Cardiocerebral infarction (CCI), defined as the concomitant occurrence of acute myocardial infarction (AMI) and acute ischaemic stroke (AIS), has been rarely reported in the literature. The aim of this manuscript is to describe the challenges in the treatment of CCI and to highlight the different approaches in the management of this entity. We report the case of two young women admitted to our cardiology department with acute coronary syndrome concomitant with stroke at different times and whose management differed according to their ischemic and hemorrhagic risk. It is assumed that there is a possible relationship between the two conditions rather than a mere coincidence. Explanations for this association are reviewed and discussed in detail in this paper. The management of a concurrent presentation of AIS and AMI is unclear. The use of antiplatelets and anticoagulants that are integral to the management of AMI may increase the risk of haemorrhagic transformation, and the use of a thrombolytic in AIS similarly increases the risk of heart wall rupture in AMI. As there are no large-scale studies, high quality evidence or clinical guidelines, the treatment of CCI should be highly individualized.
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Ibara-Onguema, J. R. , Bourzeg, K. , Othende, F. B. E. , Jamili, M. E. , Karimi, S. E. and Hattaoui, M. E. (2023). Concomitant Acute Coronary Syndrome and Acute Ischemic Stroke: A Particular Association and a Therapeutic Dilemma. Open Access Library Journal, 10, e9877. doi: http://dx.doi.org/10.4236/oalib.1109877.
Virani, S.S., Alonso, A., Benjamin, E.J., et al. (2020) Heart Disease and Stroke Statistics-2020 Update: A Report from the American Heart Association. Circulation, 141, e139-e596. https://doi.org/10.1161/CIR.0000000000000746
Prosser, J., Mac Gregor, L., Lees, K.R., et al. (2007) Predictors of Early Cardiac Morbidity and Mortality after Ischemic Stroke. Stroke, 38, 2295-2302.
https://doi.org/10.1161/STROKEAHA.106.471813
Omar, H.R., Fathy, A., Rashad, R., et al. (2010) Concomitant Acute Right Ventricular Infarction and Ischemic Cerebrovascular Stroke, Possible Explanations. International Archives of Medicine, 3, 25. https://doi.org/10.1186/1755-7682-3-25
Zinkstok, S.M. and Roos, Y.B. (2012) Early Administration of Aspirin in Patients Treated with Alteplase for Acute Ischaemic Stroke: A Randomised Controlled Trial. The Lancet, 380, 731-737. https://doi.org/10.1016/S0140-6736(12)60949-0
Patel, M.R., Meine, T.J., Lindblad, L., et al. (2006) Cardiac Tamponade in the Fibrinolytic Era: Analysis of >100,000 Patients with ST-Segment Elevation Myocardial Infarction. American Heart Journal, 151, 316-322.
https://doi.org/10.1016/j.ahj.2005.04.014
Akinseye, O.A., Shahreyar, M., Heckle, M.R., et al. (2018) Simultaneous Acute Cardio-Cerebral Infarction: Is There a Consensus for Management? Annals of Translational Medicine, 6, 7. https://doi.org/10.21037/atm.2017.11.06
Rokey, R., Rolak, L.A., Harati, Y., et al. (1984) Coronary Artery Disease in Patients with Cerebrovascular Disease: A Prospective Study. Annals of Neurology, 16, 50-53.
https://doi.org/10.1002/ana.410160110
Chin, P.L., Kaminski, J. and Rout, M. (1977) Myocardial Infarction Coincident with Cerebrovascular Accidents in the Elderly. Age Ageing, 6, 29-37.
https://doi.org/10.1093/ageing/6.1.29
Budaj, A., Flasinska, K., Gore, J.M., et al. (2005) Magnitude of and Risk Factors for In-Hospital and Postdischarge Stroke in Patients with Acute Coronary Syndromes: Findings from a Global Registry of Acute Coronary Events. Circulation, 111, 3242-3247. https://doi.org/10.1161/CIRCULATIONAHA.104.512806
Yeo, L.L. andersson, T., Yee, K.W., et al. (2017) Synchronous Cardiocerebral Infarction in the Era of Endovascular Therapy: Which to Treat First? Journal of Thrombosis and Thrombolysis, 44, 104-111. https://doi.org/10.1007/s11239-017-1484-2
Kijpaisalratana, N., Chutinet, A. and Suwanwela, N.C. (2017) Hyperacute Simultaneous Cardiocerebral Infarction: Rescuing the Brain or the Heart First? Frontiers in Neurology, 8, 664. https://doi.org/10.3389/fneur.2017.00664
Loh, E., Sutton, M.S.J., Wun, C.C., et al. (1997) Ventricular Dysfunction and the Risk of Stroke after Myocardial Infarction. The New England Journal of Medicine, 336, 251-257. https://doi.org/10.1056/NEJM199701233360403
Chlapoutakis, G.N., Kafkas, N.V., Katsanos, S.M., et al. (2010) Acute Myocardial Infarction and Transient Ischemic Attack in a Patient with Lone Atrial Fibrillation and Normal Coronary Arteries. International Journal of Cardiology, 139, e1-e4.
https://doi.org/10.1016/j.ijcard.2008.06.085
Kleber, F.X., Hauschild, T., Schulz, A., et al. (2017) Epidemiology of Myocardial Infarction Caused by Presumed Paradoxical Embolism via a Patent Foramen Ovale. Circulation Journal, 81, 1484-1489. https://doi.org/10.1253/circj.CJ-16-0995
Ovbiagele, B. (2013) Low-Normal Systolic Blood Pressure and Secondary Stroke Risk. Journal of Stroke and Cerebrovascular Diseases, 22, 633-638.
https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.12.003
Bersano, A., Melchiorre, P., Moschwitis, G., et al. (2014) Tako-Tsubo Syndrome as a Consequence and Cause of Stroke. Functional Neurology, 29, 135-137.
Elochukwu, I., Hera, A.K. and Tamara, S. (2022) Cardio-Cerebral Infarction in Left MCA Strokes: A Case Series and Literature Review. Journal of the Neurological Sciences, 43, 2413-2422. https://doi.org/10.1007/s10072-021-05628-x
Kijeong, L., Woohyun, P., Kwon, D.S., et al. (2021) Which One to Do First? A Case Report of Simultaneous Acute Ischemic Stroke and Myocardial Infarction. Journal of Neurocritical Care, 14, 109-112. https://doi.org/10.18700/jnc.210030
Nolte, C.H., Regina, V.R., et al. (2020) Prediction of Acute Coronary Syndrome in Acute Ischemic Stroke (PRAISE)—Protocol of a Prospective, Multicenter Trial with Central Reading and Predefined Endpoints. BMC Neurology, 20, 318.
https://doi.org/10.1186/s12883-020-01903-0
Lee, M., Saver, J.L., Hong, K., et al. (2013) Risk-Benefit Profile of Long-Term Dualversus Single-Antiplatelet Therapy among Patients with Ischemic Stroke. A Systematic Review and Meta-Analysis. Annals of Internal Medicine, 159, 463-470.
https://doi.org/10.7326/0003-4819-159-7-201310010-00006
Ciccone, A., Abraha, I. and Santilli, I. (2006) Glycoprotein IIb-IIIa Inhibitors for Acute Ischaemic Stroke. Cochrane Database of Systematic Reviews, 4, CD005208.
https://doi.org/10.1002/14651858.CD005208.pub2
Wers, W.J., Rabinstein, A.A., Ackerson, T., et al. (2019) 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, 50, e344-e418. https://doi.org/10.1161/STR.0000000000000215
O’Gara, P.T., Kushner, F.G., Ascheim, D.D., et al. (2013) 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. Journal of the American College of Cardiology, 127, 529-555.
