TY - JOUR
T1 - Temporal trends, predictors, and outcomes of acute ischemic stroke in acute myocardial infarction in the United States
AU - Aggarwal, Gaurav
AU - Patlolla, Sri Harsha
AU - Aggarwal, Saurabh
AU - Cheungpasitporn, Wisit
AU - Doshi, Rajkumar
AU - Sundaragiri, Pranathi R.
AU - Rabinstein, Alejandro A.
AU - Jaffe, Allan S.
AU - Barsness, Gregory W.
AU - Cohen, Marc
AU - Vallabhajosyula, Saraschandra
N1 - Publisher Copyright:
© 2021 The Authors.
PY - 2021
Y1 - 2021
N2 - 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.
AB - 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.
KW - Acute ischemic stroke
KW - Acute myocardial infarction
KW - Cerebrovascular circulation
KW - Complications
KW - Outcomes research
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U2 - 10.1161/JAHA.120.017693
DO - 10.1161/JAHA.120.017693
M3 - Article
C2 - 33399018
AN - SCOPUS:85099767090
SN - 2047-9980
VL - 10
SP - 1
EP - 18
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 2
M1 - e017693
ER -