Stroke after acute myocardial infarction: Relation to infarct size

Abstract

In a consecutive series of 783 patients with acute myocardial infarction, 13 (17%) 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 1160IU/1, 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/1 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. © 1978, British Medical Journal Publishing Group. All rights reserved.