Mehta Shivani, Kakouros Nikolaos, Mir Tanveer, Loree Stacy, Qureshi Waqas
Department of Internal Medicine (S.M.), Wayne State University/Trinity Health Oakland, Pontiac, MI.
Division of Cardiology, Department of Internal Medicine, University of Massachusetts Chan School of Medicine, Worcester (N.K., W.Q.).
Stroke. 2024 May;55(5):1245-1253. doi: 10.1161/STROKEAHA.123.044550. Epub 2024 Mar 26.
Acute myocardial infarction may concomitantly occur with acute ischemic stroke. The prevalence, complications, and outcomes of acute ST-segment-elevation myocardial infarction (STEMI) in patients hospitalized with acute ischemic stroke are not well studied.
We examined hospitalized patients with acute ischemic stroke who were included in the National Inpatient Sample from 2016 to 2019. Acute ischemic stroke and STEMI were defined by using the diagnostic codes. Patients with Non-STEMI were excluded. The prevalence of complications and outcomes were expressed as percentages. Multivariable logistic regression analysis was used to examine the association of STEMI with a primary outcome of mortality and secondary outcomes. A subgroup analysis of patients with STEMI who underwent percutaneous coronary intervention was also performed.
Of the total (n=2 080 795) patients with acute ischemic stroke, 0.3% (n=6275; mean age, 70.5 years, 50.1% females, 69.5% White) also had STEMI diagnosed during the hospitalization. Of these, 1775 (28.3%) died in the STEMI group and 76 435 (3.7%) died in the group without STEMI. The most frequent complications in the STEMI group were acute kidney injury, intracranial hemorrhage, and ventricular arrhythmias. All secondary outcomes were associated with the diagnosis of STEMI (odds ratio [OR], 3.19 [95% CI, 2.82-3.6]; ≤0.001). STEMI was associated with mortality (OR, 8.37 [95% CI, 7.25-9.66]; ≤0.001) and intracranial hemorrhage (OR, 2.23 [95% CI, 1.84-2.70]; ≤0.001). Percutaneous coronary intervention was performed in 14.3% of STEMI subgroup patients. Percutaneous coronary intervention is not associated with mortality (OR, 0.93 [95% CI, 0.6-1.43]; =0.7), and intracranial hemorrhage (OR, 1.54 [95% CI, 0.0.93-2.56]; =0.1).
Patients with acute ischemic stroke with STEMI have a higher percentage of mortality. Percutaneous coronary intervention in the subgroup of patients with acute ischemic stroke with concomitant STEMI was not associated with increased odds of mortality and intracranial hemorrhage.
急性心肌梗死可能与急性缺血性卒中同时发生。急性缺血性卒中住院患者中急性ST段抬高型心肌梗死（STEMI）的患病率、并发症及预后尚未得到充分研究。
我们研究了2016年至2019年纳入全国住院患者样本的急性缺血性卒中住院患者。急性缺血性卒中和STEMI通过诊断编码定义。排除非STEMI患者。并发症和预后的患病率以百分比表示。采用多变量逻辑回归分析来研究STEMI与主要结局死亡率及次要结局之间的关联。还对接受经皮冠状动脉介入治疗的STEMI患者进行了亚组分析。
在总计2080795例急性缺血性卒中患者中，0.3%（n = 6275；平均年龄70.5岁，50.1%为女性，69.5%为白人）在住院期间也被诊断为STEMI。其中，STEMI组1775例（28.3%）死亡，非STEMI组76435例（3.7%）死亡。STEMI组最常见的并发症是急性肾损伤、颅内出血和室性心律失常。所有次要结局均与STEMI诊断相关（优势比[OR]，3.19[95%置信区间，2.82 - 3.6]；P≤0.001）。STEMI与死亡率相关（OR，8.37[95%置信区间，7.25 - 9.66]；P≤0.001）和颅内出血相关（OR，2.23[95%置信区间，1.84 - 2.70]；P≤0.001）。14.3%的STEMI亚组患者接受了经皮冠状动脉介入治疗。经皮冠状动脉介入治疗与死亡率无关（OR，0.93[95%置信区间，0.6 - 1.43]；P = 0.7），与颅内出血无关（OR，1.54[95%置信区间，0.93 - 2.56]；P = 0.1）。
急性缺血性卒中合并STEMI的患者死亡率更高。急性缺血性卒中合并STEMI亚组患者的经皮冠状动脉介入治疗与死亡率和颅内出血几率增加无关。
