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

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 Supplement

First Page

B436

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