Cardiovascular Disease: Cardiovascular Disease |

Trends and Outcomes for In-Hospital Ischemic Stroke in Acute Myocardial Infarction From 2002-2012: An Analysis of Nationwide Inpatient Sample Data FREE TO VIEW

Abhishek Mishra, MD; Harshil Shah
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University of Iowa, Coralville, IA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):72A. doi:10.1016/j.chest.2016.08.080
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SESSION TITLE: Cardiovascular Disease

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Acute Myocardial Infarction (AMI) and Ischemic Stroke (IS) are amongst the major causes of mortality and morbidity in the United States. However, there are limited data with regards to trends and outcomes of in-hospital IS events in AMI hospitalized patients.

METHODS: We reviewed the Healthcare Cost and Utilization Project (HCUP) and National Inpatient Sample (NIS) database from 2002 to 2012 for admission of AMI as a primary diagnosis using International Classification of Diseases, 9th Revision, and Clinical Modification (ICD-9-CM) codes 410.xx. In-hospital IS was defined as the presence of secondary ICD-9-CM codes of 433.xx-437.1. Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting (CABG) were identified by ICD-9-CM procedure codes. We used Cochrane-Armitage trend test and multivariate regression to analyze changes in trends and outcomes.

RESULTS: From 2002-2012, a total of 704,3113 admissions with AMI occurred and 99338 (1.4%) were complicated by in-hospital IS. In trend analysis, overall in-hospital IS incidence decreased modestly; however it increased notably in those who received PCI or CABG. Overall, in-hospital IS was associated with increased odds for in-hospital mortality (Adjusted OR; 95% CI; p-value)(2.83; 2.71-2.96; p<0.01) and discharge to specialized care (4.39; 4.16-4.63; p<0.01). Also, in-hospital mortality trend due to in-hospital IS (adjusted OR increased from 2.79 to 3.47; p<0.01) and discharge to specialized care (adjusted OR increased from 3.92 to 6.27; p<0.01) were increased.

CONCLUSIONS: This study suggests that in-hospital IS in hospitalized AMI patients is associated with significant mortality and morbidity and its trend has increased in patients undergoing PCI or CABG.

CLINICAL IMPLICATIONS: Based on our results, there is significant mortality and morbidity in AMI patients having in-hopsital IS who underwent PCI or CABG. At one end, PCI and CABG provide mortality benefit in patients with AMI but at other end these patients have adverse outcomes. It will be interesting to explore responsible factors in order to improve the outcomes

DISCLOSURE: The following authors have nothing to disclose: Abhishek Mishra, Harshil Shah

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