Incidence and Outcomes of Cardiocerebral Infarction: A Cohort Study of 2 National Population-Based Registries

Jamie Sin-Ying Ho; Huili Zheng; Benjamin Yong-Qiang Tan; Andrew Fu-Wah Ho; David Foo; Ling-Li Foo; Patrick Zhan-Yun Lim; Boon Wah Liew; Aftab Ahmad; Bernard P L Chan; Hui Meng Chang; Keng He Kong; Sherry H Young; Kok Foo Tang; Terrance Chua; Derek J Hausenloy; Tiong-Cheng Yeo; Huay-Cheem Tan; James W L Yip; Ping Chai; Narayanaswamy Venketasubramanian; Mark Yan-Yee Chan; Leonard Leong-Litt Yeo; Ching-Hui Sia

doi:10.1161/STROKEAHA.123.044530

Incidence and Outcomes of Cardiocerebral Infarction: A Cohort Study of 2 National Population-Based Registries

Stroke. 2024 Sep;55(9):2221-2230. doi: 10.1161/STROKEAHA.123.044530. Epub 2024 Jul 31.

Authors

Jamie Sin-Ying Ho¹, Huili Zheng², Benjamin Yong-Qiang Tan^{3

4}, Andrew Fu-Wah Ho^{5

6}, David Foo⁷, Ling-Li Foo⁸, Patrick Zhan-Yun Lim⁹, Boon Wah Liew¹⁰, Aftab Ahmad¹¹, Bernard P L Chan⁴, Hui Meng Chang¹², Keng He Kong¹³, Sherry H Young¹⁴, Kok Foo Tang¹⁵, Terrance Chua¹⁶, Derek J Hausenloy^{3

17

18

19}, Tiong-Cheng Yeo^{1

3}, Huay-Cheem Tan^{1

3}, James W L Yip^{1

3}, Ping Chai^{1

3}, Narayanaswamy Venketasubramanian²⁰, Mark Yan-Yee Chan^{1

3}, Leonard Leong-Litt Yeo^{3

4}, Ching-Hui Sia^{1

3}

Affiliations

¹ Department of Cardiology, National University Heart Centre Singapore (J.S.-Y.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., C.-H.S.).
² Clinical Research Unit, Khoo Teck Puat Hospital, Singapore (H.Z.).
³ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore (B.Y.-Q.T., D.J.H., T.-C.Y., H.-C.T., J.W.L.Y., P.C., M.Y.-Y.C., L.L.-L.Y., C.-H.S.).
⁴ Division of Neurology, Department of Medicine (B.Y.-Q.T., B.P.L.C., L.L.-L.Y.), National University Health System, Singapore.
⁵ Department of Emergency Medicine, Singapore General Hospital (A.F.-W.H.).
⁶ Pre-Hospital and Emergency Research Centre (A.F.-W.H.), Duke-National University of Singapore Medical School.
⁷ Tan Tock Seng Hospital, Singapore (D.F.).
⁸ Health Promotion Board, National Registry of Diseases Office, Singapore (L.-L.F.).
⁹ Department of Cardiology, Khoo Teck Puat Hospital, Singapore (P.Z.-Y.L.).
¹⁰ Department of Cardiology, Changi General Hospital, Singapore (B.W.L.).
¹¹ Department of Neurology, Ng Teng Fong General Hospital (A.A.), National University Health System, Singapore.
¹² Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute (H.M.C.).
¹³ Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, Singapore (K.H.K.).
¹⁴ Department of Rehabilitation Medicine, Changi General Hospital, Singapore (S.H.Y.).
¹⁵ Tang Neurology and Medical Clinic, Mount Elizabeth Medical Centre, Singapore (K.F.T.).
¹⁶ Department of Cardiology (T.C.), National Heart Centre Singapore.
¹⁷ Cardiovascular and Metabolic Disorders Program (D.J.H.), Duke-National University of Singapore Medical School.
¹⁸ National Heart Research Institute Singapore (D.J.H.), National Heart Centre Singapore.
¹⁹ The Hatter Cardiovascular Institute, University College London, United Kingdom (D.J.H.).
²⁰ Raffles Neuroscience Centre, Raffles Hospital, Singapore (N.V.).

PMID: 39082144
DOI: 10.1161/STROKEAHA.123.044530

Abstract

Background: Cardiocerebral infarction (CCI), which is concomitant with acute myocardial infarction (AMI) and acute ischemic stroke (AIS), is a rare but severe presentation. However, there are few data on CCI, and the treatment options are uncertain. We investigated the characteristics and outcomes of CCI compared with AMI or AIS alone.

Methods: We performed a retrospective cohort study of 120 531 patients with AMI and AIS from the national stroke and AMI registries in Singapore. Patients were categorized into AMI only, AIS only, synchronous CCI (same-day), and metachronous CCI (within 1 week). The primary outcome was all-cause mortality, and the secondary outcome was cardiovascular mortality. The mortality risks were compared using Cox regression. Multivariable models were adjusted for baseline demographics, clinical variables, and treatment for AMI or AIS.

Results: Of 127 919 patients identified, 120 531 (94.2%) were included; 74 219 (61.6%) patients had AMI only, 44 721 (37.1%) had AIS only, 625 (0.5%) had synchronous CCI, and 966 (0.8%) had metachronous CCI. The mean age was 67.7 (SD, 14.0) years. Synchronous and metachronous CCI had a higher risk of 30-day mortality (synchronous: adjusted HR [aHR], 2.41 [95% CI, 1.77-3.28]; metachronous: aHR, 2.80 [95% CI, 2.11-3.73]) than AMI only and AIS only (synchronous: aHR, 2.90 [95% CI, 1.87-4.51]; metachronous: aHR, 4.36 [95% CI, 3.03-6.27]). The risk of cardiovascular mortality was higher in synchronous and metachronous CCI than AMI (synchronous: aHR, 3.03 [95% CI, 2.15-4.28]; metachronous: aHR, 3.41 [95% CI, 2.50-4.65]) or AIS only (synchronous: aHR, 2.58 [95% CI, 1.52-4.36]; metachronous: aHR, 4.52 [95% CI, 2.95-6.92]). In synchronous CCI, AMI was less likely to be managed with PCI and secondary prevention medications (P<0.001) compared with AMI only.

Conclusions: Synchronous CCI occurred in 1 in 200 cases of AIS and AMI. Synchronous and metachronous CCI had higher mortality than AMI or AIS alone.

Keywords: Singapore; demography; myocardial infarction; percutaneous coronary intervention; stroke.

MeSH terms

Aged
Aged, 80 and over
Cohort Studies
Female
Humans
Incidence
Ischemic Stroke / epidemiology
Ischemic Stroke / mortality
Ischemic Stroke / therapy
Male
Middle Aged
Myocardial Infarction* / epidemiology
Myocardial Infarction* / mortality
Registries*
Retrospective Studies
Singapore / epidemiology