Bodenheimer M M, Sauer D, Shareef B, Brown M W, Fleiss J L, Moss A J
Harris Chasanoff Heart Institute, Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York 11042.
J Am Coll Cardiol. 1994 Jul;24(1):61-6. doi: 10.1016/0735-1097(94)90542-8.
We sought to compare the likelihood of stroke in patients with anterior versus nonanterior myocardial infarction.
The association between anterior infarction and left ventricular thrombus has led to the assumption that embolization from thrombi is an important cause of stroke in patients with anterior infarction. We hypothesized that if anterior infarction is a cause of left ventricular thrombi, the number of strokes should be disproportionately higher in patients with anterior than nonanterior infarction.
We performed a retrospective analysis of 2,466 patients randomized from day 3 to day 15 after infarction as part of a multicenter placebo-controlled study of diltiazem to prevent cardiac death or myocardial infarction. Any acute focal cerebral disorder resulting in localizing findings characterized as a stroke or transient ischemic attack was considered an event.
Of 91 events during a follow-up period of 12 to 52 months, 23 (3.2%) occurred in 724 patients with an anterior and 68 (3.9%) in 1,742 patients with a nonanterior myocardial infarction (relative risk 0.81; 95% confidence interval 0.51 to 1.30). Power analysis revealed that the negativity of the study was not the result of inadequate sample size. Life table analysis showed no difference in cumulative event rate (p = 0.42) according to site of infarction. Cox regression analysis showed that of 10 clinical covariates, only systolic blood pressure was predictive of stroke (p < 0.001). The use of warfarin did not contribute to the model. Finally, the addition of site of infarction (anterior vs. nonanterior) did not contribute significantly to the Cox model.
Although there is a significant incidence of stroke after acute myocardial infarction, there is no relation between the occurrence of stroke and site of infarction. These data do not support the presumed causal relation between anterior myocardial infarction, thrombus and stroke.
我们试图比较前壁心肌梗死与非前壁心肌梗死患者发生卒中的可能性。
前壁梗死与左心室血栓之间的关联导致人们认为，血栓栓塞是前壁梗死患者发生卒中的重要原因。我们推测，如果前壁梗死是左心室血栓形成的原因，那么前壁梗死患者的卒中发生率应不成比例地高于非前壁梗死患者。
作为一项地尔硫䓬预防心源性死亡或心肌梗死的多中心安慰剂对照研究的一部分，我们对2466例梗死3至15天后随机分组的患者进行了回顾性分析。任何导致具有卒中或短暂性脑缺血发作定位表现的急性局灶性脑部疾病均被视为事件。
在12至52个月的随访期内发生的91例事件中，724例前壁心肌梗死患者中有23例（3.2%）发生，1742例非前壁心肌梗死患者中有68例（3.9%）发生（相对风险0.81；95%置信区间0.51至1.30）。效能分析显示，研究结果为阴性并非样本量不足所致。生命表分析显示，根据梗死部位，累积事件发生率无差异（p = 0.42）。Cox回归分析显示，在10项临床协变量中，只有收缩压可预测卒中（p < 0.001）。华法林的使用对模型无贡献。最后，梗死部位（前壁与非前壁）的加入对Cox模型无显著贡献。
尽管急性心肌梗死后卒中发生率较高，但卒中的发生与梗死部位无关。这些数据不支持前壁心肌梗死、血栓与卒中之间假定的因果关系。
