Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

《国家中心数据管理与共享系统操作说明书 —— 研究者部分》

Myocardial Infarction is Associated with Increased Stroke Severity, In-hospital Mortality and Complications: Insights from China Stroke Center Alliance Registries Short Title：Myocardial Infarction Increases Stroke Severity

First author：段鸿洲

Corresponding author：莫大鹏，王拥军

ischemic stroke; myocardial infarction; mortality; complications

essential_information

  • Person in charge：段鸿洲
  • Data Sources： CSCA
  • Number of papers：CSCA20210145
  • Published time：2021-10-06

2021-10-06

Published articles

Journal：Journal of the American Heart Association

Publication type: Original Research Article

IF(IF): 5.07

PMID: 34612071 Link To Pubmed Full text Download

Background And Purpose

Prior studies have shown an increased risk of ischemic stroke (IS) after myocardial infarction (MI); however, there are limited studies concerning the characteristics, in-hospital mortality and complications of IS patients with a medical history of MI. We hypothesized that IS patients with a medical history of MI may suffer more severe strokes and have a higher risk of in-hospital mortality and complications than IS patients without a medical history of MI.

Method

Consecutive in-hospital data were extracted from the China Stroke Center Alliance (CSCA) database from August 2015 to July 2019. Patient characteristics, hospital tests, in-hospital mortality and complications were analyzed and compared in IS patients with or without a past history of MI.

Conclusion

IS patients with a medical history of MI have an increased risk of severe stroke, in-hospital mortality and complications. Studies exploring the underlying mechanisms are needed to improve and tailor stroke treatment strategies.

Main results

Of 893,429 IS patients, we identified 81,646 (9.1%) patients with a history of MI (MI group). Compared with IS patients without MI (nMI group), MI group patients were older, had a lower prevalence of current smoking, had a higher prevalence of a relative medical history, and took more medications prior to admission. Compared with the nMI group, the MI group had a higher NIHSS score after onset (4.0 vs 3.0, Hodges-Lehmann estimator 22.5) and a higher proportion of severe strokes (NIHSS score≥15) (7.1% vs 4.4%, ASD=11.6%). In the fully adjusted models, the risk of in-hospital mortality was higher in the MI group (OR 1.74, 95% CI 1.57-1.92, P<0.0001). MI group patients also had a higher risk of complications, including urinary tract infection (OR 1.28, 95% CI 1.2-1.36, P<0.0001), gastrointestinal bleeding (OR 1.29, 95% CI 1.19-1.39, P<0.0001), pneumonia (OR 1.24, 95% CI 1.21-1.28, P<0.0001), depression (OR 1.33, 95% CI 1.24-1.42, P<0.0001), seizure (OR 1.35, 95% CI 1.22-1.49, P<0.0001), atrial fibrillation (OR 1.78, 95% CI 1.71-1.86, P<0.0001), and cardiac or respiratory arrest (OR 1.98, 95% CI 1.78-2.2, P<0.0001).