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

Sri Harsha Patlolla,Allan S Jaffe,Pranathi R Sundaragiri,Saraschandra Vallabhajosyula,Gregory W Barsness,Alejandro A Rabinstein,Wisit Cheungpasitporn,Rajkumar Doshi

doi:10.3390/jcm9092717

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.

Highlights

Intracranial hemorrhage (ICH) is a rare but catastrophic complication in patients with acute myocardial infarction (AMI) [1,2]
Between 1 January 2000 and 31 December 2017, there were a total of 11,622,528 admissions for AMI, of which intracranial hemorrhage (ICH) was noted in 23,422 (0.2%)
Higher proportions of concomitant acute organ failure, cardiac arrest, and cardiogenic shock were seen in AMI admissions complicated by ICH

Summary

Introduction

Intracranial hemorrhage (ICH) is a rare but catastrophic complication in patients with acute myocardial infarction (AMI) [1,2]. Concomitant ICH in AMI is associated with higher in-hospital mortality [5,7,8]. Contemporary data on the burden of ICH in AMI patients is limited. There is a paucity of contemporary data on the burden of intracranial hemorrhage (ICH) complicating acute myocardial infarction (AMI). 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). 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). Conclusions: ICH causes a substantial burden in AMI due to associated higher in-hospital mortality and poor functional outcomes

Methods

Results

Conclusion