title: The incidence and risk factors of associated acute myocardial infarction (AMI) in acute cerebral ischemic (ACI) events in the United States.
abstract: OBJECTIVE
  To determine the association between myocardial infarction (AMI) and clinical outcome in patients with primary admissions diagnosis of acute cerebral ischemia (ACI) in the US.
  
  
  METHODS
  Data from Nationwide Inpatient Sample (NIS) was queried from 2002-2011 for inpatient admissions of patients with a primary diagnosis of ACI with and without AMI using International Classification of Diseases, Ninth Revision, Clinical Modification coding (ICD-9). A multivariate stepwise regression analysis was performed to assess the correlation between identifiable risk factors and clinical outcomes.
  
  
  RESULTS
  During 10 years the NIS recorded 886,094 ACI admissions with 17,526 diagnoses of AMI (1.98%). The overall cumulative mortality of cohort was 5.65%. In-hospital mortality was associated with AMI (aOR 3.68; 95% CI 3.49-3.88, p≤0.0001), rTPA administration (aOR 2.39 CI, 2.11-2.71, p<0.0001), older age (aOR 1.03, 95% CI, 1.03-1.03, P<0.0001) and women (aOR 1.06, 95% CI 1.03-1.08, P<0.0001). Overall, mortality risk declined over the course of study; from 20.46% in 2002 to 11.8% in 2011 (OR 0.96, 95% CI 0.95-0.96, P<0.0001). Survival analysis demonstrated divergence between the AMI and non-AMI sub-groups over the course of study (log-rank p<0.0001).
  
  
  CONCLUSIONS
  Our study demonstrates that although the prevalence of AMI in patients hospitalized with primary diagnosis of ACI is low, it negatively impacts survival. Considering the high clinical burden of AMI on mortality of ACI patients, a high quality monitoring in the event of cardiac events should be maintained in this patient cohort. Whether prompt diagnosis and treatment of associated cardiovascular diseases may improve outcome, deserves further study.
authors.affiliation: Department of Neurological Surgery, University of Texas Health Sciences Center, San Antonio, Texas, United States of America.
authors.forename: Ali
authors.initials: A
authors.lastname: Seifi
authors.affiliation: Department of Neurological Surgery, University of Texas Health Sciences Center, San Antonio, Texas, United States of America.
authors.forename: Kevin
authors.initials: K
authors.lastname: Carr
authors.affiliation: Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Maltenfort
authors.affiliation: Division of Neuro Critical Care, Capital Institute for Neurosciences, Trenton, New Jersey, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Moussouttas
authors.affiliation: Department of Neurological Surgery, University of Texas Health Sciences Center, San Antonio, Texas, United States of America; Department of Neurology, University of Texas Health Sciences Center, San Antonio, Texas, United States of America.
authors.forename: Lee
authors.initials: L
authors.lastname: Birnbaum
authors.affiliation: Department of Neurological Surgery, University of Texas Health Sciences Center, San Antonio, Texas, United States of America; Department of Neurology, University of Texas Health Sciences Center, San Antonio, Texas, United States of America.
authors.forename: Augusto
authors.initials: A
authors.lastname: Parra
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America.
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America; Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
authors.forename: Rodney
authors.initials: R
authors.lastname: Bell
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America; Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
authors.forename: Fred
authors.initials: F
authors.lastname: Rincon
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000401:mortality; D014481:United States / Q000453:epidemiology