INCIDENCE AND MORTALITY FROM EARLY STROKE ASSOCIATED WITH ACUTE MYOCARDIAL-INFARCTION IN THE PRETHROMBOLYTIC AND THROMBOLYTIC ERAS

Objectives. This study sought to compare the incidence of early cerebr ovascular events and subsequent mortality in two cohorts of consecutiv e patients with acute myocardial infarction (AMI), admitted to coronar y care units (CCUs) in Israel, in the prethrombolytic and thrombolytic eras. Background. During the past decade, substantial changes have oc curred in the medical treatment of AMI, and important new therapies ha ve been introduced that could all affect stroke risk and type by diver se mechanisms. Yet the overall impact of these new therapeutic modalit ies on the incidence of stroke complicating AMI is not clear. Methods. We compared the incidence and mortality rates of cerebrovascular even ts complicating AMI within CCUs among 5,839 consecutive patients admit ted in the period 1981 to 1983 versus 2,012 patients from two prospect ive nationwide surveys conducted in all CCUs operating in Israel in 19 92 and 1994. Results. The demographic and clinical characteristics of patients with AMI in both periods were comparable. Patients admitted i n the period 1981 to 1983 did not receive thrombolysis and reperfusion therapy; those admitted in 1992 and 1994 received thrombolysis (45%) and coronary angioplasty or coronary artery bypass graft surgery (14%) , and antiplatelet and anticoagulant treatments were more frequently u sed, The incidence of early cerebrovascular events was 0.74% (43 of 5, 839) in 1981 to 1983 versus 0.75% (15 of 2,012) in the 1992 to 1994 co hort. Patients,vith an AMI who experienced a cerebrovascular event wer e somewhat older in both groups and had a high rate of previous cerebr ovascular events, congestive heart failure and atrial and ventricular arrhythmias during the hospital period. Mortality declined by one thir d between the two periods. However, the mortality rate of patients wit h AMI who sustained a cerebrovascular event remained high (greater tha n or equal to 40% for 30 days, 60% for 1 year),Conclusions. The overal l incidence of early cerebrovascular events complicating AMI remained similar (0.75%) in the prethrombolytic and thrombolytic eras, Mortalit y rates of patients with an AMI but no cerebrovascular events decrease d substantially over the past decade but not in patients with AMI with a cerebrovascular event. (C) 1997 by the American College of Cardiolo gy.