Incidence and outcomes of hospitalized acute ischemic stroke patients with subsequent ST-segment-elevation myocardial
Arhum Mahmood1, Song Peng Ang2, Yusuf Kamran Qadeer3
1Department of Medicine, Henry Ford Hospital, Detroit, MI, United States.
Insights
Patients admitted with acute ischemic stroke (AIS) who also experienced ST-segment elevation myocardial infarction (STEMI) had significantly higher mortality and complication rates. However, the incidence of STEMI following AIS decreased from 2016 to 2021.
Area of Science:
- Cardiology
- Neurology
- Inpatient Medicine
Background:
- Acute ischemic stroke (AIS) patients can develop acute ST-segment elevation myocardial infarction (STEMI).
- The risks, incidence, complications, and outcomes of STEMI in AIS patients are not well understood.
- This study investigates the association between STEMI and outcomes in hospitalized AIS patients.
Purpose of the Study:
- To evaluate the incidence, complications, and mortality associated with STEMI in patients hospitalized with AIS.
- To analyze the temporal trends of STEMI and mortality in AIS patients from 2016 to 2021.
Main Methods:
- Analysis of 2,804,819 patients from the National Inpatient Sample (2016-2021).
- AIS and STEMI were identified using ICD-10 codes; patients with Non-STEMI were excluded.
- Multivariable logistic regression was used to assess the association of STEMI with mortality and secondary outcomes.
Main Results:
- Of 2,804,819 AIS patients, 6,550 had STEMI.
- STEMI was associated with significantly higher mortality (24.96% vs. 3.10%) and increased risk of cardiogenic shock, cardiac arrest, and acute kidney injury (AKI).
- The incidence of STEMI among AIS patients decreased from approximately 0.3% in 2016 to 0.2% in 2021.
Conclusions:
- STEMI in AIS patients is linked to substantially increased mortality and secondary complications.
- Despite a decrease in incidence, STEMI remains a critical concern for AIS patient outcomes.
- Early identification and management of STEMI in AIS patients are crucial.
Background:
Patients admitted with acute ischemic stroke (AIS) may experience accompanying acute ST-Segment myocardial infarction after AIS. The cardiovascular risks, incidence, complications, and outcomes of acute STEMI in patients hospitalized with AIS remains underexplored.
Methods:
We evaluated 2,804,819 patients that presented with AIS who were listed in the National Inpatient Sample from 2016 to 2021. AIS and STEMI were defined according to the ICD-10 Diagnostic Codes. Patients with Non-STEMI were excluded. The risk of specific complications and outcomes were expressed as percentages. Multivariable logistic regression analysis was used to examine the association of STEMI with a primary outcome of mortality and secondary outcomes. The temporal trend of both the incidence of STEMI after AIS as well as the mortality rate between 2016 and 2021 were expressed as percentages over time.
Results:
Of the total (n = 2,804,819) patients with AIS, 6,550 also had STEMI diagnosed during the hospitalization. Of these, 1,635 (24.96%) died in the STEMI group and 86,810 (3.10%) died in the group without STEMI. All of the secondary outcome measures were significantly associated with a diagnosis of STEMI. STEMI was associated with mortality [OR 7.43 (95% CI, 6.44-8.57); P < 0.001], cardiogenic shock [OR 29.64, (95% CI, 22.64-38.81); P < 0.001], cardiac arrest [OR, 7.76 (95% CI, 6.01-10.03); P < 0.001], and AKI [OR 1.96 (95% CI, 1.72-2.23); P < 0.001] among other complications. When assessed yearly, the temporal trend of STEMI among AIS patients showed a decrease in frequency from about 0.3% in 2016 to about 0.2% in 2021. Furthermore, comparing the mortality between AIS patients with and without STEMI showed a significant difference with a higher mortality in the AIS with STEMI population.
Conclusions:
Patients admitted with acute ischemic stroke who had STEMI have a significant mortality increase compared to those who did not have STEMI. They also had a significant increase in secondary complications including cardiac arrest, cardiogenic shock, AKI, and need for further medical interventions. Temporally, we have seen a decrease in STEMI after AIS over the interval.
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