Incidence and Long‐Term Outcomes of Stroke in Patients Presenting With ST‐Segment Elevation–Myocardial Infarction: Insights From the Midwest STEMI Consortium

Abstract

Background Contemporary real‐world data on stroke in patients presenting with ST‐segment–elevation myocardial infarction (STEMI) are scarce. Methods and Results We evaluated the incidence, trends, cause, and predictors of stroke from 2003 to 2019 in 4 large regional STEMI programs in the upper Midwest that use similar transfer and treatment protocols. We also evaluated the long‐term impact of stroke on 5‐year mortality. Multivariate logistic and Cox regression analysis was used to identify variables independently associated with stroke in patients presenting with STEMI and identify variables associated with 5‐year mortality. A total of 12 868 patients presented with STEMI during the study period. Stroke occurred in 98 patients (0.76%). The incidence of stroke remained stable over time (0.5% in 2003, 1.2% in 2019; P ‐trend=0.22). Most (75%) of strokes were ischemic, with a median time to stroke symptoms of 14 hours after primary percutaneous coronary intervention (interquartile range, 4–72 hours), which led to a small minority (3%) receiving endovascular treatment and high in‐hospital mortality (18%). On multivariate regression analysis, age (increment of 10 years) (odds ratio [OR], 1.32; 95% CI, 1.10–1.58; P ‐value=0.003) and preintervention cardiogenic shock (OR, 2.03; (95% CI, 1.03–3.78; P =0.032)) were associated with a higher risk of in‐hospital stroke. In‐hospital stroke was independently associated with increased risk of 5‐year mortality (hazard ratio, 2.01; 95% CI, 1.13–3.57; P =0.02). Conclusions In patients presenting with STEMI, the risk of stroke is low (0.76%). A stroke in patients presenting with STEMI is associated with significantly higher in‐hospital (18%) and long‐term mortality (35% at 5 years). Stroke was associated with double the risk of 5‐year death.

Myocardial infarction with non-obstructive coronary arteries: a single-center retrospective study by sex and race

“…The inhospital rate of CVA at 1.0% was also unusually high and much higher than the expected rate of 0.05-0.1% with diagnostic coronary angiography 9 . In fact, it was higher than the <1% rate in patients presenting with ST elevation myocardial infarction 10 . One potential explanation for this could be an underlying predisposition to thrombophilia in patients with MINOCA.…”

Survival after Consecutive Myocardial Infarction and Stroke: A Case Report

“…Stroke, as a complication of MI, affects 0.76-3.2% of patients and demonstrates an increasing incidence trend [4][5][6][7]. Patients with STEMI are at a higher risk of stroke compared with patients presenting with non-ST-segment elevation myocardial infarction [18].…”

“…Long term mortality is estimated to be 33-35% [4,9]. Furthermore, about half of patients with both STEMI and stroke are discharged to a nursing facility, and only 60% of them are eventually discharged home [4]. Additionally, stroke is also associated with longer hospital stay, increased hospital readmissions, and consecutively higher cost, which contribute additional burdens to the patient and the whole healthcare system as well [5][6][7].…”

“…MI and stroke share major risk factors, such as obesity, dyslipidaemia, hypertension, diabetes, and smoking [3]. According to different articles, the occurrence of stroke as a complication after MI is noted for 0.76-3.2% patients, with an increasing trend [4][5][6][7]. More than 50% of strokes occur on the first day after admission for MI, and nearly 90% within the first 5 days [8].…”

“…More than 50% of strokes occur on the first day after admission for MI, and nearly 90% within the first 5 days [ 8 ]. Based on different articles, 30–89% of strokes after MI are ischemic [ 4 , 5 , 8 , 9 ]. Two thirds of in-hospital ischemic strokes following MI are cardioembolic origin [ 8 , 9 ].…”