@article{8779d5519b71477f9cc98ce661f4a6ec,
title = "Recent Myocardial Infarction is Associated With Increased Risk in Older Adults With Acute Ischemic Stroke Receiving Thrombolytic Therapy",
abstract = "Background: Intravenous recombinant tissue-type plasminogen activator (rtPA) remains the only medical therapy to improve outcomes for acute ischemic stroke (AIS), but the safety of rtPA in AIS patients with a history of recent myocardial infarction (MI) remains controversial. Methods and Results: We sought to determine whether the presence of recent MI would alter the risk of mortality and rtPA-related complications. Multivariate logistic regression models were used to compare in-hospital outcomes between rtPA-treated AIS patients with recent MI within 3 months and those with no history of MI from the Get With The Guidelines-Stroke hospitals between February 2009 and December 2015. Among 40 396 AIS patients aged ≥65 years treated with rtPA, 241 (0.6%) had recent MI, of which 19.5% were ST-segment–elevation myocardial infarction. Patients with recent MI had more severe stroke than those without (median National Institutes of Health Stroke Scale [interquartile range]: 13.0 [7.0–20.0] versus 11.0 [6.0–18.0]). Recent MI was associated with an increased risk of mortality compared with no history of MI (17.4% versus 9.0%; adjusted odds ratio 1.60 [95% CI, 1.10–2.33]; P=0.014), but no statistically significant differences in rtPA-related complications (13.5% versus 9.4%; adjusted odds ratio 1.28 [0.88–1.86]; P=0.19). Recent ST-segment–elevation myocardial infarction was associated with higher risk of death and rtPA-related complications, but non–ST-segment–elevation myocardial infarction was not. Conclusions: Among older AIS patients treated with rtPA, recent MI was associated with an increased risk of in-hospital mortality. Further investigations are necessary to determine whether the benefit of rtPA outweighs its risk among AIS patients with recent MI.",
keywords = "contraindication, eligibility criteria, recombinant tissue plasminogen activator, stroke, thrombolysis",
author = "Taku Inohara and Li Liang and Kosinski, {Andrzej S.} and Smith, {Eric E.} and Schwamm, {Lee H.} and Hernandez, {Adrian F.} and Bhatt, {Deepak L.} and Fonarow, {Gregg C.} and Peterson, {Eric D.} and Ying Xian",
note = "Funding Information: The Get With The Guidelines‐Stroke (GWTG‐Stroke) program is provided by the American Heart Association/American Stroke Association (AHA/ASA). This study was supported, in part, by grants from the American Heart Association (AHA 13CRP14410024 and 14SDG20460081) awarded to Dr. Xian. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Funding Information: Dr Inohara receives research grants: JSPS (Japan Society for the Promotion of Science) Overseas Research fellowship and Boston Scientific. Dr Smith is a member of the GWTG Steering Committee and serving on a Data Safety and Monitoring Board for Massachusetts General Hospital. Dr Schwamm is a Chair, GWTG‐Stroke Clinical Workgroup. Dr Hernandez receives research grants: Amgen, Bristol‐Myers Squibb, GlaxoSmithKline, Janssen, Novartis, and Portola Pharmaceuticals. Honoraria: Amgen, GlaxoSmithKline Janssen, Novartis, and Boehringer Ingelheim. Dr Bhatt reports the following financial disclosures: Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, PhaseBio, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial, funded by Edwards), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo), Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice‐Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE‐DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Medtelligence/ReachMD (CME steering committees), Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and US national co‐leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR‐ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol‐Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi Aventis, Synaptic, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald's Heart Disease); Site Co‐Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott), Svelte; Trustee: American College of Cardiology; Unfunded Research: FlowCo, Fractyl, Merck, Novo Nordisk, PLx Pharma, Takeda. Dr Fonarow is a member of GWTG Steering Committee; Grant funding from Patient Centered Outcome Research Institute; Employee of the University of California which has a patent on an endovascular therapy device, Consultant: Janssen. Dr Peterson receives research grants: Janssen, Genetech, AHA Get With The Guidelines (GWTG)‐Stroke Analytic. Consultant/Advisory Board: Janssen, Boehringer Ingelhiem, Sanofi, Bayer, Merck, Astra Zeneca, Signal Path, and Venable. Xian receives research grants: Genentech, Janssen, and Daiichi Sankyo. The remaining authors have no disclosures to report. Publisher Copyright: {\textcopyright} 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.",
year = "2019",
month = aug,
day = "6",
doi = "10.1161/JAHA.119.012450",
language = "English (US)",
volume = "8",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "15",
}