Incidence and Outcomes of Hospitalized Acute Ischemic Stroke Patients with subsequent ST-Segment-Elevation Myocardial Infarction

Arhum Mahmood¹Song Peng Ang²Yusuf Kamran Qadeer¹Hafeez Ul Hassan Virk³Jonathan Alan Tangsrivimol⁴Iqra Riaz⁵Zhen Wang⁶Mahboob Alam⁷Markus Strauß^8*Chayakrit Krittanawong, MD, FACC⁹

• ¹Henry Ford Hospital, Detroit, United States
• ², Rutgers Health Community Medical Center, New Jersey, United States
• ³Cleveland Medical Center, Cleveland, United States
• ⁴Weill Cornell Medicine, New York, United States
• ⁵Adena Regional Medical Center, Ohio, United States
• ⁶Mayo Clinic, Rochester, United States
• ⁷Baylor College of Medicine, Houston, United States
• ⁸University Muenster, Münster, Germany
• ⁹HumanX, Delaware, United States

Background: 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. Methods: 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. Results: Of the total (n=2,804,819) patients with AIS, 6550 also had STEMI diagnosed during the hospitalization. Of these, 1635 (24.96%) died in the STEMI group and 86810 (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. Conclusions: 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.