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Background  Uncertainties remain about the current risk of myocardial infarction ( MI ) after ischemic stroke or transient ischemic attack.    Methods and Results  We undertook a systematic review to estimate the long‐term risk of  MI , compared to recurrent stroke, with temporal trends in ischemic stroke/transient ischemic attack patients. Annual risks and 95% confidence intervals (95%  CI ) of  MI  and recurrent stroke were estimated using random‐effect meta‐analyses. We calculated incidence ratios of  MI /recurrent stroke, for fatal and nonfatal events, using similar analyses. Rate ratios for  MI  in patients with potential risk factors compared to those without were calculated using Poisson regression.  A total of 58 studies (131 299 patients) with a mean (range) follow‐up of 3.5 (1.0‐10.0) years were included. The risk of  MI  was 1.67%/y (95%  CI  1.36‐1.98,  P  het <0.001 for heterogeneity) and decreased over time ( P  int =0.021); 96% of the heterogeneity between studies was explained by study design, study period, follow‐up duration, mean age, proportion of patients on antithrombotic therapy, and incident versus combined ischemic stroke/transient ischemic attack. The risk of recurrent stroke was 4.26%/y (95%  CI  3.43‐5.09,  P  het <0.001), with no change over time ( P  int =0.63). The risk of fatal  MI  was half the risk of recurrent strokes ending in fatality (incidence ratio=0.51, 95%  CI  0.14‐0.89,  P  het =0.58). The risk of nonfatal  MI  was 75% smaller than the risk of recurrent nonfatal stroke (incidence ratio=0.25, 95% CI  0.02‐0.50,  P  het =0.68). Male sex, hypertension, coronary and peripheral artery diseases were associated with a doubled risk of  MI .    Conclusions  After ischemic stroke/transient ischemic attack, the risk of  MI  is currently <2%/y, and recurrent stroke is a more common cause of death than  MI .

journal of the american heart association

Long‐Term Risk of Myocardial Infarction Compared to Recurrent Stroke After Transient Ischemic Attack and Ischemic Stroke: Systematic Review and Meta‐Analysis