Thompson P L, Robinson J S
Br Med J. 1978 Aug 12;2(6135):457-9. doi: 10.1136/bmj.2.6135.457.
In a consecutive series of 783 patients with acute myocardial infarction, 13 (1.7%) suffered a stroke. In all but one case the strokes occurred among the 255 patients whose peak creatine kinase (CK) concentrations fell in the upper third of the range of values (over 1160 IU/l, about eight times the upper limit of normal); the exception was a patient with a pre-existing ventricular aneurysm. The incidence of stroke in the patients with CK over 1160 IU/l was 4.7%, 24 times the incidence when peak CK was below this value (0.2%). Higher peak serum enzyme concentrations were associated with an even higher incidence of stroke. Comparison of peak enzyme concentrations with cumulated CK showed a close correlation (r = 0.90 with peak CK; r = 0.85 with peak aspartate transaminase), suggesting that the peak enzyme values reflected infarct size. Thus the risk of stroke after infarction was a function of the size of the myocardial infarct; two-thirds of the patients had negligible risk of stroke and did not need anticoagulant prophylaxis.
在连续的783例急性心肌梗死患者中，13例（1.7%）发生了卒中。除1例患者外，其余所有卒中均发生在255例患者中，这些患者的肌酸激酶（CK）峰值浓度处于数值范围的上三分之一（超过1160 IU/L，约为正常上限的8倍）；例外的是1例既往有室壁瘤的患者。CK超过1160 IU/L的患者卒中发生率为4.7%，是CK峰值低于此值时（0.2%）发生率的24倍。更高的血清酶峰值浓度与更高的卒中发生率相关。将酶峰值浓度与累积CK进行比较显示出密切相关性（与CK峰值的r = 0.90；与天冬氨酸转氨酶峰值的r = 0.85），这表明酶峰值反映了梗死面积。因此，梗死后卒中的风险是心肌梗死面积的函数；三分之二的患者发生卒中的风险可忽略不计，无需进行抗凝预防。
