Vivek Rai, MD
Brammås A, Jakobsson S, Ulvenstam A, Mooe T. Mortality After Ischemic Stroke in Patients With Acute MyocardialInfarction: Predictors and Trends Over Time in Sweden. Stroke. 2013

Mortality after acute myocardial ischemia (AMI) complicated by ischemic stroke (IS) is considered high but reliable estimates are not available. Brammås and colleagues tried to answer this question based on analysis of data of 173,233 patients of AMI collected from Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA) during the period of 1998-2008. They further dichotomized the study period in groups of 2 years to study trends of over time.

In brief, the results suggest the incidence of IS within one year of AMI is 4% and 36.5% of these patients died during that year. This is in contrast to 18.3% mortality in patients who did not suffer IS. Overall, patients who died, as also those who had IS, were older and had more co-morbid conditions. Heart failure, renal disease, peripheral arterial disease and diabetes had strongest association with death. 1-year mortality over the 10-year study period declined although it was consistently higher in women than men.
The large number of patients included in this study gives reliable estimate of numbers although the findings don’t come as a surprise to me. As such, this new information will not change my clinical practice. The information might be of use during discussions with family and patients about future directions of their care.
One interesting point to note is the difference in mortality between men and women. I think that this needs to be investigated a bit more to try and identify the reasons behind this disparity as we may find deficiencies in current clinical care that have potential for improvement in future.