Cases of stroke complicating heart attack down

NEW YORK (Reuters Health) - While the incidence of stroke as a complication of heart attack has decreased since the late 1990s, death during hospitalization in affected patients has not shown a corresponding decrease, new data suggest.

"Although contemporary therapies may be reducing the risk of stroke in patients with (heart attack), more attention should be directed to improving the short-term prognosis of these high-risk patients," conclude Dr. Jane S. Saczynski, of the University of Massachusetts Medical School, Worcester, and colleagues in the Archives of Internal Medicine.

In looking at data on 9,220 patients hospitalized for heart attack between 1986 and 2005, Saczynski's team found that 132 patients (1.4 percent) suffered a first acute stroke during hospitalization.

The frequency of stroke increased through the 1990s, peaked in 1999, and declined slightly thereafter, the researchers found.

Age at least 75 years, female gender, a previous heart attack, and development of a serious irregular heart beat called atrial fibrillation during hospitalization were all associated with significantly increased odds of stroke. Having had a minimally invasive coronary intervention during hospitalization was associated with a lower risk of stroke.

The researchers also found that the likelihood of dying while hospitalized was significantly higher among patients who experienced an acute stroke compared to those who did not (34.1 percent versus 11.6 percent).

Further, patients with bleeding or "hemorrhagic" stroke were more likely to die while in the hospital than those with ischemic stroke - the kind that results from a blockage.

In their analysis of trends over time, the investigators found that the risk of dying during hospitalization for heart attack in patients who suffer a stroke has not decreased in recent years.

SOURCE: Archives of Internal Medicine, October 27, 2008.