Can both occur together?
PULSE Issue 45 | July 2025
Cardiocerebral Infarction (CCI) is a rare but severe condition where an ischemic stroke and a myocardial infarction, also known as heart attack, occur at the same time or in rapid succession. Although strokes and heart attacks are common medical emergencies on their own, the possible simultaneous occurrence of both is often overlooked, despite the life-threatening consequences.
To better understand and address this dangerous overlap, a multidisciplinary team led by Dr Sia Ching Hui, Consultant, Department of Cardiology, NUHCS, involving cardiologists from NUHCS and neurologists from the National University Hospital - in collaboration with statutory boards such as Health Promotion Board and National Registry of Disease Office, and medical centres including Khoo Teck Puat Hospital, Singapore General Hospital, National Neuroscience Institute, Tan Tock Seng Hospital and National Heart Centre Singapore - embarked on a research study for improved CCI patient outcomes.
A Closer Look into the Heart-Brain Connection
Strokes and heart attacks together account for a quarter of global deaths¹. Evidence shows a bidirectional association between the two, where the occurrence of one increases the risk of the other²,³. While previous case reports and series suggest CCI is associated with poorer patient outcomes including prolonged dependence on life-support systems, increased hospital stays and readmissions, and higher mortality4, its incidence and clinical impact remain neglected due to limited large-scale studies. To bridge this gap, the team used information from Singapore’s two largest population-based registries to research on the incidence, treatment, and outcomes of patients with CCI.
An analysis was conducted on 120,531 patients who experienced an ischemic stroke, heart attack, or both between 2007 and 2018. Findings showed patients with CCI were more likely to have Atrial Fibrillation5 - suggesting possible cardioembolic causes6 - and faced worse outcomes, including all-cause mortality and cardiovascular mortality, compared to those with stroke or heart attack alone.
The research findings revealed that around 1 in every 200 ischemic stroke and/or heart attack cases are synchronous CCI that occurs at the same time or consecutively. These patients have a two to four times higher risk of mortality compared to those experiencing either condition alone. With greater availability of digital medical records and advancements like artificial intelligence, effective adoption of these tools and further clinical research is required to enable more rapid advancements to manage such understudied conditions.
This study was first presented at the Singapore Cardiac Society Annual Scientific Meeting 2023, where it was awarded the Best Paper for Free Paper Session 1. In 2024, the full manuscript was later published in Stroke7 – the world’s leading peer-reviewed journal in cerebrovascular disease investigation. This study was also featured in Blogging Stroke8 – the official blog of the American Heart Association’s Stroke Council. These milestones make this collaborative project extremely fulfilling in not only deepening clinical understanding but also raising awareness on the impact of this rare but lethal condition.
