TCT-1021 Incidence and Outcomes of Hospitalized Acute Ischemic Stroke Patients with subsequent ST-Segment-Elevation Myocardial Infarction

Document Type

Conference Proceeding

Publication Date

10-28-2025

Publication Title

J Am Coll Cardiol

Keywords

acute kidney failure, adult, assisted circulation, cardiogenic shock, carotid artery surgery, cerebrovascular accident, comorbidity, complication, conference abstract, controlled study, epidemiology, female, heart arrest, high risk population, hospitalization, human, ICD-10, incidence, intubation, major clinical study, male, middle aged, morbidity, mortality, non ST segment elevation myocardial infarction, ST segment elevation myocardial infarction, stroke patient, therapy

Abstract

Background: Acute ischemic stroke (AIS) and ST-segment elevation myocardial infarction (STEMI) are two life-threatening, atherothrombotic conditions with overlapping risk profiles. While their individual pathophysiology is well described, the occurrence of STEMI during AIS hospitalization and its clinical impact remain underexplored. Methods: We analyzed 2,804,819 adult patients hospitalized with AIS from 2016-2021 using the National Inpatient Sample, a nationally representative database. Patients with concomitant STEMI were identified using ICD-10 Diagnostic codes; those with NSTEMI were excluded. The primary outcome was in-hospital mortality. Secondary outcomes included cardiogenic shock, cardiac arrest, acute kidney injury (AKI), procedural interventions, and resource utilization. Multivariable logistic regression adjusted for demographics, comorbidities, and hospital-level variables. Temporal trends were assessed over the 6-year period. Results: Among 2,804,819 AIS admissions, 6,550 (0.23%) had a STEMI during hospitalization. Patients with STEMI had significantly higher in-hospital mortality (24.96% vs 3.10%, p<0.001). STEMI was independently associated with increased odds of mortality (OR 7.43, 95% CI 6.44-8.57), cardiogenic shock (OR 9.64, 95% CI 7.21-12.89), cardiac arrest (OR 7.76, 95% CI 6.01-10.03), and AKI (OR 1.96, 95% CI 1.72-2.23), among other complications. STEMI patients mroe frequently required PCI, mechanical circulatory support, intubation, and had longer hospital stays. From 2016 to 2021, STEMI incidence among AIS patients declined (∼30% to ∼20%), yet mortality in this subgroup remained disproportionately high. Conclusion: STEMI in patients hospitalized with AIS is associated with a seven-fold increased risk of in-hospital mortality and a dramatically worse secondary complications including cardiac arrest, cardiogenic shock, AKI, and need for further medical interventions. Despite a decreasing incidence over time, this overlap syndrome demands urgent clinical recognition and integrated neurologic-cardiac care pathways to improve recognition, management protocols, and interdisciplinary care strategies to mitigate morbidity and mortality in this high-risk population. Categories: ENDOVASCULAR: Stroke, Stroke Prevention, Carotid Intervention

Volume

86

Issue

17

First Page

B436

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