Is the mechanism of synchronous cardiocerebral infarction (CCI) different from that of metachronous CCI?

Abstract

Background: Cardiocerebral infarction (CCI) is the simultaneous occurrence of acute ischemic stroke (AIS) and myocardial infarction (MI) at the same time (synchronous), or one after another (metachronous). This study aimed to investigate the differences in the underlying mechanisms between synchronous and metachronous CCI. Methods: This study analyzed patients with AIS registered in the Clinical Research Collaboration for Stroke in Korea Prospective Registry at a single Stroke Center from January 2019 to December 2022. Patients with synchronous and metachronous CCI (MI within 72 hours after AIS) were included. Severity at admission and modified Rankin Scale scores 3 months after treatment were assessed. Results: Among 3,319 AIS patients, 12 (0.36%) were diagnosed with acute CCI (male, 8; mean age, 69.6±14.0 years). Of these, six (0.18%) had synchronous CCI, while the other six had metachronous CCI. The synchronous CCI group exhibited lower neurological severity at admission than the metachronous CCI group (median National Institutes of Health Stroke Scale, 3.5 vs. 12.5). Among the 12 patients, seven (58%) had ST-elevation myocardial infarction (STEMI), with five (83%) of the synchronous CCI cases presenting as STEMI. Two cases of new-onset atrial fibrillation occurred exclusively in patients with synchronous CCI. Also, one case with synchronous CCI had a thrombus in the left ventricle. Conclusion: Acute CCI is rare and manifests with varying degrees of severity. Our study suggests that AIS in synchronous CCI may be secondary to embolism caused by a preceding MI. In contrast, metachronous CCI exhibits diverse mechanisms, including secondary myocardial injury resulting from a preceding severe AIS.