Incidence and Long-Term Outcomes of Stroke in Patients Presenting With ST-Segment Elevation-Myocardial Infarction:
Michael Megaly1, Mehmet Yildiz2, Edward Tannenbaum3
1Minneapolis Heart Institute at Abbott Northwestern Hospital Minneapolis MN.
Insights
The risk of stroke in ST-segment-elevation myocardial infarction (STEMI) patients is low at 0.76%. However, experiencing a stroke significantly increases both in-hospital and long-term mortality risk by double.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Real-world data on stroke incidence in ST-segment-elevation myocardial infarction (STEMI) patients is limited.
- Understanding stroke in STEMI is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the incidence, trends, causes, and predictors of stroke in STEMI patients.
- To assess the long-term impact of stroke on 5-year mortality in this population.
Main Methods:
- Analysis of data from 12,868 STEMI patients across 4 regional programs (2003-2019).
- Utilized multivariate logistic and Cox regression to identify stroke predictors and mortality associations.
- Examined stroke characteristics, treatment, and in-hospital outcomes.
Main Results:
- Stroke occurred in 0.76% of STEMI patients, with stable incidence over time.
- Ischemic stroke was most common (75%), often occurring after primary percutaneous coronary intervention.
- Older age and pre-intervention cardiogenic shock were significant stroke predictors.
- In-hospital stroke independently increased 5-year mortality risk (HR 2.01).
Conclusions:
- The incidence of stroke in STEMI patients is low but associated with substantially higher in-hospital (18%) and 5-year mortality (35%).
- Stroke in STEMI patients represents a significant adverse event impacting long-term survival.
Abstract:
Background Contemporary real-world data on stroke in patients presenting with ST-segment-elevation myocardial infarction (STEMI) are scarce. Methods and Results We evaluated the incidence, trends, cause, and predictors of stroke from 2003 to 2019 in 4 large regional STEMI programs in the upper Midwest that use similar transfer and treatment protocols. We also evaluated the long-term impact of stroke on 5-year mortality. Multivariate logistic and Cox regression analysis was used to identify variables independently associated with stroke in patients presenting with STEMI and identify variables associated with 5-year mortality. A total of 12 868 patients presented with STEMI during the study period. Stroke occurred in 98 patients (0.76%). The incidence of stroke remained stable over time (0.5% in 2003, 1.2% in 2019; P-trend=0.22). Most (75%) of strokes were ischemic, with a median time to stroke symptoms of 14 hours after primary percutaneous coronary intervention (interquartile range, 4-72 hours), which led to a small minority (3%) receiving endovascular treatment and high in-hospital mortality (18%). On multivariate regression analysis, age (increment of 10 years) (odds ratio [OR], 1.32; 95% CI, 1.10-1.58; P-value=0.003) and preintervention cardiogenic shock (OR, 2.03; (95% CI, 1.03-3.78; P=0.032)) were associated with a higher risk of in-hospital stroke. In-hospital stroke was independently associated with increased risk of 5-year mortality (hazard ratio, 2.01; 95% CI, 1.13-3.57; P=0.02). Conclusions In patients presenting with STEMI, the risk of stroke is low (0.76%). A stroke in patients presenting with STEMI is associated with significantly higher in-hospital (18%) and long-term mortality (35% at 5 years). Stroke was associated with double the risk of 5-year death.
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