Introduction The safety of intravenous thrombolysis (iv-rtPA) for acute ischemic stroke (AIS) after recent myocardial infarction (MI) is still a matter of debate. We aimed to study the safety of delivering iv-rtPA to AIS patients with a MI within the preceding 3 months. Methods Retrospective review of consecutive AIS admitted to two university hospitals’ stroke units and systematic literature review (PubMed and EMBASE) for AIS patients treated with iv-rtPA and MI in the previous 3 months. Cardiac complications (cardiac rupture/tamponade, intracardiac thrombus embolization or life-threatening arrhythmias) were assessed by type of MI (non-[NSTEMI] or ST-elevation [STEMI]), MI location and time-elapsed between events. Results Forty-five patients were included, 29 hospital cases and 16 from the literature review. Twenty-three (51%) patients had concurrent AIS and MI. In the remaining, MI occurred 1 to 63 days before AIS. Twenty-three patients had a STEMI, 10 (43.5%) left anterior and 13 (56.5%) inferior. Two patients died due to cardiac rupture, both with left anterior STEMI, 1 to 3 days before stroke. Both cases of tamponade after pericarditis and death due to presumed cardiac rupture occurred in patients with an inferior STEMI in the week preceding stroke. Thrombus embolization occurred in one patient with inferior STEMI, 2 days before stroke, who also experienced a life-threatening arrhythmia. The other two major arrhythmia cases occurred in patients with inferior STEMI, one concurrent with AIS and one in the preceding week. No NSTEMI patients had cardiac complications. Conclusion In patients with acute ischemic stroke and recent or concurrent myocardial infarction, myocardial infarction type and location, and the time elapsed between the two events should be taken into consideration when deciding to deliver intravenous thrombolysis. While recent NSTEMI or concurrent events seem safe, STEMI in the week preceding stroke, should prompt caution.
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