Abstract
IntroductionPatients with myocardial infarction (MI) are at a higher risk of both ischemic and hemorrhagic cerebrovascular accidents (CVA). Data regarding trends and outcomes of patients hospitalized with MI and coexisting CVA remain scant.HypothesisPatients with MI with coexisting CVA have higher length and cost of hospitalization and higher in-hospital mortality compared to those without CVA.MethodsWe assessed the incidence, trends and outcomes in patients with MI who had a CVA and compared this to patients with MI who did not have a CVA by utilizing nationwide inpatient sample database. Individual trends and outcomes of subarachnoid hemorrhage (SAH), hemorrhagic stroke (HS) and ischemic stroke (IS) were also assessed in patients with MI.ResultsA total of 550,849 patients with a diagnosis of myocardial infarction were included in the analysis, out of which 84,981 patients had a coexisting diagnosis of CVA. The number of patients with coexisting MI and CVA increased significantly from 2005 to 2012 (10% vs 20%, p<0.001). This was mostly driven by an increase in IS which almost doubled from 2005 to 2012 (9.8% vs 19.0%, p<0.001). Patients with coexisting MI and CVA had significantly increased length of stay (11.1 vs 8.3 days, p <0.001), cost of hospitalization ($99,069 vs $70,229, p<0.001) and in-hospital mortality (OR 1.6, p<0.001) when compared to MI patients without CVA. SAH was associated with highest risk of in-hospital mortality (Odds ratio (OR) for SAH 5.0, p<0.001; OR for HS 3.3, p<0.001; OR for IS 1.3, p<0.001).ConclusionThe rates of CVA in patients with MI have increased significantly in the United States. CVA is associated with a longer and costlier hospital stay and a higher in-hospital mortality in patients with MI.