Intracranial Hemorrhage Complicating Acute Myocardial Infarction: An 18-Year National Study of Temporal Trends, Predictors, and Outcomes

Published on Aug 22, 2020in Journal of Clinical Medicine4.242
· DOI :10.3390/JCM9092717
Sri Harsha Patlolla9
Estimated H-index: 9
(Mayo Clinic),
Pranathi R. Sundaragiri8
Estimated H-index: 8
(Mayo Clinic)
+ 5 AuthorsSaraschandra Vallabhajosyula25
Estimated H-index: 25
(Mayo Clinic)
Sources
Abstract
Background: There is a paucity of contemporary data on the burden of intracranial hemorrhage (ICH) complicating acute myocardial infarction (AMI). This study sought to evaluate the temporal trends, predictors, and outcomes of ICH in AMI. Methods: The National Inpatient Sample (2000–2017) was used to identify adult (>18 years) AMI admissions with ICH. In-hospital mortality, hospitalization costs, length of stay, and measure of functional ability were the outcomes of interest. The discharge destination along with use of tracheostomy and percutaneous endoscopic gastrostomy were used to estimate functional burden. Results: Of a total 11,622,528 AMI admissions, 23,422 (0.2%) had concomitant ICH. Compared to those without, the ICH cohort was on average older, female, of non-White race, had greater comorbidities, and had higher rates of arrhythmias (all p < 0.001). Female sex, non-White race, ST-segment elevation AMI presentation, use of fibrinolytics, mechanical circulatory support, and invasive mechanical ventilation were identified as individual predictors of ICH. The AMI admissions with ICH received less frequent coronary angiography (46.9% vs. 63.8%), percutaneous coronary intervention (22.7% vs. 41.8%), and coronary artery bypass grafting (5.4% vs. 9.2%), as compared to those without (p < 0.001). ICH was associated with a significantly higher in-hospital mortality (41.4% vs. 6.1%; adjusted OR 5.65 (95% CI 5.47–5.84); p < 0.001), longer hospital length of stay, higher hospitalization costs, and greater use of percutaneous endoscopic gastrostomy (all p < 0.001). Among ICH survivors (N = 13, 689), 81.3% had a poor functional outcome at discharge. Conclusions: ICH causes a substantial burden in AMI due to associated higher in-hospital mortality and poor functional outcomes.
References21
Newest
#1Saraschandra Vallabhajosyula (Mayo Clinic)H-Index: 25
#2Malcolm R. Bell (Mayo Clinic)H-Index: 56
Last. Gregory W. Barsness (Mayo Clinic)H-Index: 41
view all 6 authors...
Background: There are limited data on complications in acute myocardial infarction (AMI) admissions receiving extracorporeal membrane oxygenation (ECMO). Methods: Adult (>18 years) admissions with AMI receiving ECMO support were identified from the National Inpatient Sample database between 2000 and 2016. Complications were classified as vascular, lower limb amputation, hematologic, and neurologic. Outcomes of interest included temporal trends, in-hospital mortality, hospitalization costs, and l...
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#1Saraschandra Vallabhajosyula (Mayo Clinic)H-Index: 10
#2Sri Harsha Patlolla (Mayo Clinic)H-Index: 9
Last. Gregory W. Barsness (Mayo Clinic)H-Index: 41
view all 10 authors...
Background: There are few studies evaluating regional disparities in the care of acute myocardial infarction-cardiogenic shock (AMI-CS). Methods and Results: Using the National Inpatient Sample fro...
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#1Anna V. Subramaniam (Mayo Clinic)H-Index: 6
#2Gregory W. Barsness (Mayo Clinic)H-Index: 41
Last. Saraschandra Vallabhajosyula (Mayo Clinic)H-Index: 25
view all 4 authors...
Cardiogenic shock (CS) is associated with hemodynamic compromise and end-organ hypoperfusion due to a primary cardiac etiology. In addition to vasoactive medications, percutaneous mechanical circulatory support (MCS) devices offer the ability to support the hemodynamics and prevent acute organ failure. Despite the wide array of available MCS devices for CS, there are limited data on the complications from these devices. In this review, we seek to summarize the complications of MCS devices in the...
Source
#1Saraschandra Vallabhajosyula (Mayo Clinic)H-Index: 25
#2Shannon M. Dunlay (Mayo Clinic)H-Index: 56
Last. Gregory W. Barsness (Mayo Clinic)H-Index: 41
view all 8 authors...
Abstract Background There are limited data on prolonged invasive mechanical ventilation (IMV) and tracheostomy use in intubated acute myocardial infarction with cardiogenic shock (AMI-CS) patients. Methods Using the National Inpatient Sample, all admissions with AMI-CS requiring IMV between January 1, 2000, and December 31, 2014, were included. Prolonged IMV was defined as IMV use >96 h. Outcomes of interest included temporal trends in use of prolonged IMV and tracheostomy, in-hospital mortality...
Source
#1Saraschandra Vallabhajosyula (Mayo Clinic)H-Index: 25
#2Shannon M. Dunlay (Mayo Clinic)H-Index: 56
Last. Gregory W. Barsness (Mayo Clinic)H-Index: 41
view all 9 authors...
Abstract Background There are limited data on acute noncardiac multiorgan failure in cardiogenic shock complicating acute myocardial infarction (AMI-CS). Objectives The authors sought to evaluate the 15-year national trends, resource utilization, and outcomes of single and multiple noncardiac organ failures in AMI-CS. Methods This was a retrospective cohort study of AMI-CS using the National Inpatient Sample database from 2000 to 2014. Previously validated codes for respiratory, renal, hepatic, ...
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#1Rohan Khera (UTSW: University of Texas Southwestern Medical Center)H-Index: 29
#2Suveen Angraal (Yale University)H-Index: 8
Last. Harlan M. Krumholz (Yale University)H-Index: 218
view all 8 authors...
Importance Publicly available data sets hold much potential, but their unique design may require specific analytic approaches. Objective To determine adherence to appropriate research practices for a frequently used large public database, the National Inpatient Sample (NIS) of the Agency for Healthcare Research and Quality (AHRQ). Design, Setting, and Participants In this observational study of the 1082 studies published using the NIS from January 2015 through December 2016, a representative sam...
Source
#1Connie N. Hess (Duke University)H-Index: 22
#2Eric D. Peterson (Duke University)H-Index: 165
Last. Tracy Y. Wang (Duke University)H-Index: 64
view all 9 authors...
Abstract Background Antithrombotic therapy for acute myocardial infarction (MI) with atrial fibrillation (AF) among higher risk older patients treated with percutaneous coronary intervention (PCI) remains unclear. Objectives This study sought to determine appropriate antithrombotic therapy for acute MI patients with AF treated with PCI. Methods We examined 4,959 patients ≥65 years of age with acute MI and AF who underwent coronary stenting (Acute Coronary Treatment and Intervention Outcomes Netw...
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#1Kenneth W. Mahaffey (Stanford University)H-Index: 117
#2Rebecca Hager (Durham University)H-Index: 2
Last. Lars Wallentin (Uppsala University)H-Index: 143
view all 12 authors...
Methods and Results-—We pooled patient-level data from 4 contemporary antithrombotic therapy trials. Multivariable modeling identified independent predictors of ICH. ICHs were adjudicated by a clinical events committee. Of 37 815 patients, 135 (0.4%) had an ICH. The median (25th, 75th percentiles) follow-up was 332 (184, 434) days but differed across trials. Locations of ICH were intracerebral (50%), subdural (31%), subarachnoid (18.5%), and intraventricular (11%). Independent predictors of ICH ...
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#10Maurice Giroud (University of Burgundy)H-Index: 60
Background and Purpose—Stroke is a serious complication after acute myocardial infarction (AMI) and is closely associated with decreased survival. This study aimed to investigate the frequency, characteristics, and factors associated with in-hospital and postdischarge stroke in patients with AMI. Methods—Eight thousand four hundred eighty-five consecutive patients admitted to a cardiology intensive care unit for AMI, between January 2001 and July 2010. Stroke/transient ischemic attack were colle...
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#1Emil Binsell-Gerdin (Umeå University)H-Index: 2
#2Anna Graipe (Umeå University)H-Index: 4
Last. Thomas Mooe (Umeå University)H-Index: 16
view all 5 authors...
Background/objectives: Hemorrhagic stroke is a rare but serious complication after an acute myocardial infarction (AMI). The aims of our study were to establish the incidence, time trends and predi ...
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Cited By1
Newest
#1Anna V. Subramaniam (Mayo Clinic)H-Index: 6
#2Sri Harsha Patlolla (Mayo Clinic)H-Index: 9
Last. Saraschandra Vallabhajosyula (Mayo Clinic)H-Index: 25
view all 9 authors...
Background The role of race and ethnicity in the outcomes of cardiac arrest (CA) complicating acute myocardial infarction (AMI) is incompletely understood. Methods and Results This was a retrospective cohort study of adult admissions with AMI-CA from the National Inpatient Sample (2012-2017). Self-reported race/ethnicity was classified as White, Black, and others (Hispanic, Asian or Pacific Islander, Native American, Other). Outcomes of interest included in-hospital mortality, coronary angiograp...
Source
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