Association Between Myocardial Infarction and In-Hospital Complications in Cervical Spinal Cord Injury: A Retrospective Cohort Study

Abstract

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in individuals with spinal cord injury (SCI), with a particularly high burden in patients with upper cervical spine injuries. Outcomes of SCI in patients with chronic CVD have been the topic of extensive research, but the incidence and impact of myocardial infarction (MI) in the acute post-injury phase are not well established. In this study, we examined the incidence of MI in cervical SCI and its impact on in-hospital complications, mortality, and resource utilization. We conducted a retrospective cohort study using data from the American College of Surgeons Trauma Quality Improvement Program from 2010 to 2020, identifying adult patients (≥16 years) with cervical SCI. MI was identified based on ischemic electrocardiographic changes, troponin elevation greater than three times the upper limit of normal, and physician-documented diagnosis. Outcomes included in-hospital major adverse events, immobility-related adverse events, mortality, total length of stay (LOS), intensive care unit (ICU) LOS, and duration of mechanical ventilation. The association between the development of MI and outcomes in patients with cervical SCI was analyzed using multivariate regression analyses, adjusting for baseline covariates. A total of 39,030 patients with cervical SCI were included, of whom 161 (0.4%) had a history of MI. Patients with MI were older (67 ± 14 vs. 53 ± 19 years, p < 0.001) and had a higher prevalence of hypertension, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, and congestive heart failure (all p < 0.05). MI was associated with significantly increased odds of major adverse events, including acute kidney injury (odds ratio [OR]: 7.2, 95% confidence interval [CI]: 4.4–11.3), acute respiratory distress syndrome (OR: 3.9, 95% CI: 2.2–6.5), cardiac arrest (OR: 5.4, 95% CI: 3.6–8.0), ventilator-associated pneumonia (OR: 3.9, 95% CI: 2.6–5.7), cerebrovascular accident (OR: 3.5, 95% CI: 1.4–7.2), sepsis (OR: 4.9, 95% CI: 2.7–8.1), and unplanned ICU admission (OR: 1.9, 95% CI: 1.1–3.1, all p < 0.05). MI was also associated with increased odds of pressure ulcers (OR: 2.8, 95% CI: 1.7–4.4, p < 0.001). Patients with MI had higher odds of mortality (OR: 3.9, 95% CI: 2.7–5.7, p < 0.001) and significantly prolonged hospital stays, with an increase of 8.5 days (95% CI: 6.0–10.9, p < 0.001) in total LOS, 7.3 days (95% CI: 5.5–9.1, p < 0.001) in ICU LOS, and 6.4 days (95% CI: 3.7–9.2, p < 0.001) on mechanical ventilation. MI in the acute phase of cervical SCI is rare but is associated with significantly worse in-hospital outcomes, prolonged ICU stays, and higher mortality. Given the heightened cardiovascular vulnerability in this population, early recognition and targeted management strategies are warranted to mitigate adverse outcomes.