Intracranial Hemorrhage Complicating Acute Myocardial Infarction: An 18-Year National Study of Temporal Trends, Predictors, and Outcomes
Abstract
:1. Introduction
2. Methods
Statistical Analysis
3. Results
4. Discussion
Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
Abbreviations
AMI | Acute myocardial infarction |
CABG | Coronary artery bypass grafting |
HCUP | Healthcare cost and utilization project |
ICD-9CM | International Classification of Diseases-9 Clinical Modification |
ICD-10CM | International Classification of Diseases-10 Clinical Modification |
ICH | Intracranial hemorrhage |
NIS | National/nationwide inpatient sample |
NSTEMI | non-ST-segment elevation myocardial infarction |
PCI | Percutaneous coronary intervention |
STEMI | ST-segment elevation myocardial infarction |
References
- Brass, L.M.; Lichtman, J.H.; Wang, Y.; Gurwitz, J.H.; Radford, M.J.; Krumholz, H.M. Intracranial hemorrhage associated with thrombolytic therapy for elderly patients with acute myocardial infarction. Stroke 2000, 31, 1802–1811. [Google Scholar] [CrossRef] [Green Version]
- Armstrong, P.W.; Gershlick, A.H.; Goldstein, P.; Wilcox, R.; Danays, T.; Lambert, Y.; Sulimov, V.; Ortiz, F.R.; Ostojic, M.; Welsh, R.C.; et al. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N. Engl. J. Med. 2013, 368, 1379–1387. [Google Scholar] [CrossRef] [Green Version]
- Binsell-Gerdin, E.; Graipe, A.; Ögren, J.; Jernberg, T.; Mooe, T. Hemorrhagic stroke the first 30-days after an acute myocardial infarction: Incidence, time trends and predictors of risk. Int. J. Cardiol. 2014, 176, 133–138. [Google Scholar] [CrossRef]
- Fox, K.A.; Carruthers, K.; Steg, P.G.; Avezum, Á.; Granger, C.B.; Montalescot, G.; Goodman, S.G.; Gore, J.M.; Quill, A.L.; Eagle, K.A.; et al. Has the frequency of bleeding changed over time for patients presenting with an acute coronary syndrome? The Global Registry of Acute Coronary Events. Eur. Heart J. 2009, 31, 667–675. [Google Scholar] [CrossRef] [PubMed]
- Hachet, O.; Guenancia, C.; Stamboul, K.; Daubail, B.; Richard, C.; Béjot, Y.; Yameogo, V.; Gudjoncik, A.; Cottin, Y.; Giroud, M.; et al. Frequency and predictors of stroke after acute myocardial infarction. Stroke 2014, 45, 3514–3520. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Westerhout, C.M.; Hernández, A.V.; Steyerberg, E.W.; Bueno, H.; White, H.; Théroux, P.; Moliterno, D.J.; Armstrong, P.W.; Califf, R.M.; Wallentin, L.C.; et al. Predictors of stroke within 30 days in patients with non-ST-segment elevation acute coronary syndromes. Eur. Heart J. 2006, 27, 2956–2961. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Giugliano, R.P.; Giraldez, R.R.; Morrow, D.A.; Antman, E.M.; Gibson, C.M.; Mohanavelu, S.; Murphy, S.A.; McCabe, C.H.; Braunwald, E. Relations between bleeding and outcomes in patients with ST-elevation myocardial infarction in the ExTRACT-TIMI 25 trial. Eur. Heart J. 2010, 31, 2103–2110. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Budaj, A.; Flasinska, K.; Gore, J.M.; Anderson, F.A.; Dabbous, O.H.; Spencer, F.A.; Goldberg, R.J.; Fox, K.A.A.; GRACE Investigators. Magnitude of and risk factors for in-hospital and postdischarge stroke in patients with acute coronary syndromes. Circulation 2005, 111, 3242–3247. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Washington, C.W.; Derdeyn, C.P.; Dacey, R.G.; Dhar, R.; Zipfel, G.J. Analysis of subarachnoid hemorrhage using the nationwide inpatient sample: The NIS-SAH severity score and outcome measure. J. Neurosurg. 2014, 121, 482–489. [Google Scholar] [CrossRef]
- Sandstrom, R.; Mokler, P.J.; Hoppe, K.M. Discharge destination and motor function outcome in severe stroke as measured by the functional independence measure/function-related group classification system. Arch. Phys. Med. Rehabil. 1998, 79, 762–765. [Google Scholar] [CrossRef]
- Raposeiras-Roubín, S.; Abu-Assi, E.; Caneiro Queija, B.; Cobas Paz, R.; D’Ascenzo, F.; Henriques, J.P.S.; Saucedo, J.; Gonzalez-Juanatey, J.; Wilton, S.B.; Kikkert, W.J.; et al. Incidence, predictors and prognostic impact of intracranial bleeding within the first year after an acute coronary syndrome in patients treated with percutaneous coronary intervention. Eur. Heart J. Acute Cardiovasc. Care 2019. [Google Scholar] [CrossRef] [PubMed]
- Vallabhajosyula, S.; Dunlay, S.M.; Prasad, A.; Kashani, K.; Sakhuja, A.; Gersh, B.J.; Jaffe, A.S.; Holmes, D.R., Jr.; Barsness, G.W. Acute noncardiac organ failure in acute myocardial infarction with cardiogenic shock. J. Am. Coll. Cardiol. 2019, 73, 1781–1791. [Google Scholar] [CrossRef] [PubMed]
- Vallabhajosyula, S.; Patlolla, S.H.; Dunlay, S.M.; Prasad, A.; Bell, M.R.; Jaffe, A.S.; Gersh, B.J.; Rihal, C.S.; Holmes, D.R.; Barsness, G.W. Regional variation in the management and outcomes of acute myocardial infarction with cardiogenic shock in the United States. Circ. Heart Fail. 2020, 13, e006661. [Google Scholar] [CrossRef] [PubMed]
- McDonald, R.J.; Cloft, H.J.; Kallmes, D.F. Intracranial hemorrhage is much more common after carotid stenting than after endarterectomy. Stroke 2011, 42, 2782–2787. [Google Scholar] [CrossRef] [Green Version]
- Quan, H.; Sundararajan, V.; Halfon, P.; Fong, A.; Burnand, B.; Luthi, J.C.; Saunders, L.C.; Beck, C.A.; Feasby, T.E.; Ghali, W.A. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med. Care 2005, 43, 1130–1139. [Google Scholar] [CrossRef]
- Vallabhajosyula, S.; Dunlay, S.M.; Kashani, K.; Vallabhajosyula, S.; Vallabhajosyula, S.; Sundaragiri, P.R.; Jaffe, A.S.; Barsness, G.W. Temporal trends and outcomes of prolonged invasive mechanical ventilation and tracheostomy use in acute myocardial infarction with cardiogenic shock in the United States. Int. J. Cardiol. 2019, 285, 6–10. [Google Scholar] [CrossRef]
- Vallabhajosyula, S.; Bell, M.R.; Sandhu, G.S.; Jaffe, A.S.; Holmes, D.R.; Barsness, G.W., Jr. Complications in patients with acute myocardial infarction supported with extracorporeal membrane oxygenation. J. Clin. Med. 2020, 9, 839. [Google Scholar] [CrossRef] [Green Version]
- Khera, R.; Angraal, S.; Couch, T.; Welsh, J.W.; Nallamothu, B.K.; Girotra, S.; Chan, P.S.; Krumholz, H.M. Adherence to methodological standards in research using the national inpatient sample. JAMA 2017, 318, 2011–2018. [Google Scholar] [CrossRef]
- Mahaffey, K.W.; Hager, R.; Wojdyla, D.; White, H.D.; Armstrong, P.W.; Alexander, J.H.; Tricoci, P.; Lopes, R.D.; Ohman, E.M.; Roe, M.T.; et al. Analysis of intracranial hemorrhage in acute coronary syndromes: Incidence, predictors, and clinical outcomes. J. Am. Heart Assoc. 2015, 4, e001512. [Google Scholar] [CrossRef] [Green Version]
- Hess, C.N.; Peterson, E.D.; Peng, S.A.; de Lemos, J.A.; Fosbol, E.L.; Thomas, L.; Bhatt, D.L.; Saucedo, J.F.; Wang, T.Y. Use and outcomes of triple therapy among older patients with acute myocardial infarction and atrial fibrillation. J. Am. Coll. Cardiol. 2015, 66, 616–627. [Google Scholar] [CrossRef] [Green Version]
- Subramaniam, A.V.; Barsness, G.W.; Vallabhajosyula, S.; Vallabhajosyula, S. Complications of temporary percutaneous mechanical circulatory support for cardiogenic shock: An appraisal of contemporary literature. Cardiol. Ther. 2019, 8, 211–228. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Characteristic | ICH (N = 23,422) | No ICH (N = 11,599,106) | p | |
---|---|---|---|---|
Age (Years) | 71.6 ± 12.7 | 67.6 ± 14.2 | <0.001 | |
Female Sex | 45.5 | 39.7 | <0.001 | |
Race | White | 58.1 | 63.6 | <0.001 |
Black | 9.7 | 7.9 | ||
Others a | 32.2 | 28.4 | ||
Primary payer | Medicare | 68.8 | 57.6 | <0.001 |
Medicaid | 6.5 | 6.1 | ||
Private | 18.2 | 27.9 | ||
Others b | 6.5 | 8.4 | ||
Quartile of median household income for zip code | 0–25th | 23.9 | 24.4 | <0.001 |
26th–50th | 27.5 | 27.2 | ||
51st–75th | 23.5 | 24.5 | ||
75th–100th | 25.2 | 23.9 | ||
Charlson Comorbidity Index | 0–3 | 12.3 | 37.6 | <0.001 |
4–6 | 49.2 | 44.5 | ||
≥7 | 38.4 | 17.9 | ||
Comorbidities | Hypertension | 58.0 | 62.5 | <0.001 |
Hyperlipidemia | 28.7 | 47.5 | <0.001 | |
Chronic kidney disease | 11.8 | 11.0 | <0.001 | |
Heart failure | 31.8 | 29.3 | <0.001 | |
Cancer | 7.8 | 7.4 | 0.01 | |
Hospital teaching status and location | Rural | 8.5 | 11.2 | <0.001 |
Urban non-teaching | 36.6 | 39.5 | ||
Urban teaching | 54.9 | 49.3 | ||
Hospital bed-size | Small | 9.6 | 11.2 | <0.001 |
Medium | 24.2 | 25.5 | ||
Large | 66.2 | 63.3 | ||
Hospital region | Northeast | 19.7 | 19.6 | <0.001 |
Midwest | 21.2 | 22.9 | ||
South | 39.1 | 40.1 | ||
West | 20.0 | 17.4 | ||
AMI type | STEMI | 51.9 | 37.1 | <0.001 |
NSTEMI | 48.1 | 62.9 | <0.001 | |
Atrial fibrillation or flutter | 24.3 | 17.4 | <0.001 | |
Supraventricular tachycardia | 1.2 | 0.9 | 0.001 | |
Ventricular tachycardia/fibrillation | 13.8 | 8.0 | <0.001 | |
Multi-organ failure | 30.8 | 9.4 | <0.001 | |
Cardiac arrest | 16.0 | 5.0 | <0.001 | |
Cardiogenic shock | 12.3 | 4.8 | <0.001 | |
Fibrinolytic therapy c | 8.4 | 2.2 | <0.001 | |
Coronary angiography | 40.5 | 63.6 | <0.001 | |
Percutaneous coronary intervention | 25.4 | 41.5 | <0.001 | |
Coronary artery bypass grafting | 5.4 | 9.2 | <0.001 | |
MCS | Total | 8.9 | 4.8 | <0.001 |
IABP | 7.8 | 4.5 | <0.001 | |
Percutaneous MCS | 0.9 | 0.2 | <0.001 | |
ECMO | 0.6 | 0.0 | <0.001 | |
Pulmonary artery catheterization | 1.9 | 1.1 | <0.001 | |
Invasive mechanical ventilation | 36.4 | 5.9 | <0.001 | |
Acute hemodialysis | 1.4 | 0.6 | <0.001 |
Total Cohort (N = 11,622,528) | Odds Ratio | 95% Confidence Interval | p | ||
---|---|---|---|---|---|
Lower Limit | Upper Limit | ||||
Age (years) | ≤75 years | Reference category | |||
>75 years | 0.71 | 0.69 | 0.73 | <0.001 | |
Female sex | 1.08 | 1.05 | 1.11 | <0.001 | |
Race | White | Reference category | |||
Black | 1.23 | 1.18 | 1.29 | <0.001 | |
Others a | 1.26 | 1.23 | 1.30 | <0.001 | |
Primary payer | Medicare | Reference category | |||
Medicaid | 1.36 | 1.29 | 1.44 | <0.001 | |
Private | 1.12 | 1.08 | 1.17 | <0.001 | |
Others b | 1.31 | 1.24 | 1.39 | <0.001 | |
Charlson Comorbidity Index | 0–3 | Reference category | |||
4–6 | 3.89 | 3.72 | 4.07 | <0.001 | |
≥7 | 7.92 | 7.53 | 8.34 | <0.001 | |
Hypertension | 0.81 | 0.79 | 0.84 | <0.001 | |
Hospital teaching status and location | Rural | Reference category | |||
Urban non-teaching | 1.60 | 1.48 | 1.64 | <0.001 | |
Urban teaching | 2.30 | 2.19 | 2.42 | <0.001 | |
Hospital bed-size | Small | Reference category | |||
Medium | 1.19 | 1.14 | 1.26 | <0.001 | |
Large | 1.53 | 1.47 | 1.60 | <0.001 | |
Hospital region | Northeast | Reference category | |||
Midwest | 0.97 | 0.93 | 1.01 | 0.22 | |
South | 1.10 | 1.06 | 1.14 | <0.001 | |
West | 1.10 | 1.06 | 1.15 | <0.001 | |
AMI type | STEMI | Reference category | |||
NSTEMI | 0.46 | 0.45 | 0.47 | <0.001 | |
Cardiac arrest | 1.82 | 1.74 | 1.90 | <0.001 | |
Cardiogenic shock | 0.79 | 0.75 | 0.83 | <0.001 | |
Atrial fibrillation or flutter | 1.11 | 1.08 | 1.15 | <0.001 | |
Supraventricular tachycardia | 1.00 | 0.89 | 1.13 | 0.94 | |
Ventricular tachycardia/fibrillation | 1.03 | 0.98 | 1.07 | 0.22 | |
Fibrinolytic therapy c | 4.28 | 4.07 | 4.49 | <0.001 | |
Coronary angiography | 0.53 | 0.52 | 0.55 | <0.001 | |
Percutaneous coronary intervention | 0.67 | 0.65 | 0.70 | <0.001 | |
Coronary artery bypass grafting | 0.46 | 0.43 | 0.49 | <0.001 | |
Pulmonary artery catheterization | 0.97 | 0.88 | 1.07 | 0.59 | |
Mechanical circulatory support | 1.61 | 1.52 | 1.70 | <0.001 | |
Multi-organ failure | 2.48 | 2.40 | 2.56 | <0.001 |
© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Patlolla, S.H.; Sundaragiri, P.R.; Cheungpasitporn, W.; Doshi, R.; Barsness, G.W.; Rabinstein, A.A.; Jaffe, A.S.; Vallabhajosyula, S. Intracranial Hemorrhage Complicating Acute Myocardial Infarction: An 18-Year National Study of Temporal Trends, Predictors, and Outcomes. J. Clin. Med. 2020, 9, 2717. https://doi.org/10.3390/jcm9092717
Patlolla SH, Sundaragiri PR, Cheungpasitporn W, Doshi R, Barsness GW, Rabinstein AA, Jaffe AS, Vallabhajosyula S. Intracranial Hemorrhage Complicating Acute Myocardial Infarction: An 18-Year National Study of Temporal Trends, Predictors, and Outcomes. Journal of Clinical Medicine. 2020; 9(9):2717. https://doi.org/10.3390/jcm9092717
Chicago/Turabian StylePatlolla, Sri Harsha, Pranathi R. Sundaragiri, Wisit Cheungpasitporn, Rajkumar Doshi, Gregory W. Barsness, Alejandro A. Rabinstein, Allan S. Jaffe, and Saraschandra Vallabhajosyula. 2020. "Intracranial Hemorrhage Complicating Acute Myocardial Infarction: An 18-Year National Study of Temporal Trends, Predictors, and Outcomes" Journal of Clinical Medicine 9, no. 9: 2717. https://doi.org/10.3390/jcm9092717