| Background:Acute myocardial infarction and acute ischemic stroke has become the current harm to human health and even the main diseases of life,the incidence rate is also rising with the gradual improvement of living conditions in recent years.According to 2014 statistics,there are 290 million patients with cardiovascular disease,which including 2.5 million patients with myocardial infarction and 6 million patients with ischemic stroke.They have common risk factors and similar pathogenesis,and often complicate with each other to result in serious complications and mortality.At present,there are only a few retrospective studies on the risk factors of patients with acute coronary syndromes complicated with acute ischemic stroke,and the results are controversial.The patients need reliable treatment strategies,but there are no large-scale clinical trials have been found to explore their treatment regimen.Objective:1.To analyze the risk factors and clinical characteristics of AMI complicated with AIS;2.To screen appropriate risk factors for thrombosis and bleeding;3.To explore a reasonable antiplatelet therapy of the secondary prevention strategy.Methods:1.A retrospective analysis was carried out in 75 patients with AMI complicated with AIS in our hospital from January 2010 to April 2015,and clinical date of 80 cases with AMI and 80 cases with AIS were analyzed to find the risk factors;GRACE factors,CRUSADE factors,ESSEN factors,GRASPS factors were analyzed to screen the appropriate risk factors of thrombosis and bleeding were screened.2.75 cases of AMI complicated with AIS were divided into three groups,7 patients with no anti-platele(no drug group),19 patients with single anti-platele(single anti-platele group)and 49 patients with dual anti-platelet(double anti-platele group).Then all were followed up for 1 year to analyzed with the antiplatelet therapy.Results:1.Logistics regression analysis showed that the independent risk factors are male,higher in history of ischemic stroke,Cr(P<0.05,OR>1),and DBP is a protective factor(P<0.001,OR<1).2.GRAS score was statistically different between the three groups(134.03±38.66 vs 87.10±25.64 vs 145.67±4.27,P<0.05),and AMI complicated with AIS group has more high-risk patients than the AIS group in GRACE score(73% vs 9%,P<0.05).But the ESSEN score and its grading comparison between the three groups was not statistically significant(P>0.05).CRASADE scores and its grading were statistically different between the three groups(P>0.05).AMI complicated with AIS group was significantly higher than the AMI group in GRASPS score(65.98±4.58 vs 72.00±8.52,P<0.01),and has more high risk and very high risk patients(0% vs 23%,0% vs 13%,both P<0.01).3.There were 4 cases(57.10%),7 cases(36.80%)and 3 cases(6.10%)occurred the major adverse cardiovascular events respectively in no drug group,single anti-platele group and double anti-platele group,the differences were statistically significant(all P <0.01).And there were 0 cases(0%),3 cases(15.8%)and 3 cases(6.1%)occurred the combined end-point respectively in the three groups,the difference was not statistically significant(P = 0.391).Conclusion:1.The incidence risk factors of AMI complicated with AIS are male,decrease of DBP in admission,history of ischemic stroke,increase of serum creatinine,and cardiac dysfunction,multi-cerebral infarction as its clinical characteristics.2.In our attempt,the GRACE score can be used to measure the risk of thrombosis in patients with AMI complicated with AIS,and the GRASPS score can be used to measure the risk of bleeding.3.Compared with single anti-platele and no anti-platele therapy,dual anti-platelet therapy can significantly reduce all-cause death and recurrent myocardial infarction or ischemic stroke risk in patients with AMI complicated with AIS.And dual anti-platelet therapy doesn't increase the risk of bleeding than single anti-platele therapy. |
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