Temporal Trends, Predictors, and Outcomes of Acute Ischemic Stroke in Acute Myocardial Infarction in the United States

• Type of Material: Article
• Authors: Gaurav Aggarwal, Jersey City Medical Center; Sri H Patlolla, Mayo Clinic; Saurabh Aggarwal, Unity Point Clinic; Wisit Cheungpasitporn, University of Mississippi; Rajkumar Doshi, University of Nevada; Pranathi R Sundaragiri, Mayo Clinic, Rochester; Alejandro A Rabinstein, Mayo Clinic, Rochester; Allan S Jaffe, Mayo Clinic, Rochester; Gregory W Barsness, Mayo Clinic, Rochester; Marc Cohen, Rutgers‐New Jersey Medical School; Saraschandra Vallabhajosyula, Mayo Clinic, Rochester
• Language: English
• Date: 2021-01-19
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.120.017693
• Title of Journal or Parent Work: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: 10
• Issue: 2
• Start Page: 1
• End Page: 18
• Grant/Funding Information: Dr Vallabhajosyula is supported by the Clinical and Translational Science Award (CTSA) Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). The article contents are solely the responsibility of the authors and do not necessarily represent the official view of the NIH.
• Keywords: LONG-TERM SURVIVAL; Life Sciences & Biomedicine; MANAGEMENT; CLASSIFICATION; Science & Technology; acute ischemic stroke; cerebrovascular circulation; outcomes research; MORTALITY; acute myocardial infarction; ARRHYTHMIAS; HEMORRHAGE; SECONDARY; Cardiovascular System & Cardiology; ACUTE CORONARY SYNDROMES; complications; Cardiac & Cardiovascular Systems; RISK-FACTORS
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

BACKGROUND: There are limited contemporary data prevalence and outcomes of acute ischemic stroke (AIS) complicating acute myocardial infarction (AMI). METHODS AND RESULTS: Adult (>18 years) AMI admissions using the National Inpatient Sample database (2000–2017) were evaluated for in-hospital AIS. Outcomes of interest included in-hospital mortality, hospitalization costs, length of stay, discharge disposition, and use of tracheostomy and percutaneous endoscopic gastrostomy. The discharge destination was used to classify survivors into good and poor outcomes. Of a total 11 622 528 AMI admissions, 183 896 (1.6%) had concomi-tant AIS. As compared with 2000, in 2017, AIS rates increased slightly among ST-segment–elevation AMI (adjusted odds ratio, 1.10 [95% CI, 1.04–1.15]) and decreased in non–ST-segment–elevation AMI (adjusted odds ratio, 0.47 [95% CI, 0.46–0.49]) admissions (P<0.001). Compared with those without, the AIS cohort was on average older, female, of non-White race, with greater comorbidities, and higher rates of arrhythmias. The AMI-AIS admissions received less frequent coronary angiography (46.9% versus 63.8%) and percutaneous coronary intervention (22.7% versus 41.8%) (P<0.001). The AIS cohort had higher in-hospital mortality (16.4% versus 6.0%; adjusted odds ratio, 1.75 [95% CI, 1.72–1.78]; P<0.001), longer hospital length of stay, higher hospitalization costs, greater use of tracheostomy and percutaneous endoscopic gastrostomy, and less frequent discharges to home (all P<0.001). Among AMI-AIS survivors (N=153 318), 57.3% had a poor functional outcome at discharge with relatively stable temporal trends. CONCLUSIONS: AIS is associated with significantly higher in-hospital mortality and poor functional outcomes in AMI admissions.