Bodenheimer MM; Sauer D; Shareef B; Brown MW; Fleiss JL; Moss AJ. Relation between myocardial infarct location and stroke. Journal of the American College of Cardiology, 1994 Jul, 24(1):61-6.
ABSTRACT:
OBJECTIVES. We sought to compare the likelihood of stroke in
patients with anterior versus nonanterior myocardial infarction.
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.
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.
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.
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.
Nakamura Y; Kawai C; Moss AJ; Raubertas RF; Brown MW; Kinoshita M; Sasayama S; Nonogi H; Omae T; Tamaki S; et al. Comparison between Japan and North America in the post-hospital course after recovery from an acute coronary event. International Journal of Cardiology, 1996 Aug, 55(3):245-54.
ABSTRACT:
We compared the post-hospital prognosis after an acute coronary event (acute myocardial infarction and unstable angina) in 106 patients in Japan vs. 789 patients in North America who were prospectively enrolled in the Multicenter Study of Myocardial Ischemia and were followed-up for an average of 26 months per patients. Risk factors more frequent in Japan were older age, males and smoking at enrollment, but the rest of many risk factors were similar. After adjusting for differences in clinical and medication variables, Cox analyses indicated patients in North America had a significantly greater risk of experiencing a primary end-point (cardiac death, non-fatal myocardial infarction or unstable angina) than patients in Japan (hazard ratio [North America:Japan] = 3.1, P = 0.003). There was a non-significant trend in the restricted end-points (cardiac death or non-fatal myocardial infarction) with North America having more frequent events than Japan (hazard ratio = 2.2, P = 0.12). The long-term outcome after recovery from an acute coronary event is more favorable in Japan than in North America, mostly due to a reduction in subsequent hospitalization for unstable angina. The reason for these findings cannot be explained by differences in the measured risk factors or medications.
Moriel M; Benhorin J; Brown MW; Raubertas RF; Severski PK; Van Voohees L; Bodenheimer MM; Tzivoni D; Wackers FJ; Mass AJ. Detection and significance of myocardial ischemia in women versus men within six months of acute myocardial infarction or unstable angina. The Multicenter Myocardial Ischemia Research Group. American Journal of Cardiology, 1996 Apr 15, 77(10):798-804.
ABSTRACT:
Ischemia detection after an acute coronary event predicts subsequent
cardiac events. However, gender-related aspects in the prevalence
and prognostic significance of ischemia detection after an acute
coronary event have not been reported. Noninvasive tests, which
included resting 12-lead electrocardiogram (ECG), 24-hour ambulatory
ECG, exercise ECG, and thallium-201 stress scintigraphy were performed
in 936 stable patients (224 women and 712 men) 1 to 6 months (average
2.7) after an acute coronary event (i.e., myocardial infarction
or unstable angina). Primary end points during an average follow-up
of 23 months included cardiac death, nonfatal myocardial infarction,
and unstable angina, while restricted end points included the
first 2. Ischemia detection was significantly less frequent among
women than among men on 24-hour ambulatory ECG, exercise ECG,
and thallium-201 stress scintigraphy. Primary end points occurred
in 19.2% of women and in 19% of men, and restricted end points
occurred in 5.8% of women versus 8%. of men (p = NS). Cox analyses
revealed that gender and its interaction with each of the ischemia
tests did not contribute to the prediction of the primary or restricted
end points. We conclude that in stable patients 1 to 6 months
after an acute coronary event, ischemia detection by noninvasive
tests was significantly less prevalent in women than in men. However,
subsequent cardiac event rates in women were similar to those
observed in men, and there was no gender-ischemic detection interaction
regarding subsequent events.