# Incidence and outcomes of hospitalized acute ischemic stroke patients with subsequent ST-segment-elevation myocardial infarction

## TL;DR

This study finds that patients hospitalized with stroke who also have a heart attack (STEMI) face much higher risks of death and complications compared to those without a heart attack.

## Contribution

The study quantifies the incidence and outcomes of STEMI in hospitalized stroke patients using a large national database.

## Key findings

- STEMI occurred in 0.23% of stroke patients and was strongly linked to higher mortality and complications.
- Mortality was 24.96% in stroke patients with STEMI versus 3.10% without STEMI.
- The incidence of STEMI after stroke decreased from 0.3% in 2016 to 0.2% in 2021.

## Abstract

Patients admitted with acute ischemic stroke (AIS) may experience accompanying acute ST-Segment myocardial infarction after AIS. The cardiovascular risks, incidence, complications, and outcomes of acute STEMI in patients hospitalized with AIS remains underexplored.

We evaluated 2,804,819 patients that presented with AIS who were listed in the National Inpatient Sample from 2016 to 2021. AIS and STEMI were defined according to the ICD-10 Diagnostic Codes. Patients with Non-STEMI were excluded. The risk of specific 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. The temporal trend of both the incidence of STEMI after AIS as well as the mortality rate between 2016 and 2021 were expressed as percentages over time.

Of the total (n = 2,804,819) patients with AIS, 6,550 also had STEMI diagnosed during the hospitalization. Of these, 1,635 (24.96%) died in the STEMI group and 86,810 (3.10%) died in the group without STEMI. All of the secondary outcome measures were significantly associated with a diagnosis of STEMI. STEMI was associated with mortality [OR 7.43 (95% CI, 6.44–8.57); P < 0.001], cardiogenic shock [OR 29.64, (95% CI, 22.64–38.81); P < 0.001], cardiac arrest [OR, 7.76 (95% CI, 6.01–10.03); P < 0.001], and AKI [OR 1.96 (95% CI, 1.72–2.23); P < 0.001] among other complications. When assessed yearly, the temporal trend of STEMI among AIS patients showed a decrease in frequency from about 0.3% in 2016 to about 0.2% in 2021. Furthermore, comparing the mortality between AIS patients with and without STEMI showed a significant difference with a higher mortality in the AIS with STEMI population.

Patients admitted with acute ischemic stroke who had STEMI have a significant mortality increase compared to those who did not have STEMI. They also had a significant increase in secondary complications including cardiac arrest, cardiogenic shock, AKI, and need for further medical interventions. Temporally, we have seen a decrease in STEMI after AIS over the interval.