Article Data

  • Views 868
  • Dowloads 116

Original Research

Open Access

Risk factors for acute myocardial infarction in patients with acute cerebral infarction: a case-control study

  • Junjie Lei1
  • Yan Liang1
  • Yanfang Peng1
  • Lei Zhang1,*,

1Department of Cerebrovascular Diseases, The Fifth Affiliated Hospital of Sun Yat-sen University, 519000 Zhuhai, Guangdong, China

DOI: 10.22514/sv.2024.067 Vol.20,Issue 6,June 2024 pp.18-24

Submitted: 03 July 2023 Accepted: 18 September 2023

Published: 08 June 2024

*Corresponding Author(s): Lei Zhang E-mail:


This retrospective case-control study examined factors associated with in-hospital acute myocardial infarction (AMI) in patients hospitalized for acute cerebral infarction (ACI). In-patients with AMI following ACI (n = 33) and age- and sex-matched controls who had ACI without AMI (n = 66) were recruited in a 1:2 ratio, and their data were assessed. The results showed that the group of patients experiencing AMI after ACI exhibited a significantly higher prevalence of ischemic heart disease (p = 0.036) and heart failure (p < 0.001), had elevated fibrinogen levels (p = 0.029), presented with higher National Institutes of Health Stroke Scale (NIHSS) scores at admission (p < 0.001) and a lower proportion of them underwent thrombolytic therapy (p = 0.004) compared to the ACI-only group. The mortality rate was substantially higher in the AMI after ACI group than in the ACI-only group (18.2% vs. 1.5%, p = 0.008). Multivariable logistic regression analysis identified that higher NIHSS scores at admission (odds ratio, OR = 1.21, 95% confidence interval, CI = 1.16–1.39, p = 0.004), elevated high-sensitivity C-reactive protein (hs-CRP) levels (OR = 1.07, 95% CI = 1.001–1.14, p = 0.047) and the administration of thrombolytic therapy (OR = 0.02, 95% CI = 0.001–0.48, p = 0.015) were independently associated with AMI following ACI. In conclusion, NIHSS scores at admission, hs-CRP levels and thrombolytic therapy were found to be independent factors associated with in-hospital AMI following ACI.


Risk factor; Acute myocardial infarction; Acute cerebral infarction; Heart failure; Mortality

Cite and Share

Junjie Lei,Yan Liang,Yanfang Peng,Lei Zhang. Risk factors for acute myocardial infarction in patients with acute cerebral infarction: a case-control study. SignaVitae. 2024. 20(6);18-24.


[1] Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, et al. Heart disease and stroke statistics—2023 update: a report from the American Heart Association. Circulation. 2023; 147: e93–e621.

[2] Jing M, Bao LXY, Seet RCS. Estimated incidence and mortality of stroke in China. JAMA Network Open. 2023; 6: e231468.

[3] Robbins BT, Howington GT, Swafford K, Zummer J, Woolum JA. Advancements in the management of acute ischemic stroke: a narrative review. Journal of the American College of Emergency Physicians Open. 2023; 4: e12896.

[4] Giménez-Muñoz A, Ara JR, Abad Díez JM, Campello Morer I, Pérez Trullén JM. Trends in stroke hospitalisation rates and in-hospital mortality in Aragon, 1998–2010. Neurología. 2018; 33: 224–232.

[5] Wei Z, Yang J, Qian H, Yang Y. Impact of marital status on management and outcomes of patients with acute myocardial infarction: insights from the China acute myocardial infarction registry. Journal of the American Heart Association. 2022; 11: e025671.

[6] Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). Circulation. 2018; 138: e618–6e51.

[7] de Araujo ALV, Santos RD, Bittencourt MS, Dantas RN, Jr., Oshiro CA, Nomura CH, et al. Ischemic stroke caused by large-artery atherosclerosis: a red flag for subclinical coronary artery disease. Frontiers in Neurology. 2023; 14: 1082275.

[8] Boulanger M, Béjot Y, Rothwell PM, Touzé E. Long‐term risk of myocardial infarction compared to recurrent stroke after transient ischemic attack and ischemic stroke: systematic review and meta-analysis. Journal of the American Heart Association. 2018; 7: e007267.

[9] Méloux A, Béjot Y, Rochette L, Cottin Y, Vergely C. Brain-heart interactions during ischemic processes. Stroke. 2020; 51: 679–686.

[10] Alqahtani F, Aljohani S, Tarabishy A, Busu T, Adcock A, Alkhouli M. Incidence and outcomes of myocardial infarction in patients admitted with acute ischemic stroke. Stroke. 2017; 48: 2931–2938.

[11] Micheli S, Agnelli G, Caso V, Alberti A, Palmerini F, Venti M, et al. Acute myocardial infarction and heart failure in acute stroke patients: frequency and influence on clinical outcome. Journal of Neurology. 2012; 259: 106–110.

[12] Powers WJ, Rabinstein AA, Ackerson T, Adevoe OM, Bambakidis NC, Becker K. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Journal of Vascular Surgery. 2018; 67: 1934.

[13] Adams HP, Davis PH, Leira EC, Chang KC, Bendixen BH, Clarke WR, et al. Baseline NIH stroke scale score strongly predicts outcome after stroke: a report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology. 1999; 53: 126–131.

[14] Wang H, cheng Y, Chen S, Li X, Zhu Z, Zhang W. Impact of elevated hemoglobin a1c levels on functional outcome in patients with acute ischemic stroke. Journal of Stroke and Cerebrovascular Diseases. 2019; 28: 470–476.

[15] Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993; 24: 35–41.

[16] Zou L, Han R. Inflammatory response and immune regulation in brain-heart interaction after stroke. Cardiovascular Therapeutics. 2022; 2022: 2406122.

[17] Wang X, Lin Y, Wang F. Development of a risk score model for the prediction of patients needing percutaneous coronary intervention. Journal of Clinical Laboratory Analysis. 2023; 37: e24849.

[18] Suzuki T, Kataoka Y, Shiozawa M, Morris K, Kiyoshige E, Nishimura K, et al. Heart-brain team approach of acute myocardial infarction complicating acute stroke: characteristics of guideline-recommended coronary revascularization and antithrombotic therapy and cardiovascular and bleeding outcomes. Journal of the American Heart Association. 2023; 12: e027156.

[19] Scheitz JF, Mochmann H, Nolte CH, Haeusler KG, Audebert HJ, Heuschmann PU, et al. Troponin elevation in acute ischemic stroke (TRELAS)—protocol of a prospective observational trial. BMC Neurology. 2011; 11: 98.

[20] Lian H, Xu X, Shen X, Chen J, Mao D, Zhao Y, et al. Early prediction of cerebral-cardiac syndrome after ischemic stroke: the PANSCAN scale. BMC Neurology. 2020; 20: 272.

[21] Pana TA, Wood AD, Mamas MA, Clark AB, Bettencourt‐Silva JH, McLernon DJ, et al. Myocardial infarction after acute ischaemic stroke: incidence, mortality and risk factors. Acta Neurologica Scandinavica. 2019; 140: 219–228.

[22] Liao J, O’Donnell MJ, Silver FL, Thiruchelvam D, Saposnik G, Fang J, et al. In‐hospital myocardial infarction following acute ischaemic stroke: an observational study. European Journal of Neurology. 2009; 16: 1035–1040.

[23] Bao Q, Zhang J, Wu X, Zhao K, Guo Y, Yang M, et al. Clinical significance of plasma D-Dimer and fibrinogen in outcomes after stroke: a systematic review and meta-analysis. Cerebrovascular Diseases. 2023; 52: 318–343.

[24] Yaghi S. Diagnosis and management of cardioembolic stroke. CONTINUUM: Lifelong Learning in Neurology. 2023; 29: 462–485.

[25] Rao SS, Agasthi P. Thrombolysis in myocardial infarction risk score. StatPearls publishing: Treasure Island (FL). 2023.

[26] Kaptoge S, Di Angelantonio E, Lowe G, Pepys MB, Thompson SG, Collins R, et al. C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. The Lancet. 2010; 375: 132–140.

[27] Buckley DI, Fu R, Freeman M, Rogers K, Helfand M. C-reactive protein as a risk factor for coronary heart disease: a systematic review and meta-analyses for the U.S. Preventive services task force. Annals of Internal Medicine. 2009; 151: 483–495.

[28] Polyakova EA, Mikhaylov EN. The prognostic role of high-sensitivity C-reactive protein in patients with acute myocardial infarction. Journal of Geriatric Cardiology. 2020; 17: 379–383.

[29] Lin XL, Sun HX, Li FQ, Zhao JY, Zhao DH, Liu JH, et al. Admission high‐sensitivity C‐reactive protein levels improve the Grace risk score prediction on in‐hospital outcomes in acute myocardial infarction patients. Clinical Cardiology. 2022; 45: 282–290.

[30] Kaura A, Hartley A, Panoulas V, Glampson B, Shah ASV, Davies J, et al. Mortality risk prediction of high-sensitivity C-reactive protein in suspected acute coronary syndrome: a cohort study. PLOS Medicine. 2022; 19: e1003911.

[31] Alkarithi G, Duval C, Shi Y, Macrae FL, Ariëns RAS. Thrombus structural composition in cardiovascular disease. Arteriosclerosis, Thrombosis, and Vascular Biology. 2021; 41: 2370–2383.

[32] Gerhardt T, Haghikia A, Stapmanns P, Leistner DM. Immune mechanisms of plaque instability. Frontiers in Cardiovascular Medicine. 2021; 8: 797046.

[33] Narvaez Linares NF, Munelith-Souksanh K, Tanguay AFN, Plamondon H. The impact of myocardial infarction on basal and stress-induced heart rate variability and cortisol secretion in women: a pilot study. Comprehensive Psychoneuroendocrinology. 2022; 9: 100113.

[34] Nesci A, Carnuccio C, Ruggieri V, D’Alessandro A, Di Giorgio A, Santoro L, et al. Gut microbiota and cardiovascular disease: evidence on the metabolic and inflammatory background of a complex relationship. International Journal of Molecular Sciences. 2023; 24: 9087.

[35] Feng Q, Li Q, Zhou H, Sun L, Lin C, Jin Y, et al. The role of major immune cells in myocardial infarction. Frontiers in Immunology. 2022; 13: 1084460.

[36] Cartlidge T, Kovacevic M, Navarese EP, Werner G, Kunadian V. Role of percutaneous coronary intervention in the modern-day management of chronic coronary syndrome. Heart. 2023; 109: 1429–1435.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time