Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Neurocrit Care. 2022 Jun;36(3):772-780. doi: 10.1007/s12028-021-01365-3. Epub 2021 Oct 25.
Acute myocardial infarction (AMI) is the rarest and least studied cardiac complication of aneurysmal subarachnoid hemorrhage (aSAH). Precise estimates of the incidence of AMI after aSAH are unavailable. Our goal was to estimate the incidence of registry-based AMI (rb-AMI) after aSAH and determine its association with clinical outcomes.
Adult patients with aSAH in the National Inpatient Samples from 2002 to 2014 were included in the study. We evaluated risk factors for rb-AMI using univariate and multivariate regression models. Clinical outcomes that were assessed included functional status at discharge, in-patient mortality, length of stay, and total hospitalization cost, adjusting for patient demographics and cardiovascular risk factors through an inverse probability weighted analysis. Subgroup analyses were further performed stratified by rb-AMI type (ST-segment elevation myocardial infarction [STEMI] vs. non-STEMI [NSTEMI]).
A total of 139,734 patients with aSAH were identified, 3.6% of whom had rb-AMI. NSTEMI was the most common type of rb-AMI occurring after aSAH (71% vs. 29% for NSTEMI vs. STEMI, respectively). Patient characteristics associated with higher odds of rb-AMI included age, female sex, poor aSAH grade, and various cardiovascular risk factors. Rb-AMI was also associated with poor functional status at discharge, higher in-hospital mortality, and a longer and more costly hospital stay.
Rb-AMI occurs in 3.6% of patients with aSAH and is associated with poor functional status at discharge, higher in-patient mortality, and a longer and more costly hospitalization. Differentiating between different types of rb-AMI would be important in optimizing the management of patients with aSAH. Our definition of rb-AMI likely includes patients with neurogenic stress cardiomyopathy, which may confound the results.
急性心肌梗死（AMI）是颅内动脉瘤性蛛网膜下腔出血（aSAH）最少见且研究最少的心脏并发症。目前尚无 aSAH 后 AMI 发生率的精确估计。我们的目标是估计 aSAH 后基于登记的 AMI（rb-AMI）的发生率，并确定其与临床结果的关系。
本研究纳入了 2002 年至 2014 年国家住院患者样本中患有 aSAH 的成年患者。我们使用单变量和多变量回归模型评估了 rb-AMI 的危险因素。通过逆概率加权分析，根据患者人口统计学和心血管危险因素，评估了出院时的功能状态、住院死亡率、住院时间和总住院费用等临床结局。进一步进行了亚组分析，按 rb-AMI 类型（ST 段抬高型心肌梗死 [STEMI] 与非 ST 段抬高型心肌梗死 [NSTEMI]）进行分层。
共确定了 139734 例 aSAH 患者，其中 3.6%患有 rb-AMI。NSTEMI 是 aSAH 后最常见的 rb-AMI 类型（分别为 71%和 29%为 NSTEMI 与 STEMI）。与 rb-AMI 发生几率较高相关的患者特征包括年龄、女性、较差的 aSAH 分级以及各种心血管危险因素。rb-AMI 还与出院时功能状态较差、住院死亡率较高以及住院时间更长和费用更高相关。
rb-AMI 发生在 3.6%的 aSAH 患者中，与出院时功能状态较差、住院死亡率较高以及住院时间更长和费用更高相关。区分不同类型的 rb-AMI 对于优化 aSAH 患者的管理很重要。我们对 rb-AMI 的定义可能包括患有神经源性应激性心肌病的患者，这可能会混淆结果。
