH, Fisher KA, Darling C. et al. Recent trends in post-discharge mortality among patients with an initial acute myocardial infarction. Am J Cardiol 2012; 110 (08) 1073-1077
  • 27 Thygesen K, Alpert JS, Jaffe AS. et al; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol 2018; 72 (18) 2231-2264
  • 28 Jogu HR, Arora S, Vaduganathan M. et al. Wake Forest University long-term follow-up of type 2 myocardial infarction: the Wake-Up T2MI Registry. Clin Cardiol 2019; 42 (06) 592-604
  • 29 Sandoval Y, Jaffe AS. Type 2 myocardial infarction: JACC review topic of the week. J Am Coll Cardiol 2019; 73 (14) 1846-1860
  • 30 Ay H, Koroshetz WJ, Benner T. et al. Neuroanatomic correlates of stroke-related myocardial injury. Neurology 2006; 66 (09) 1325-1329
  • 31 Yaghi S, Chang AD, Ricci BA. et al. Early elevated troponin levels after ischemic stroke suggests a cardioembolic source. Stroke 2018; 49 (01) 121-126
  • 32 McCarthy CP, Raber I, Chapman AR. et al. Myocardial injury in the era of high-sensitivity cardiac troponin assays: a practical approach for clinicians. JAMA Cardiol 2019; 4 (10) 1034-1042
  • 33 Mendis S, Thygesen K, Kuulasmaa K. et al; Writing group on behalf of the participating experts of the WHO consultation for revision of WHO definition of myocardial infarction. World Health Organization definition of myocardial infarction: 2008-09 revision. Int J Epidemiol 2011; 40 (01) 139-146
  • 34 Goetti R, Kozerke S, Donati OF. et al. Acute, subacute, and chronic myocardial infarction: quantitative comparison of 2D and 3D late gadolinium enhancement MR imaging. Radiology 2011; 259 (03) 704-711
  • 35 Powers WJ, Rabinstein AA, Ackerson T. et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019; 50 (12) e344-e418
  • 36 Inohara T, Liang L, Kosinski AS. 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; 8 (15) e012450
  • 37 Mahaffey KW, Granger CB, Sloan MA. et al. Risk factors for in-hospital nonhemorrhagic stroke in patients with acute myocardial infarction treated with thrombolysis: results from GUSTO-I. Circulation 1998; 97 (08) 757-764
  • 38 Mooe T, Olofsson BO, Stegmayr B, Eriksson P. Ischemic stroke. Impact of a recent myocardial infarction. Stroke 1999; 30 (05) 997-1001
  • 39 Lichtman JH, Krumholz HM, Wang Y, Radford MJ, Brass LM. Risk and predictors of stroke after myocardial infarction among the elderly: results from the Cooperative Cardiovascular Project. Circulation 2002; 105 (09) 1082-1087
  • 40 Manea MM, Dragoş D, Stoica E, Bucşa A, Marinică I, Tuţă S. Early ST-segment elevation acute myocardial infarction after thrombolytic therapy for acute ischemic stroke: a case report. Medicine (Baltimore) 2018; 97 (50) e13347
  • 41 Yeo LLL, Andersson T, Yee KW. et al. Synchronous cardiocerebral infarction in the era of endovascular therapy: which to treat first?. J Thromb Thrombolysis 2017; 44 (01) 104-111
  • 42 Diener HC, Easton JD, Granger CB. et al; RE-SPECT ESUS Investigators. Design of Randomized, double-blind, Evaluation in secondary Stroke Prevention comparing the EfficaCy and safety of the oral Thrombin inhibitor dabigatran etexilate vs. acetylsalicylic acid in patients with Embolic Stroke of Undetermined Source (RE-SPECT ESUS). Int J Stroke 2015; 10 (08) 1309-1312
  • 43 Kamel H, Longstreth Jr WT, Tirschwell DL. et al. The AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke randomized trial: rationale and methods. Int J Stroke 2019; 14 (02) 207-214
  • 44 Delewi R, Zijlstra F, Piek JJ. Left ventricular thrombus formation after acute myocardial infarction. Heart 2012; 98 (23) 1743-1749
  • 45 Lamas GA, Vaughan DE, Pfeffer MA. Left ventricular thrombus formation after first anterior wall acute myocardial infarction. Am J Cardiol 1988; 62 (01) 31-35
  • 46 Kamel H, Bartz TM, Elkind MSV. et al. Atrial cardiopathy and the risk of ischemic stroke in the CHS (Cardiovascular Health Study). Stroke 2018; 49 (04) 980-986
  • 47 Chapman AR, Shah ASV, Lee KK. et al. Long-term outcomes in patients with type 2 myocardial infarction and myocardial injury. Circulation 2018; 137 (12) 1236-1245
  • 48 Poçi D, Hartford M, Karlsson T, Herlitz J, Edvardsson N, Caidahl K. Role of the CHADS2 score in acute coronary syndromes: risk of subsequent death or stroke in patients with and without atrial fibrillation. Chest 2012; 141 (06) 1431-1440
  • 49 Barra S, Almeida I, Caetano F. et al. Stroke prediction with an adjusted R-CHA2DS2VASc score in a cohort of patients with a myocardial infarction. Thromb Res 2013; 132 (02) 293-299
  • 50 Mannino M, Asciutto S, Terruso V, Gammino M, Cellura MG, Monaco S. Myocardial infarction following intravenous thrombolysis for acute ischemic stroke: case report and literature review. J Stroke Cerebrovasc Dis 2017; 26 (06) e105-e107
  • 51 Hart RG, Diener HC, Coutts SB. et al; Cryptogenic Stroke/ESUS International Working Group. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol 2014; 13 (04) 429-438
  • 52 Josephson SA, Hills NK, Johnston SC. NIH Stroke Scale reliability in ratings from a large sample of clinicians. Cerebrovasc Dis 2006; 22 (5-6): 389-395
  • 53 Lyden P, Raman R, Liu L, Emr M, Warren M, Marler J. National Institutes of Health Stroke Scale certification is reliable across multiple venues. Stroke 2009; 40 (07) 2507-2511
  • 54 Paciaroni M, Agnelli G, Falocci N. et al. Early recurrence and cerebral bleeding in patients with acute ischemic stroke and atrial fibrillation: effect of anticoagulation and its timing: the RAF study. Stroke 2015; 46 (08) 2175-2182
  • 55 Levine GN, Bates ER, Bittl JA. et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: an update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. Circulation 2016; 134 (10) e123-e155
  • 56 Steg PG, Bhatt DL. Viewpoint: a proposal for a simple algorithm for managing oral anticoagulation and antiplatelet therapy in patients with non-valvular atrial fibrillation and coronary stents. Eur Heart J Acute Cardiovasc Care 2017; 6 (01) 93-97
  • 57 Kirchhof P, Benussi S, Kotecha D. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg 2016; 50 (05) e1-e88
  • 58 Knijnik L, Rivera M, Blumer V. et al. Prevention of stroke in atrial fibrillation after coronary stenting. Stroke 2019; 50 (08) 2125-2132
  • 59 Lopes RD, Heizer G, Aronson R. et al; AUGUSTUS Investigators. Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. N Engl J Med 2019; 380 (16) 1509-1524
  • 60 Anadani M, Orabi MY, Alawieh A. et al. Blood pressure and outcome after mechanical thrombectomy with successful revascularization. Stroke 2019; 50 (09) 2448-2454
  • 61 Anadani M, Arthur AS, Tsivgoulis G. et al. Blood pressure goals and clinical outcomes after successful endovascular therapy: a multicenter study. Ann Neurol 2020; 87 (06) 830-839
  • 62 Adams Jr HP, del Zoppo G, Alberts MJ. et al; American Heart Association, American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 2007; 38 (05) 1655-1711
  • 63 Jauch EC, Saver JL, Adams Jr HP. et al; American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral Vascular Disease, Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44 (03) 870-947
  • 64 Demaerschalk BM, Kleindorfer DO, Adeoye OM. et al; American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2016; 47 (02) 581-641
  • 65 European Stroke Organisation (ESO) Executive Committee, ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008; 25 (05) 457-507
  • 66 Seiffge DJ, Werring DJ, Paciaroni M. et al. Timing of anticoagulation after recent ischaemic stroke in patients with atrial fibrillation. Lancet Neurol 2019; 18 (01) 117-126
  • 67 O'Gara PT, Kushner FG, Ascheim DD. et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127 (04) e362-e425
  • 68 Becker RC, Gore JM, Lambrew C. et al. A composite view of cardiac rupture in the United States National Registry of Myocardial Infarction. J Am Coll Cardiol 1996; 27 (06) 1321-1326
  • 69 Yang P, Zhang Y, Zhang L. et al; DIRECT-MT Investigators. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. N Engl J Med 2020; 382 (21) 1981-1993
  • 70 Amsterdam EA, Wenger NK, Brindis RG. et al; ACC/AHA Task Force Members, Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130 (25) 2354-2394
  • 71 Lee TH, Marcantonio ER, Mangione CM. et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100 (10) 1043-1049
  • 72 Chevli PA, Jogu HR, Islam T. et al. Abstract 11511: impact of post-discharge angiotensin-converting enzyme inhibitors/angiotensin receptor blockers on mortality in patients with asymptomatic troponin elevation in the perioperative period. Circulation 2019; 140 (Suppl. 01) A11511-A
  • 73 Jogu HR, Chevli PA, Bose A. et al. Abstract 451: beta blocker use in asymptomatic patients with sepsis and elevated troponin is associated with lower risk of mortality. Circ Res 2017; 121 (Suppl. 01) A451-A
  • 74 Mullis AH, Jogu HR, Ahmad MI. et al. Abstract 16215: statin use in asymptomatic patients with sepsis and elevated troponin is associated with lower risk of mortality. Circulation 2016; 134 (Suppl. 01) A16215-A
  • 75 Qureshi W, Jogu HR. Use of antiplatelets and anticoagulants in septic patients with troponin elevation. INSIGHTS FROM TYPE II MI STUDY. 2017; 69 (11, Suppl): 1025
  • 76 Shenouda S, Dutta A, Jogu H. et al. Abstract 15000: survival effect of beta-blockers in patients with asymptomatic perioperative troponin elevation. Circulation 2019; 140 (Suppl. 01) A15000-A