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Worcester Heart Attack Study

Jane S. Saczynski, PhD; Frederick A. Spencer, MD; Joel M. Gore, MD; Jerry H. Gurwitz, MD; Jorge Yarzebski, MD; Darleen Lessard, MS; Robert J. Goldberg, PhD

Arch Intern Med. 2008;168(19):2104-2110.

Background  Given the improved survival of patients after acute myocardial infarction (AMI), more patients are at risk for cerebrovascular complications of AMI. Trends in the magnitude of stroke in the setting of AMI are not well characterized, however, and neither have contemporary trends in the hospital death rates of patients developing acute stroke been examined.

Results  Of 9220 patients without a history of stroke hospitalized with confirmed AMI between 1986 and 2005 in all greater Worcester medical centers, 132 (1.4%) experienced an acute stroke during hospitalization. The proportion of patients with AMI who developed a stroke increased through the 1980s and 1990s but declined slightly thereafter. Advanced age, female sex, a previous myocardial infarction (MI), and the occurrence of atrial fibrillation during hospitalization were associated with a greater risk of stroke. Receipt of a percutaneous coronary intervention during hospitalization was associated with a lower risk of stroke. Compared with patients who did not experience a stroke, patients developing a stroke in the 1990s were approximately 3 times more likely to die during hospitalization (odds ratio [OR], 2.91; 95% confidence interval [CI], 1.72-5.19), whereas those experiencing a stroke in the 2000s were 5 times more likely to die (OR, 5.36; 95% CI, 2.71-10.64).

Conclusions  Although the incidence rates of stroke complicating AMI have declined somewhat since 1999, there is not a corresponding decline in the odds of dying during hospitalization in those developing a stroke. Although contemporary therapies may be reducing the risk of stroke in patients with AMI, more attention should be directed to improving the short-term prognosis of these high-risk patients.

Author Affiliations : Department of Medicine (Drs Saczynski, Spencer, Gore, Gurwitz, Yarzebski, and Goldberg and Ms Lessard), and Meyers Primary Care Institute (Drs Saczynski, Gurwitz, and Goldberg), University of Massachusetts Medical School, Worcester; and Division of Cardiovascular Medicine and Thrombosis, Faculty of Health Sciences Medicine, McMaster University, Hamilton, Ontario, Canada (Dr Spencer).

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