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

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.

Management and Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Uninsured Compared With Privately Insured Individuals

“…22 Demographic characteristics, hospital characteristics, acute organ failure, mechanical circulatory support, cardiac procedures, and noncardiac organ support use were identified for all admissions using previously used methodologies from our group. 23–39…”

“…22 Demographic characteristics, hospital characteristics, acute organ failure, mechanical circulatory support, cardiac procedures, and noncardiac organ support use were identified for all admissions using previously used methodologies from our group. [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The primary outcome was the in-hospital mortality in uninsured AMI-CS admissions compared with private insured individuals. Secondary outcomes included temporal trends in admissions, use of coronary angiography, PCI, MCS, use of donot-resuscitate (DNR) status, palliative care referrals, hospitalization costs, length of hospital stay and discharge disposition in uninsured and privately insured individuals with AMI-CS.…”

Prehospital misdiagnosis of acute cerebral disease for acute coronary syndrome: a retrospective study

“…Recent investigations on ICH concomitant to ACS reveal its rareness (0.2-0.4%) but also point out the poorer overall outcome [21,22]. In both studies patients with concomitant ICH received more antiaggregant drugs.…”

Traumatic Brain Injury With Concomitant Myocardial Infarction: A Clinical Dilemma

“…Cardiac catheterization may be performed without antithrombotic or antiplatelet use in cases of hemodynamic instability or STEMI after acute intracerebral hemorrhage [12]. Patlolla et al reported that most patients with acute MI with intracranial hemorrhage less often required coronary angiography, percutaneous coronary intervention, or coronary artery bypass grafting as compared to those without intracranial hemorrhage [13].…”