Albaeni Aiham, Harris Ché Matthew, Nasser Hesham, Sifontes Sirhley, Hasan S Mustajab, Guduru Sai, Abusaada Khalid, Chatila Khaled, Gilani Syed, Khalife Wissam I
Department of Medicine, Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA.
Department of General Internal Medicine, Johns Hopkins School of Medicine, Division of Hospital Medicine Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
Int J Cardiol Heart Vasc. 2020 Dec 10;31:100684. doi: 10.1016/j.ijcha.2020.100684. eCollection 2020 Dec.
In-hospital ischemic stroke following acute ST-elevation myocardial infarction (STEMI) has not been evaluated on a national scale in the United States.
We used 2003 to 2014 Nationwide Inpatient Sample data to identify adults with a principal diagnosis of STEMI. Patients were divided into two groups defined by presence or absence of ischemic stroke. Clinical characteristics and in-hospital outcomes were studied using relevant statistics. Multiple linear and logistic regression models identified factors associated with ischemic stroke, national trend of in-hospital stroke incidence and in-hospital mortality.
Of 1,842,529 STEMI patients hospitalized from 2003 to 2014, 22,268 (1.2%) developed acute in-hospital ischemic stroke. Those with acute strokes were older (age ≥ 65 years: 70% vs 46%), more likely female (51% vs 33%), and had higher rates of atrial fibrillation (28.9% vs 12.2%) and heart failure (40.5% vs 21.1%). Age and gender adjusted incidence of in-hospital ischemic stroke following STEMI remained stable; 1.4% in 2003 and 1.5% in 2014 (P trend = 0.50). However, age and gender adjusted in-hospital mortality declined in STEMI patients with and without in-hospital ischemic stroke [AOR 0.97 (0.95-0.99) P trend = 0.03, and AOR 0.98 (0.98-0.99) P trend < 0.001, respectively]. Patients with ischemic strokes had higher in-hospital mortality (25.7% Vs 7.2%, p < 0.001), [AOR 2.11, 95% CI (1.92-2.32)].
In the United States, the incidence of acute in-hospital stroke remained stable from 2003 to 2014 following STEMI with significant decrease of in-hospital mortality trends. Despite slight improvement in mortality trends, in-hospital mortality rates remained elevated calling for interventions to optimize health care delivery.
在美国，急性ST段抬高型心肌梗死（STEMI）后院内缺血性卒中尚未在全国范围内得到评估。
我们使用2003年至2014年全国住院患者样本数据来识别主要诊断为STEMI的成年人。患者根据是否发生缺血性卒中分为两组。使用相关统计方法研究临床特征和院内结局。多元线性和逻辑回归模型确定了与缺血性卒中、院内卒中发病率的全国趋势以及院内死亡率相关的因素。
在2003年至2014年住院的1,842,529例STEMI患者中，22,268例（1.2%）发生了急性院内缺血性卒中。急性卒中患者年龄更大（年龄≥65岁：70%对46%），女性比例更高（51%对33%），房颤发生率更高（28.9%对12.2%），心力衰竭发生率更高（40.5%对21.1%）。STEMI后院内缺血性卒中的年龄和性别调整发病率保持稳定；2003年为1.4%，2014年为1.5%（P趋势=0.50）。然而，有和没有院内缺血性卒中的STEMI患者的年龄和性别调整后的院内死亡率均有所下降[AOR 0.97（0.95 - 0.99），P趋势=0.0
