Post-MI Stroke Risk Stays Elevated for Months

For all your heart attack friends you meet while in the hospital. Best to inform them of this and get a stroke prevention protocol from their doctor.
https://www.medpagetoday.com/meetingcoverage/ana/75867?

Heart attack tied to "more prolonged risk of stroke than we have thought

• by Judy George, Contributing Writer, MedPage Today October 23, 2018

ATLANTA -- Ischemic stroke risk was elevated up to 3 months after hospitalization for acute myocardial infarction (MI), an observational study of more than 1.7 million Medicare beneficiaries found.
Stroke risk was highest in the first 4 weeks (HR 2.7, 95% CI 2.3-3.2) after acute MI, and remained elevated in weeks 5 to 8 (HR 2.0, 95% CI 1.6-2.4) and weeks 9 to 12 (HR 1.6, 95% CI 1.3-2.0), according to Alexander Merkler, MD, of Weill Cornell Medicine in New York, and co-authors, in a poster presentation here at the American Neurological Association annual meeting.
"Acute MI is associated with a more prolonged risk of stroke than we have thought," Merkler told MedPage Today. "Patients who have an MI are at a high risk for stroke for at least 3 months, which is longer than the 1-month time window that is currently considered the at-risk period."
That 1-month window is "from old studies conducted in 1970s and 80s and has stuck with our current guidelines," Merkler noted.(Notice the word guidelines NOT protocols.)
"The results of our study may allow clinicians to more accurately counsel patients regarding their stroke etiology and the results of our study may allow refinement of stroke etiology classification systems and clinical trial selection criteria," he added. "Our results may change the way we classify certain stroke and should increase awareness(fuck awareness, where is the prevention protocol you lazy and incompetent fuckers?) of the heightened risk of stroke after MI."
Merkler and colleagues looked at inpatient and outpatient claims data for 1,746,476 Medicare beneficiaries older than 65, including 46,182 hospitalized for MI. Patients with MI were older, more likely to be male, and had more stroke risk factors than those free of MI.
Over mean follow-up of 4.6 years, 80,466 people in the study had acute ischemic stroke. The researchers did not count patients who had ischemic stroke prior to or within a hospitalization for acute MI to exclude strokes related to percutaneous coronary interventions.
After adjusting for demographics, stroke risk factors, and Charlson comorbidities, the researchers found that ischemic stroke risk was high up to 12 weeks after acute MI hospitalization. Beyond that time, though, stroke risk was no longer elevated. Results were unchanged in sensitivity analyses.
While "the study provides interesting data that patients who have heart attacks may have a higher risk of stroke over at least 2 months" later, it's not clear what this finding means, observed Rebecca Gottesman, MD, PhD, of Johns Hopkins University, who was not involved with the research.
"It's hard to know whether this is due to the heart attack itself, or due to the risk factors that are shared between heart attack and stroke which might just indicate that people with heart attack are at higher risk for stroke in general," Gottesman told MedPage Today. The study authors adjusted for some of these other risk factors, but in an observational study, it's likely these weren't fully accounted for, she noted.
In addition, the study used administrative data from Medicare, and the way risk factors and disease are coded may not be completely accurate or may not capture all cases, Gottesman said.

The work was funded by the NIH, the Leon Levy Foundation in Neuroscience, the Florence Gould Endowment for Discovery in Stroke, and the Michael Goldberg Research Fund.
Merkler had nothing to disclose.

• Primary Source

  American Neurological Association

  Source Reference: Merkler A, et al “Duration of heightened ischemic stroke risk after acute myocardial infarction” ANA 2018; Abstract M122.