Download PDF
Semin Neurol 2021; 41(04): 331-339
DOI: 10.1055/s-0041-1726333
Review Article

Acute Ischemic Stroke Associated with Myocardial Infarction: Challenges and Management

Anusha Boyanpally 
1   Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
,
Shawna Cutting
1   Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
2   The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, Rhode Island
,
Karen Furie
1   Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
2   The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, Rhode Island
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) may co-occur simultaneously or in close temporal succession, with occurrence of one ischemic vascular event increasing a patient's risk for the other. Both employ time-sensitive treatments, and both benefit from expert consultation. Patients are at increased risk of stroke for up to 3 months following AMI, and aggressive treatment of AMI, including use of reperfusion therapy, decreases the risk of AIS. For patients presenting with AIS in the setting of a recent MI, treatment with alteplase, an intravenous tissue plasminogen activator, can be given, provided anterior wall myocardial involvement has been carefully evaluated. It is important for clinicians to recognize that troponin elevations can occur in the setting of AIS as well as other clinical scenarios and that this may have implications for short- and long-term mortality.

Keywords

ischemic stroke - acute myocardial infarction - thrombolytic therapy - cerebral infarction - tissue plasminogen activator - percutaneous coronary intervention


Publication History

Article published online:
13 April 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Brammås A, Jakobsson S, Ulvenstam A, Mooe T. Mortality after ischemic stroke in patients with acute myocardial infarction: predictors and trends over time in Sweden. Stroke 2013; 44 (11) 3050-3055
    CrossrefPubMedGoogle Scholar
  • 2 Witt BJ, Ballman KV, Brown Jr RD, Meverden RA, Jacobsen SJ, Roger VL. The incidence of stroke after myocardial infarction: a meta-analysis. Am J Med 2006; 119 (04) 354.e1-354.e9
    CrossrefPubMedGoogle Scholar
  • 3 Chin PL, Kaminski J, Rout M. Myocardial infarction coincident with cerebrovascular accidents in the elderly. Age Ageing 1977; 6 (01) 29-37
    CrossrefPubMedGoogle Scholar
  • 4 Thompson PL, Robinson JS. Stroke after acute myocardial infarction: relation to infarct size. BMJ 1978; 2 (6135): 457-459
    CrossrefPubMedGoogle Scholar
  • 5 Omar HR, Fathy A, Rashad R, Helal E. Concomitant acute right ventricular infarction and ischemic cerebrovascular stroke; possible explanations. Int Arch Med 2010; 3: 25
    CrossrefPubMedGoogle Scholar
  • 6 Kijpaisalratana N, Chutinet A, Suwanwela NC. Hyperacute simultaneous cardiocerebral infarction: Rescuing the brain or the heart first?. Front Neurol 2017; 8: 664
    CrossrefPubMedGoogle Scholar
  • 7 Adams Jr HP, Bendixen BH, Kappelle LJ. et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24 (01) 35-41
    CrossrefPubMedGoogle Scholar
  • 8 Ay H, Furie KL, Singhal A, Smith WS, Sorensen AG, Koroshetz WJ. An evidence-based causative classification system for acute ischemic stroke. Ann Neurol 2005; 58 (05) 688-697
    CrossrefPubMedGoogle Scholar
  • 9 Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. New approach to stroke subtyping: the A-S-C-O (phenotypic) classification of stroke. Cerebrovasc Dis 2009; 27 (05) 502-508
    CrossrefPubMedGoogle Scholar
  • 10 Merkler AE, Diaz I, Wu X. et al. Duration of heightened ischemic stroke risk after acute myocardial infarction. J Am Heart Assoc 2018; 7 (22) e010782
    CrossrefPubMedGoogle Scholar
  • 11 Powers WJ, Rabinstein AA, Ackerson T. et al; American Heart Association Stroke Council. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49 (03) e46-e110
    CrossrefPubMedGoogle Scholar
  • 12 Maggioni AP, Franzosi MG, Santoro E, White H, Van de Werf F, Tognoni G. The risk of stroke in patients with acute myocardial infarction after thrombolytic and antithrombotic treatment. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico II (GISSI-2), and The International Study Group. N Engl J Med 1992; 327 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 13 Behar S, Tanne D, Abinader E. et al; The SPRINT Study Group. Cerebrovascular accident complicating acute myocardial infarction: incidence, clinical significance and short- and long-term mortality rates. Am J Med 1991; 91 (01) 45-50
    CrossrefPubMedGoogle Scholar
  • 14 Ulvenstam A, Kajermo U, Modica A, Jernberg T, Söderström L, Mooe T. Incidence, trends, and predictors of ischemic stroke 1 year after an acute myocardial infarction. Stroke 2014; 45 (11) 3263-3268
    CrossrefPubMedGoogle Scholar
  • 15 Loh E, Sutton MS, Wun CC. et al. Ventricular dysfunction and the risk of stroke after myocardial infarction. N Engl J Med 1997; 336 (04) 251-257
    CrossrefPubMedGoogle Scholar
  • 16 Komrad MS, Coffey CE, Coffey KS, McKinnis R, Massey EW, Califf RM. Myocardial infarction and stroke. Neurology 1984; 34 (11) 1403-1409
    CrossrefPubMedGoogle Scholar
  • 17 Kajermo U, Ulvenstam A, Modica A, Jernberg T, Mooe T. Incidence, trends, and predictors of ischemic stroke 30 days after an acute myocardial infarction. Stroke 2014; 45 (05) 1324-1330
    CrossrefPubMedGoogle Scholar
  • 18 Luo J, Li H, Qin X. et al. Increased risk of ischemic stroke associated with new-onset atrial fibrillation complicating acute coronary syndrome: a systematic review and meta-analysis. Int J Cardiol 2018; 265: 125-131
    CrossrefPubMedGoogle Scholar
  • 19 Tanne D, Gottlieb S, Hod H, Reicher-Reiss H, Boyko V, Behar S. Secondary Prevention Reinfarction Israeli Nifedipine Trial (SPRINT) and Israeli Thrombolytic Survey Groups. Incidence and mortality from early stroke associated with acute myocardial infarction in the prethrombolytic and thrombolytic eras. J Am Coll Cardiol 1997; 30 (06) 1484-1490
    CrossrefPubMedGoogle Scholar
  • 20 Longstreth Jr WT, Litwin PE, Weaver WD. The MITI Project Group. Myocardial infarction, thrombolytic therapy, and stroke. A community-based study. Stroke 1993; 24 (04) 587-590
    CrossrefPubMedGoogle Scholar
  • 21 Hariri E, Tisminetzky M, Lessard D, Yarzebski J, Gore J, Goldberg R. Twenty-five-year (1986-2011) trends in the incidence and death rates of stroke complicating acute myocardial infarction. Am J Med 2018; 131 (09) 1086-1094
    CrossrefPubMedGoogle Scholar
  • 22 Binsell-Gerdin E, Graipe A, Ögren J, Jernberg T, Mooe T. Hemorrhagic stroke the first 30 days after an acute myocardial infarction: incidence, time trends and predictors of risk. Int J Cardiol 2014; 176 (01) 133-138
    CrossrefPubMedGoogle Scholar
  • 23 Wasser J, Goldberg RJ, Spencer FA, Yarzebski J, Gore JM. Multidecade-long trends (1986-2005) in the utilization of coronary reperfusion and revascularization treatment strategies in patients hospitalized with acute myocardial infarction: a community-wide perspective. Coron Artery Dis 2009; 20 (01) 71-80
    CrossrefPubMedGoogle Scholar
  • 24 Al Suwaidi J, Al Habib K, Asaad N. et al. Immediate and one-year outcome of patients presenting with acute coronary syndrome complicated by stroke: findings from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2). BMC Cardiovasc Disord 2012; 12: 64
    CrossrefPubMedGoogle Scholar
  • 25 Putaala J, Nieminen T. Stroke risk period after acute myocardial infarction revised. J Am Heart Assoc 2018; 7 (22) e011200
    CrossrefPubMedGoogle Scholar
  • 26 Coles AH, Fisher KA, Darling C. et al. Recent trends in post-discharge mortality among patients with an initial acute myocardial infarction. Am J Cardiol 2012; 110 (08) 1073-1077
    CrossrefPubMedGoogle Scholar
  • 27 Thygesen K, Alpert JS, Jaffe AS. et al; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol 2018; 72 (18) 2231-2264
    CrossrefPubMedGoogle Scholar
  • 28 Jogu HR, Arora S, Vaduganathan M. et al. Wake Forest University long-term follow-up of type 2 myocardial infarction: the Wake-Up T2MI Registry. Clin Cardiol 2019; 42 (06) 592-604
    CrossrefPubMedGoogle Scholar
  • 29 Sandoval Y, Jaffe AS. Type 2 myocardial infarction: JACC review topic of the week. J Am Coll Cardiol 2019; 73 (14) 1846-1860
    CrossrefPubMedGoogle Scholar
  • 30 Ay H, Koroshetz WJ, Benner T. et al. Neuroanatomic correlates of stroke-related myocardial injury. Neurology 2006; 66 (09) 1325-1329
    CrossrefPubMedGoogle Scholar
  • 31 Yaghi S, Chang AD, Ricci BA. et al. Early elevated troponin levels after ischemic stroke suggests a cardioembolic source. Stroke 2018; 49 (01) 121-126
    CrossrefPubMedGoogle Scholar
  • 32 McCarthy CP, Raber I, Chapman AR. et al. Myocardial injury in the era of high-sensitivity cardiac troponin assays: a practical approach for clinicians. JAMA Cardiol 2019; 4 (10) 1034-1042
    CrossrefPubMedGoogle Scholar
  • 33 Mendis S, Thygesen K, Kuulasmaa K. et al; Writing group on behalf of the participating experts of the WHO consultation for revision of WHO definition of myocardial infarction. World Health Organization definition of myocardial infarction: 2008-09 revision. Int J Epidemiol 2011; 40 (01) 139-146
    CrossrefPubMedGoogle Scholar
  • 34 Goetti R, Kozerke S, Donati OF. et al. Acute, subacute, and chronic myocardial infarction: quantitative comparison of 2D and 3D late gadolinium enhancement MR imaging. Radiology 2011; 259 (03) 704-711
    CrossrefPubMedGoogle Scholar
  • 35 Powers WJ, Rabinstein AA, Ackerson T. et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2019; 50 (12) e344-e418
    CrossrefPubMedGoogle Scholar
  • 36 Inohara T, Liang L, Kosinski AS. et al. Recent myocardial infarction is associated with increased risk in older adults with acute ischemic stroke receiving thrombolytic therapy. J Am Heart Assoc 2019; 8 (15) e012450
    CrossrefPubMedGoogle Scholar
  • 37 Mahaffey KW, Granger CB, Sloan MA. et al. Risk factors for in-hospital nonhemorrhagic stroke in patients with acute myocardial infarction treated with thrombolysis: results from GUSTO-I. Circulation 1998; 97 (08) 757-764
    CrossrefPubMedGoogle Scholar
  • 38 Mooe T, Olofsson BO, Stegmayr B, Eriksson P. Ischemic stroke. Impact of a recent myocardial infarction. Stroke 1999; 30 (05) 997-1001
    CrossrefPubMedGoogle Scholar
  • 39 Lichtman JH, Krumholz HM, Wang Y, Radford MJ, Brass LM. Risk and predictors of stroke after myocardial infarction among the elderly: results from the Cooperative Cardiovascular Project. Circulation 2002; 105 (09) 1082-1087
    CrossrefPubMedGoogle Scholar
  • 40 Manea MM, Dragoş D, Stoica E, Bucşa A, Marinică I, Tuţă S. Early ST-segment elevation acute myocardial infarction after thrombolytic therapy for acute ischemic stroke: a case report. Medicine (Baltimore) 2018; 97 (50) e13347
    CrossrefPubMedGoogle Scholar
  • 41 Yeo LLL, Andersson T, Yee KW. et al. Synchronous cardiocerebral infarction in the era of endovascular therapy: which to treat first?. J Thromb Thrombolysis 2017; 44 (01) 104-111
    CrossrefPubMedGoogle Scholar
  • 42 Diener HC, Easton JD, Granger CB. et al; RE-SPECT ESUS Investigators. Design of Randomized, double-blind, Evaluation in secondary Stroke Prevention comparing the EfficaCy and safety of the oral Thrombin inhibitor dabigatran etexilate vs. acetylsalicylic acid in patients with Embolic Stroke of Undetermined Source (RE-SPECT ESUS). Int J Stroke 2015; 10 (08) 1309-1312
    CrossrefPubMedGoogle Scholar
  • 43 Kamel H, Longstreth Jr WT, Tirschwell DL. et al. The AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke randomized trial: rationale and methods. Int J Stroke 2019; 14 (02) 207-214
    CrossrefPubMedGoogle Scholar
  • 44 Delewi R, Zijlstra F, Piek JJ. Left ventricular thrombus formation after acute myocardial infarction. Heart 2012; 98 (23) 1743-1749
    CrossrefPubMedGoogle Scholar
  • 45 Lamas GA, Vaughan DE, Pfeffer MA. Left ventricular thrombus formation after first anterior wall acute myocardial infarction. Am J Cardiol 1988; 62 (01) 31-35
    CrossrefPubMedGoogle Scholar
  • 46 Kamel H, Bartz TM, Elkind MSV. et al. Atrial cardiopathy and the risk of ischemic stroke in the CHS (Cardiovascular Health Study). Stroke 2018; 49 (04) 980-986
    CrossrefPubMedGoogle Scholar
  • 47 Chapman AR, Shah ASV, Lee KK. et al. Long-term outcomes in patients with type 2 myocardial infarction and myocardial injury. Circulation 2018; 137 (12) 1236-1245
    CrossrefPubMedGoogle Scholar
  • 48 Poçi D, Hartford M, Karlsson T, Herlitz J, Edvardsson N, Caidahl K. Role of the CHADS2 score in acute coronary syndromes: risk of subsequent death or stroke in patients with and without atrial fibrillation. Chest 2012; 141 (06) 1431-1440
    CrossrefPubMedGoogle Scholar
  • 49 Barra S, Almeida I, Caetano F. et al. Stroke prediction with an adjusted R-CHA2DS2VASc score in a cohort of patients with a myocardial infarction. Thromb Res 2013; 132 (02) 293-299
    CrossrefPubMedGoogle Scholar
  • 50 Mannino M, Asciutto S, Terruso V, Gammino M, Cellura MG, Monaco S. Myocardial infarction following intravenous thrombolysis for acute ischemic stroke: case report and literature review. J Stroke Cerebrovasc Dis 2017; 26 (06) e105-e107
    CrossrefPubMedGoogle Scholar
  • 51 Hart RG, Diener HC, Coutts SB. et al; Cryptogenic Stroke/ESUS International Working Group. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol 2014; 13 (04) 429-438
    CrossrefPubMedGoogle Scholar
  • 52 Josephson SA, Hills NK, Johnston SC. NIH Stroke Scale reliability in ratings from a large sample of clinicians. Cerebrovasc Dis 2006; 22 (5-6): 389-395
    CrossrefPubMedGoogle Scholar
  • 53 Lyden P, Raman R, Liu L, Emr M, Warren M, Marler J. National Institutes of Health Stroke Scale certification is reliable across multiple venues. Stroke 2009; 40 (07) 2507-2511
    CrossrefPubMedGoogle Scholar
  • 54 Paciaroni M, Agnelli G, Falocci N. et al. Early recurrence and cerebral bleeding in patients with acute ischemic stroke and atrial fibrillation: effect of anticoagulation and its timing: the RAF study. Stroke 2015; 46 (08) 2175-2182
    CrossrefPubMedGoogle Scholar
  • 55 Levine GN, Bates ER, Bittl JA. et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: an update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery. Circulation 2016; 134 (10) e123-e155
    CrossrefPubMedGoogle Scholar
  • 56 Steg PG, Bhatt DL. Viewpoint: a proposal for a simple algorithm for managing oral anticoagulation and antiplatelet therapy in patients with non-valvular atrial fibrillation and coronary stents. Eur Heart J Acute Cardiovasc Care 2017; 6 (01) 93-97
    CrossrefPubMedGoogle Scholar
  • 57 Kirchhof P, Benussi S, Kotecha D. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg 2016; 50 (05) e1-e88
    CrossrefPubMedGoogle Scholar
  • 58 Knijnik L, Rivera M, Blumer V. et al. Prevention of stroke in atrial fibrillation after coronary stenting. Stroke 2019; 50 (08) 2125-2132
    CrossrefPubMedGoogle Scholar
  • 59 Lopes RD, Heizer G, Aronson R. et al; AUGUSTUS Investigators. Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. N Engl J Med 2019; 380 (16) 1509-1524
    CrossrefPubMedGoogle Scholar
  • 60 Anadani M, Orabi MY, Alawieh A. et al. Blood pressure and outcome after mechanical thrombectomy with successful revascularization. Stroke 2019; 50 (09) 2448-2454
    CrossrefPubMedGoogle Scholar
  • 61 Anadani M, Arthur AS, Tsivgoulis G. et al. Blood pressure goals and clinical outcomes after successful endovascular therapy: a multicenter study. Ann Neurol 2020; 87 (06) 830-839
    CrossrefPubMedGoogle Scholar
  • 62 Adams Jr HP, del Zoppo G, Alberts MJ. et al; American Heart Association, American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 2007; 38 (05) 1655-1711
    CrossrefPubMedGoogle Scholar
  • 63 Jauch EC, Saver JL, Adams Jr HP. et al; American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral Vascular Disease, Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44 (03) 870-947
    CrossrefPubMedGoogle Scholar
  • 64 Demaerschalk BM, Kleindorfer DO, Adeoye OM. et al; American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2016; 47 (02) 581-641
    CrossrefPubMedGoogle Scholar
  • 65 European Stroke Organisation (ESO) Executive Committee, ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008; 25 (05) 457-507
    CrossrefPubMedGoogle Scholar
  • 66 Seiffge DJ, Werring DJ, Paciaroni M. et al. Timing of anticoagulation after recent ischaemic stroke in patients with atrial fibrillation. Lancet Neurol 2019; 18 (01) 117-126
    CrossrefPubMedGoogle Scholar
  • 67 O'Gara PT, Kushner FG, Ascheim DD. et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127 (04) e362-e425
    PubMedGoogle Scholar
  • 68 Becker RC, Gore JM, Lambrew C. et al. A composite view of cardiac rupture in the United States National Registry of Myocardial Infarction. J Am Coll Cardiol 1996; 27 (06) 1321-1326
    CrossrefPubMedGoogle Scholar
  • 69 Yang P, Zhang Y, Zhang L. et al; DIRECT-MT Investigators. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. N Engl J Med 2020; 382 (21) 1981-1993
    CrossrefPubMedGoogle Scholar
  • 70 Amsterdam EA, Wenger NK, Brindis RG. et al; ACC/AHA Task Force Members, Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130 (25) 2354-2394
    CrossrefPubMedGoogle Scholar
  • 71 Lee TH, Marcantonio ER, Mangione CM. et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100 (10) 1043-1049
    CrossrefPubMedGoogle Scholar
  • 72 Chevli PA, Jogu HR, Islam T. et al. Abstract 11511: impact of post-discharge angiotensin-converting enzyme inhibitors/angiotensin receptor blockers on mortality in patients with asymptomatic troponin elevation in the perioperative period. Circulation 2019; 140 (Suppl. 01) A11511-A
    PubMedGoogle Scholar
  • 73 Jogu HR, Chevli PA, Bose A. et al. Abstract 451: beta blocker use in asymptomatic patients with sepsis and elevated troponin is associated with lower risk of mortality. Circ Res 2017; 121 (Suppl. 01) A451-A
    CrossrefPubMedGoogle Scholar
  • 74 Mullis AH, Jogu HR, Ahmad MI. et al. Abstract 16215: statin use in asymptomatic patients with sepsis and elevated troponin is associated with lower risk of mortality. Circulation 2016; 134 (Suppl. 01) A16215-A
    PubMedGoogle Scholar
  • 75 Qureshi W, Jogu HR. Use of antiplatelets and anticoagulants in septic patients with troponin elevation. INSIGHTS FROM TYPE II MI STUDY. 2017; 69 (11, Suppl): 1025
    PubMedGoogle Scholar
  • 76 Shenouda S, Dutta A, Jogu H. et al. Abstract 15000: survival effect of beta-blockers in patients with asymptomatic perioperative troponin elevation. Circulation 2019; 140 (Suppl. 01) A15000-A
    PubMedGoogle Scholar