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Incidence and clinical outcomes of stroke in ST ‐elevation myocardial infarction and cardiogenic shock
Author(s) -
Pahuja Mohit,
Chehab Omar,
Ranka Sagar,
Mishra Tushar,
Ando Tomo,
Yassin Ahmed S.,
Thayer Katherine L.,
Shah Palak,
Kimmelstiel Carey D.,
Salehi Payam,
Kapur Navin K.
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28919
Subject(s) - medicine , cardiogenic shock , stroke (engine) , cardiology , myocardial infarction , extracorporeal membrane oxygenation , incidence (geometry) , odds ratio , impella , optics , mechanical engineering , physics , engineering
Objective The authors sought to evaluate 10‐year national trends, incidence and clinical outcomes of stroke in CS‐STEMI. Background Stroke is a devastating complication among patients with ST‐elevation myocardial infarction (STEMI). Concomitant cardiogenic shock (CS) may further increase the risk of stroke. Use of percutaneous mechanical circulatory support (pMCS) devices may further increase stroke risk in CS‐STEMI. No studies have evaluated the risk of stroke in contemporary CS‐STEMI. Methods We performed a retrospective cohort study of CS‐STEMI patients from a large U.S. national database between 2005 and 2014. Previously validated codes for stroke were used to identify events of ischemic or hemorrhagic stroke. They were then divided into different groups: without MCS, with intra‐aortic balloon pump, percutaneous ventricular assist device (PVAD, includes Impella or TandemHeart devices), or extracorporeal membrane oxygenation. Results In 172,491 admissions, stroke was noted in 5,613 (3.2%). Between 2005 and 2014, we observed an increase in the events of overall stroke from 3.1% in 2005 to 5.0% in 2014 ( p for the trend <.001). The number of ischemic stroke events (2.4%) was higher than hemorrhagic stroke (0.1%) during the study period. Presence of stroke was associated with higher in‐hospital mortality (40.6 vs. 29.8%, 95% CI adjusted odds ratio: 1.57, 1.44–1.67; p < .0001 among stroke vs. without stroke). Conclusions The incidence of stroke events in CS‐STEMI patients increased between 2005 and 2014, and is associated with higher in‐hospital mortality, length of stay, and cost of hospitalization. The incidence of both hemorrhagic and ischemic stroke was higher with pMCS device use. Stroke prevention is a priority for CS‐STEMI patients.