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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Outcomes of Patients With Type 2 Myocardial Infarction Complicating Acute Ischemic Stroke
Salik Nazir1, Robert W Ariss1, Abdul Mannan Khan Minhas2
1Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH.
Insights
Type 2 myocardial infarction (MI) in patients with acute ischemic stroke (AIS) is linked to worse outcomes. This condition increases in-hospital mortality, costs, and readmissions, highlighting a need for targeted care strategies.
Area of Science:
- Cardiology
- Neurology
- Healthcare Management
Background:
- Acute ischemic stroke (AIS) is a leading cause of disability and mortality.
- Type 2 myocardial infarction (MI), often occurring secondary to other critical illnesses, presents a unique challenge in AIS patients.
- Understanding the specific patient profiles and outcomes associated with type 2 MI in AIS is crucial for improving patient care.
Purpose of the Study:
- To delineate the patient characteristics associated with type 2 MI among individuals hospitalized for AIS.
- To evaluate the prognostic impact of type 2 MI on inpatient mortality, functional outcomes, and resource utilization in AIS patients.
- To assess the association between type 2 MI and 30-day all-cause readmission rates following AIS hospitalization.
Main Methods:
- Utilized the National Readmission Database 2018 for a retrospective analysis.
- Identified patients with primary AIS hospitalizations, comparing those with and without type 2 MI.
- Analyzed baseline demographics, comorbidities, inpatient outcomes, hospital costs, length of stay, discharge disposition, and 30-day readmissions.
Main Results:
- Type 2 MI occurred in 0.71% (4182/587,550) of AIS hospitalizations.
- Patients with type 2 MI were older, more likely female, and had higher rates of heart failure, atrial fibrillation, prior MI, valvular heart disease, peripheral vascular disease, and chronic kidney disease.
- Type 2 MI was significantly associated with increased in-hospital mortality (aOR 1.96), poor functional outcome (aOR 1.80), higher hospital costs, increased length of stay, higher discharge to facility rates (aOR 1.70), and elevated 30-day readmissions (aOR 1.38).
Conclusions:
- Type 2 MI is an independent predictor of adverse outcomes in patients hospitalized with AIS.
- The presence of type 2 MI significantly elevates in-hospital mortality, functional impairment, and resource utilization.
- These findings underscore the importance of recognizing and managing type 2 MI in AIS patients to mitigate poor prognosis and reduce healthcare costs.
Objective:
To study the patient profiles and the prognostic impact of type 2 myocardial infarction (MI) on outcomes of acute ischemic stroke (AIS).
Methods:
The National Readmission Database 2018 was queried for patients with primary AIS hospitalizations with and without type 2 MI. Baseline characteristics, inpatient outcomes, and 30-day all-cause readmissions between cohorts were compared.
Results:
Of 587,550 AIS hospitalizations included in the study, 4182 (0.71%) had type 2 MI. Patients with type 2 MI were older (73.6 years vs 70.1 years; P<.001) and more likely to be female (52% vs 49.7%; P<.001), and they had a higher prevalence of heart failure (32.6% vs 15.5%; P<.001), atrial fibrillation (38.5% vs 24.2%; P<.001), prior MI (8.8% vs 7.7%; P<.001), valvular heart disease (17% vs 9.8%; P<.001), peripheral vascular disease (12.2% vs 9.2%; P<.001), and chronic kidney disease (24.4% vs 16.7%; P<.001). Compared with patients without type 2 MI, AIS patients with type 2 MI had significantly higher in-hospital mortality (adjusted odds ratio [aOR], 1.96; 95% CI, 1.65 to 2.32), poor functional outcome (aOR, 1.80; 95% CI, 1.62 to 2.00), more hospital costs (adjusted parameter estimate, $5618; 95% CI, $4480 to $6755), higher rate of discharge to a facility (aOR, 1.70; 95% CI, 1.52 to 1.90), increased length of stay (adjusted parameter estimate, 2.22; 95% CI, 1.72 to 2.72), and higher rate of 30-day all-cause readmissions (aOR, 1.38; 95% CI, 1.18 to 1.60).
Conclusion:
Type 2 MI in patients hospitalized with AIS is associated with poor prognosis and higher resource utilization.
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