Abstract WP244: Myocardial Infarction Risk Following Stroke and Cervical Artery Dissection: Multi-State Inpatient Sample Analysis

Abstract

Introduction: Cervical artery dissection (CAD) and acute ischemic stroke (AIS) are key health challenges. We utilized a multi-state database to examine myocardial infarction (MI) risk post stroke or CAD to estimate cardiovascular complication risk. Method: We analyzed State Inpatient Database from New York (2011-2017) and Florida (2011-2019). Adult patients with no head or neck trauma were separated into 4 groups based on diagnoses of AIS, CAD, concurrent AIS and CAD, or a reference group of transient ischemic attack, transient global amnesia, or migraine. Diagnosis identification was based on ICD-9 and ICD-10 CM codes. One-year MI risk was evaluated using Kaplan-Meier survival analysis, parametric accelerated failure time survival analysis, and additional Inverse Probability of Treatment Weighting (IPTW) analysis. Results: 827,761 patients were included (mean age 62.7 years, 61.58% female). Among all patients, 19,755 (2.39%) had MI within one-year: 1.4% of the reference group, 3.4% of the AIS group, 1.5% of the CAD group, and 1.8% of concurrent AIS and CAD group. Compared to the reference group, patients with AIS alone and patients with concurrent CAD and AIS had higher MI risk (hazard ratio [HR] 4.91, 95% CI 4.63-5.21, P < 0.001; HR 1.67, 95% CI 1.02-2.73, P = 0.04, respectively), while patients with CAD alone had no elevated risk (HR 1.17, 95% CI 0.66-2.06, P = 0.60) (Figure). After IPTW adjustment for age, diabetes, heart failure, coronary artery disease and hyperlipidemia, patients with AIS alone still had the highest risk for MI (adjusted HR [aHR] 1.87, 95% CI 1.75-1.99, P < 0.001), followed by patients with concurrent CAD and AIS (aHR 1.26, 95% CI 1.05-1.5, P = 0.012), while patients with CAD had nonsignificant risk (aHR 1.142, 95% CI 0.82-1.58, P = 0.42). Conclusion: This analysis reveals stroke patients are nearly two-fold more likely to have subsequent MI compared to those with CAD. These findings merit validation and may impact clinical evaluation and patient care.