What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ischemic stroke (n=2804819). Intervention: Concurrent STEMI vs. No concurrent STEMI. Primary outcome: In-hospital mortality (OR 7.43, 95% CI 6.44-8.57, p=<0.001).

October 30, 2025Frontiers in Cardiovascular Medicine1 citationsOpen Access

Incidence and outcomes of hospitalized acute ischemic stroke patients with subsequent ST-segment-elevation myocardial infarction

Q: What are the key findings of this study?

Concurrent STEMI in patients hospitalized with acute ischemic stroke was associated with significantly higher in-hospital mortality compared to those without STEMI (24.96% vs 3.10%, OR 7.43).

AMArhum MahmoodHenry Ford Health System SASong Peng AngGeneral Cardiology YQYusuf Kamran QadeerHenry Ford Hospital

Key Result

Concurrent STEMI in patients hospitalized with acute ischemic stroke was associated with significantly higher in-hospital mortality compared to those without STEMI (24.96% vs 3.10%, OR 7.43).

Study Design

Type

Cohort (n=2,804,819)

Multicenter

Yes

PICO

Population

Acute ischemic stroke (n=2,804,819)

Intervention / Comparator

Concurrent STEMI vs No concurrent STEMI

Primary Outcome

In-hospital mortality — OR 7.43 (6.44-8.57), p=<0.001

Main Result

Effect estimate: OR 7.43 (95% CI 6.44-8.57)

Absolute Event Rate: 24.96% vs 3.1%

p-value: p=<0.001

Limitations

Discharge-level administrative database without patient identifiers, preventing distinction of repeat hospitalizations.
Lack of important clinical details such as baseline mRS, NIHSS scores, TOAST classification, and door-to-needle times.
Inability to capture specific thrombolytic agents, timing of administration, or subsequent hemorrhagic complications.
Potential coding misclassification inherent to administrative datasets.

Abstract

Background Patients admitted with acute ischemic stroke (AIS) may experience accompanying acute ST-Segment myocardial infarction after AIS. The cardiovascular risks, incidence, complications, and outcomes of acute STEMI in patients hospitalized with AIS remains underexplored. Methods We evaluated 2,804,819 patients that presented with AIS who were listed in the National Inpatient Sample from 2016 to 2021. AIS and STEMI were defined according to the ICD-10 Diagnostic Codes. Patients with Non-STEMI were excluded. The risk of specific complications and outcomes were expressed as percentages. Multivariable logistic regression analysis was used to examine the association of STEMI with a primary outcome of mortality and secondary outcomes. The temporal trend of both the incidence of STEMI after AIS as well as the mortality rate between 2016 and 2021 were expressed as percentages over time. Results Of the total ( n = 2,804,819) patients with AIS, 6,550 also had STEMI diagnosed during the hospitalization. Of these, 1,635 (24.96%) died in the STEMI group and 86,810 (3.10%) died in the group without STEMI. All of the secondary outcome measures were significantly associated with a diagnosis of STEMI. STEMI was associated with mortality OR 7.43 (95% CI, 6.44–8.57); P 0.001, cardiogenic shock OR 29.64, (95% CI, 22.64–38.81); P 0.001, cardiac arrest OR, 7.76 (95% CI, 6.01–10.03); P 0.001, and AKI OR 1.96 (95% CI, 1.72–2.23); P 0.001 among other complications. When assessed yearly, the temporal trend of STEMI among AIS patients showed a decrease in frequency from about 0.3% in 2016 to about 0.2% in 2021. Furthermore, comparing the mortality between AIS patients with and without STEMI showed a significant difference with a higher mortality in the AIS with STEMI population. Conclusions Patients admitted with acute ischemic stroke who had STEMI have a significant mortality increase compared to those who did not have STEMI. They also had a significant increase in secondary complications including cardiac arrest, cardiogenic shock, AKI, and need for further medical interventions. Temporally, we have seen a decrease in STEMI after AIS over the interval.

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