In-Hospital acute ischemic stroke following ST-elevation myocardial infarction.

BACKGROUND: In-hospital ischemic stroke following acute ST-elevation myocardial infarction (STEMI) has not been evaluated on a national scale in the United States. METHODS: We used 2003 to 2014 Nationwide Inpatient Sample data to identify adults with a principal diagnosis of STEMI. Patients were divided into two groups defined by presence or absence of ischemic stroke. Clinical characteristics and in-hospital outcomes were studied using relevant statistics. Multiple linear and logistic regression models identified factors associated with ischemic stroke, national trend of in-hospital stroke incidence and in-hospital mortality. RESULTS: Of 1,842,529 STEMI patients hospitalized from 2003 to 2014, 22,268 (1.2%) developed acute in-hospital ischemic stroke. Those with acute strokes were older (age ≥ 65 years: 70% vs 46%), more likely female (51% vs 33%), and had higher rates of atrial fibrillation (28.9% vs 12.2%) and heart failure (40.5% vs 21.1%). Age and gender adjusted incidence of in-hospital ischemic stroke following STEMI remained stable; 1.4% in 2003 and 1.5% in 2014 (P trend = 0.50). However, age and gender adjusted in-hospital mortality declined in STEMI patients with and without in-hospital ischemic stroke [AOR 0.97 (0.95-0.99) P trend = 0.03, and AOR 0.98 (0.98-0.99) P trend < 0.001, respectively]. Patients with ischemic strokes had higher in-hospital mortality (25.7% Vs 7.2%, p < 0.001), [AOR 2.11, 95% CI (1.92-2.32)]. CONCLUSION: In the United States, the incidence of acute in-hospital stroke remained stable from 2003 to 2014 following STEMI with significant decrease of in-hospital mortality trends. Despite slight improvement in mortality trends, in-hospital mortality rates remained elevated calling for interventions to optimize health care delivery.

A Rare Case of an Immunocompetent Male With Zoster Meningitis.

Varicella zoster meningitis is an uncommon complication of herpes zoster, especially in immunocompetent patients. We report a case of a healthy 45-year-old male who developed aseptic meningitis as a result of reactivated varicella zoster virus infection. This case highlights the importance of remaining cognizant of varicella zoster virus as a cause of meningitis in not only the elderly or immunocompromised patients but also in patients who are healthy.

Comparison of the Performance of the NCDR CathPCI Score and Mehran Score to Predict Acute Kidney Injury Post-Percutaneous Coronary Intervention.

Background: A comparison of acute kindney injury (AKI) post-percutaneous coronary intervention (PCI) prediction models is lacking. In this study, we aim to compare the National Cardiovascular Data Registry (NCDR) CathPCI score to the Mehran score in acute coronary syndrome (ACS) vs non-ACS patients. Methods: We included patients who received PCI at our facility between July 2015 and December 2017. We excluded patients without a pre- and/or post-PCI serum creatinine, patients on dialysis at the time of PCI and patients with missing variables required to calculate the predictive scoring model. The primary outcome of this study was AKI post-PCI. Performance of the NCDR CathPCI score and the Mehran score were evaluated by comparing the area under the receiver-operating characteristic curve (AUROC) for both scores. Results: The analysis included 1,507 patients. In non-ACS patients, the Mehran score performed better than the NCDR CathPCI score with AUROC 0.75 and 0.68 respectively (p=0.014). When categorized into 4 risk groups, a Mehran score ≥ 2 had a sensitivity of 86% and a Mehran score of ≥ 3 had a specificity of 83% in non-ACS patients. In contrast, when the NCDR CathPCI score was categorized into risk groups, it was not able to predict the risk of AKI (p=0.78) with sensitivity of 0% for the intermediate and high risk group. In ACS patients, the NCDR CathPCI score was superior in predicting the risk for AKI with AUROC 0.79 versus 0.74 (p=.019). Conclusion: In predicting AKI post-PCI, the NCDR CathPCI score performed better in ACS populations, and the Mehran score performed better in the non-ACS population.