BackgroundContemporary real‐world data on stroke in patients presenting with ST‐segment–elevation myocardial infarction (STEMI) are scarce.Methods and ResultsWe evaluated the incidence, trends, cause, and predictors of stroke from 2003 to 2019 in 4 large regional STEMI programs in the upper Midwest that use similar transfer and treatment protocols. We also evaluated the long‐term impact of stroke on 5‐year mortality. Multivariate logistic and Cox regression analysis was used to identify variables independently associated with stroke in patients presenting with STEMI and identify variables associated with 5‐year mortality. A total of 12 868 patients presented with STEMI during the study period. Stroke occurred in 98 patients (0.76%). The incidence of stroke remained stable over time (0.5% in 2003, 1.2% in 2019; P‐trend=0.22). Most (75%) of strokes were ischemic, with a median time to stroke symptoms of 14 hours after primary percutaneous coronary intervention (interquartile range, 4–72 hours), which led to a small minority (3%) receiving endovascular treatment and high in‐hospital mortality (18%). On multivariate regression analysis, age (increment of 10 years) (odds ratio [OR], 1.32; 95% CI, 1.10–1.58; P‐value=0.003) and preintervention cardiogenic shock (OR, 2.03; (95% CI, 1.03–3.78; P=0.032)) were associated with a higher risk of in‐hospital stroke. In‐hospital stroke was independently associated with increased risk of 5‐year mortality (hazard ratio, 2.01; 95% CI, 1.13–3.57; P=0.02).ConclusionsIn patients presenting with STEMI, the risk of stroke is low (0.76%). A stroke in patients presenting with STEMI is associated with significantly higher in‐hospital (18%) and long‐term mortality (35% at 5 years). Stroke was associated with double the risk of 5‐year death.

中文翻译：

---

ST 段抬高-心肌梗死患者中风的发病率和长期结局：来自中西部 STEMI 联盟的见解

背景关于 ST 段抬高型心肌梗死 (STEMI) 患者中风的当代真实世界数据很少。方法和结果我们评估了 2003 年至 2019 年在 4 个大型区域 STEMI 项目中的发生率、趋势、原因和预测因素使用类似转移和治疗方案的中西部上游地区。我们还评估了卒中对 5 年死亡率的长期影响。多变量逻辑和 Cox 回归分析用于识别与 STEMI 患者中风独立相关的变量，并识别与 5 年死亡率相关的变量。研究期间共有 12 868 名患者出现 STEMI。98 名患者（0.76%）发生卒中。随着时间的推移，中风的发病率保持稳定（2003 年为 0.5%，2019 年为 1.2%；P-趋势=0.22)。大多数 (75%) 中风是缺血性的，初次经皮冠状动脉介入治疗后出现中风症状的中位时间为 14 小时（四分位距，4-72 小时），这导致一小部分 (3%) 接受血管内治疗和高住院死亡率（18%）。在多元回归分析中，年龄（10 岁增量）（优势比 [OR]，1.32；95% CI，1.10-1.58；P值=0.003）和干预前心源性休克（OR，2.03；（95% CI，1.03） –3.78；P = 0.032)) 与较高的院内卒中风险相关。院内卒中与 5 年死亡率风险增加独立相关（风险比，2.01；95% CI，1.13-3.57；P=0.02)。结论在出现 STEMI 的患者中，卒中风险较低 (0.76%)。出现 STEMI 的患者中风与显着较高的住院（18%）和长期死亡率（5 年时为 35%）相关。中风与双倍的 5 年死亡风险相关。