Temporal trends, predictors, and outcomes of acute ischemic stroke in acute myocardial infarction in the United States

Gaurav Aggarwal, Sri Harsha Patlolla, Saurabh Aggarwal, Wisit Cheungpasitporn, Rajkumar Doshi, Pranathi R. Sundaragiri, Alejandro A. Rabinstein, Allan S. Jaffe, Gregory W. Barsness, Marc Cohen, Saraschandra Vallabhajosyula

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Article numbere017693
Pages (from-to)1-18
Number of pages18
JournalJournal of the American Heart Association
Volume10
Issue number2
DOIs
StatePublished - 2021

Keywords

  • Acute ischemic stroke
  • Acute myocardial infarction
  • Cerebrovascular circulation
  • Complications
  • Outcomes research

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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