Patient characteristics and clinical outcomes of type 2 myocardial infarction in patients with acute ischemic stroke in the united states

Abstract

Abstract Background Type 2 myocardial infarction (MI) due to supply-demand mismatch may occur as a sequala of acute ischemic stroke (AIS). However, scarce data exits on the patient profiles and the prognostic impact of type 2 MI on outcomes of AIS. Purpose To determine the risk profiles and examine the association of type 2 MI with outcomes and resource utilization in primary AIS hospitalizations. Methods We utilized the Nationwide Readmission Database from October 1st, 2017 to December 31st, 2018 to identify primary AIS hospitalizations with and without type 2 MI in the United States. The International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes I63.x were utilized to identify patients with AIS. Complex samples multivariable logistic and linear regression models were used to determine the predictors of type 2 MI and the association with outcomes (in-hospital mortality, poor functional outcomes [defined as a composite of mortality or discharge to hospice or to a long-term facility], index length of stay, hospital costs, discharge to nursing facility, and 30-day all-cause readmissions). Results Of 587,550 AIS hospitalizations included in this study, 4,182 (0.71%) had type 2 MI. Compared to AIS hospitalization without type 2 MI, those with type 2 MI were older (73 years vs. 70 years; P<0.001), more likely to be females (52% vs. 49.7%; P<0.001), and had a higher prevalence of heart failure (32% vs. 15.5%; P<0.001), atrial fibrillation (38.5% vs. 24.2%; P<0.001), prior myocardial infarction (8.8% vs. 7.7%; P<0.001), valvular heart disease (17% vs. 9.8%; P<0.001), peripheral vascular disease (12.2% vs. 9.2%; P<0.001), chronic kidney disease (24.4% vs. 16.7%; P<0.001), neurological disorders (49.3% vs. 34.6%; P<0.001), drug abuse (4.9% vs. 4.1%; P=0.04), chronic liver disease (2.6% vs. 1.7%; P<0.001), chronic lung disease (18.1% vs. 15.8%; P<0.001), anemia (4.3% vs. 2.8%; P<0.001), and weight loss (9.7% vs. 4.4%; P<0.001). Compared with their counterparts without type 2 MI, AIS with type 2 MI had significantly higher in-hospital mortality, poor functional outcomes, hospital costs, rate of discharge to nursing facility, length of stay, and rate of 30-day all-cause readmissions (Table 1). Heart failure, weight loss, neurological disorders, drug abuse, valvular heart disease, atrial fibrillation, chronic kidney disease, and age (per year) were identified as independent predictors of type 2 MI among AIS hospitalizations (Figure 1). Conclusion Patients with AIS complicated by type 2 MI have a high prevalence of underlying cardiovascular disease. In addition, type 2 MI in patients hospitalized with AIS is associated with poor prognosis and higher resource utilization. Funding Acknowledgement Type of funding sources: None.