Concurrent cardiocerebral infarction in the emergency department: A case series from a tertiary care centre in South India.

BACKGROUND: Concurrent cardiocerebral infarction (CCI), defined as the near-simultaneous occurrence of acute ischemic stroke (AIS) and acute myocardial infarction (AMI), is a rare but life-threatening emergency with complex and often conflicting management priorities. Evidence guiding optimal treatment strategies remains limited. METHODS: We conducted a retrospective observational study of adult patients presenting with CCI to the emergency department of a tertiary care centre in South India over a 2-year period. Patients with AIS and AMI occurring within 24 h were included. Demographic, clinical, imaging, treatment, and outcome data were extracted. Descriptive comparisons were performed to summarize differences between survivors and non-survivors. The primary outcome was in-hospital mortality. RESULTS: A total of 11 patients were included. The median age was 55 years (IQR, 38-65), with a male predominance (73%). Most patients presented beyond established therapeutic windows (chest pain >12 h: 73%; neurological symptoms >4.5 h: 91%). Anterior circulation strokes predominated (91%), with moderate-to-severe neurological deficits (median NIHSS 11; IQR, 7-18). Regarding treatment eligibility, three patients were within the treatment window for both AIS and AMI, three were eligible for AMI treatment only, one for AIS treatment only, and four were outside the treatment window for both conditions. Reperfusion therapy consisted of intravenous thrombolysis alone in 18% and combined intravenous thrombolysis with percutaneous coronary intervention (PCI) in 18%, while 64% received medical management alone. In-hospital mortality was 73%. Descriptive comparisons showed that survivors had lower NIHSS scores and higher ASPECTS and GCS scores at presentation. CONCLUSION: CCI is associated with high in-hospital mortality. These findings suggest that delayed presentation and limited eligibility for timely reperfusion may contribute to poor outcomes, particularly in patients with severe neurological involvement. In emergency settings, early recognition, rapid risk stratification, and coordinated multidisciplinary decision-making are critical for optimizing outcomes in this complex dual vascular emergency.