Acute ST-segment elevation myocardial infarction and prior stroke: An analysis from the Magnesium in Coronaries (MAGIC) trial

Cooper, Howard A.; Domanski, Michael J.; Rosenberg, Yves; Norman, James; Scott, Judith H.; Assmann, Susan F.; McKinlay, Sonja M.; Hochman, Judith S.; Antman, Elliott M.; the MAGIC Trial Investigators,

doi:10.1016/j.ahj.2004.02.017

« Previous Next »American Heart Journal
Volume 148, Issue 6 , Pages 1012-1019, December 2004

Acute ST-segment elevation myocardial infarction and prior stroke: An analysis from the Magnesium in Coronaries (MAGIC) trial☆

Howard A. Cooper, MD
- Washington Hospital Center, Washington, DC, USA
- Reprint requests: Howard A. Cooper, MD, Washington Hospital Center, 110 Irving Street NW, Suite NA1103, Washington, DC 20010, USA
Michael J. Domanski, MD
- National Heart, Lung, and Blood Institute, Bethesda, Md, USA
Yves Rosenberg, MD, MPH
- National Heart, Lung, and Blood Institute, Bethesda, Md, USA
James Norman, PhD
- National Heart, Lung, and Blood Institute, Bethesda, Md, USA
Judith H. Scott, RN, MPH
- New England Research Institutes, Watertown, Mass, USA
Susan F. Assmann, PhD
- New England Research Institutes, Watertown, Mass, USA
Sonja M. McKinlay, PhD
- New England Research Institutes, Watertown, Mass, USA
Judith S. Hochman, MD
- New York University Medical Center, New York, NY, USA
Elliott M. Antman, MD
- Brigham and Women's Hospital, Boston, Mass, USA
the MAGIC Trial Investigators

Received 31 October 2003; accepted 25 February 2004.

Abstract

Background

Patients with prior stroke represent a substantial proportion of patients presenting with acute ST-segment elevation myocardial infarction (STEMI). However, the impact of prior stroke on prognosis has not been rigorously examined in the reperfusion era.

Methods

The baseline characteristics, treatments, and clinical outcomes of patients with prior stroke enrolled in the Magnesium in Coronaries (MAGIC) trial were evaluated and compared to those of patients without prior stroke.

Results

MAGIC enrolled 6213 patients with STEMI, of whom 558 (9.0%) had prior stroke. Patients with prior stroke were more likely to have a history of hypertension (88.0% vs 70.3%), diabetes (19.9% vs 14.5%), myocardial infarction (38.2% vs 25.1%), and congestive heart failure (15.6% vs 9.7%). The mean Thrombolysis in Myocardial Infarction Risk Score was higher in patients with prior stroke compared to those without prior stroke (4.37 vs 3.93, P < .0001). Patients with prior stroke were less likely to receive reperfusion therapy, even among those considered eligible at presentation (66.3% vs 80.6%, P < .0001). Compared to patients without prior stroke, inhospital stroke (3.0% vs 1.0%, P < .0001), severe congestive heart failure (23.3% vs 18.2%, P = .003), and 30-day mortality (21.0% vs 14.7%, P < .0001) were higher among patients with prior stroke. On multivariable analysis, prior stroke was independently associated with a significantly higher risk of death at 30 days (odds ratio 1.44, P = .0023).

Conclusions

Patients with prior stroke who present with STEMI are at very high risk for short-term morbidity and mortality. Aggressive treatment of these patients appears warranted.