ACUTE myocardial infarction (AMI) was associated with significantly higher long-term mortality in patients with a history of stroke, particularly those with residual neurological disability, according to new research analysing more than 10,000 individuals.
Cardiovascular disease remains a leading global cause of death, and AMI is one of its most serious manifestations. Patients with prior cerebrovascular disease often carry a higher burden of vascular risk factors, yet the impact of neurological impairment following stroke on outcomes after AMI remains poorly understood.
Researchers therefore investigated whether neurological status, measured using the modified Rankin Scale (mRS), could predict long-term mortality in individuals presenting with AMI.
Acute Myocardial Infarction Outcomes and Neurological Disability
The retrospective study analysed 10,084 patients diagnosed with AMI. Participants were categorised into three groups: those with no prior stroke, those with previous ischaemic stroke but minimal or no disability (mRS 0–1), and those with post-stroke disability (mRS 2–5). Mortality data were tracked through a national death registry over a median follow-up period of 5.26 years.
Among the cohort, 893 patients (8.9%) had a history of ischaemic stroke. Over the follow-up period, 1,829 deaths occurred, including 1,454 attributed to cardiovascular causes.
Compared with patients without prior stroke, individuals with previous ischaemic stroke but minimal disability still experienced significantly higher risks of death. All-cause mortality increased by 42% (hazard ratio [HR]:1.42; 95% confidence interval [CI]:1.20–1.67; p<0.001), while cardiovascular mortality rose by 46% (HR:1.46; 95% CI:1.21–1.76; p<0.001).
The risks were even greater among patients with post-stroke disability. In this group, all-cause mortality more than doubled (HR:2.18; 95% CI:1.84–2.60; p<0.001), and cardiovascular mortality was similarly elevated (HR:2.10; 95% CI:1.73–2.55; p<0.001).
Underlying Mechanisms and Clinical Implications
The findings suggested that neurological dysfunction following stroke may represent an important but under-recognised marker of vulnerability in patients with AMI. Even individuals who appeared neurologically intact after stroke, as indicated by low mRS scores, faced higher long-term mortality than those without prior cerebrovascular disease.
Several mechanisms may explain this association. Patients with previous stroke often have widespread atherosclerosis, endothelial dysfunction, and higher rates of comorbidities such as hypertension, diabetes, and atrial fibrillation, all of which can worsen cardiovascular outcomes. Disability following stroke may further increase risk by limiting physical activity, complicating rehabilitation, and reducing adherence to secondary prevention strategies.
Incorporating neurological assessment tools such as the modified Rankin Scale into cardiovascular risk evaluation could help clinicians better identify high-risk patients with AMI. Furthermore, improved secondary prevention and closer long-term monitoring may ultimately help reduce mortality in this particularly vulnerable population.
Reference
Feng L et al. Prognostic impact of neurological dysfunction assessed by modified Rankin Scale in acute myocardial infarction. Sci Rep. 2026; DOI:10.1038/s41598-026-43703-5.
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