TCT-470 Incidence and Clinical Characteristics of Stroke in Patients Presenting With STEMI: Insights From the Midwest STEMI Consortium
Megaly M, Tannenbaum E, Okeson B, Dworak M, Garberich R, Sharkey S, Tannenbaum M, Smith T, Henry T, and Garcia S. TCT-470 Incidence and Clinical Characteristics of Stroke in Patients Presenting With STEMI: Insights From the Midwest STEMI Consortium. J Am Coll Cardiol 2021; 78(19):B193.
J Am Coll Cardiol
Background: Contemporary real-world data on stroke in patients presenting with ST-segment elevation myocardial infarction (STEMI) are scarce.
Methods: We evaluated the incidence and etiology of stroke from 2003 to 2019 in 4 large regional STEMI programs in the upper Midwest that use similar transfer and treatment protocols. We described the clinical characteristics and discharge data of stroke patients.
Results: In total, 12,868 patients presented with STEMI during the study period. Stroke occurred in 98 patients (0.76%). The stroke etiology was ischemic in 74.5%, hemorrhagic in 21.4%, and mixed in 3%. Most of the postprocedural strokes were identified >24 hours after primary percutaneous coronary intervention (PCI) (43%). The median time to stroke symptoms after PCI was 14 hours (interquartile range: 4-72 hours). Stroke occurred before primary PCI in 13% of patients and during the procedure in 5%. On the basis of the review of medical records and neurology adjudication, the stroke etiology was determined to be procedure related, related to anoxic brain injury, or atrial fibrillation in 21%, 10%, and 7.1% of cases, respectively. A stroke after STEMI is associated with significantly higher in-hospital mortality (18%). Approximately 49.2% of patients who had in-hospital strokes were discharged to nursing facilities or assisted living facilities.
Conclusion: In patients presenting with STEMI, the risk for stroke is low (0.76%). One in 5 strokes associated with STEMI was hemorrhagic, and approximately 1 in 10 patients had their strokes before PCI. A stroke after STEMI is associated with significantly higher in-hospital mortality (18%) and half of the survivors were discharged to a facility.