{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T22:27:05Z","timestamp":1793572025055,"version":"4.5.0"},"reference-count":25,"publisher":"SAGE Publications","issue":"23-24","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Neurotrauma"],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"<jats:p>\n                    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 (\u226516 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 \u00b1 14 vs. 53 \u00b1 19 years,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001) and had a higher prevalence of hypertension, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, and congestive heart failure (all\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 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\u201311.3), acute respiratory distress syndrome (OR: 3.9, 95% CI: 2.2\u20136.5), cardiac arrest (OR: 5.4, 95% CI: 3.6\u20138.0), ventilator-associated pneumonia (OR: 3.9, 95% CI: 2.6\u20135.7), cerebrovascular accident (OR: 3.5, 95% CI: 1.4\u20137.2), sepsis (OR: 4.9, 95% CI: 2.7\u20138.1), and unplanned ICU admission (OR: 1.9, 95% CI: 1.1\u20133.1, all\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.05). MI was also associated with increased odds of pressure ulcers (OR: 2.8, 95% CI: 1.7\u20134.4,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001). Patients with MI had higher odds of mortality (OR: 3.9, 95% CI: 2.7\u20135.7,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001) and significantly prolonged hospital stays, with an increase of 8.5 days (95% CI: 6.0\u201310.9,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001) in total LOS, 7.3 days (95% CI: 5.5\u20139.1,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 0.001) in ICU LOS, and 6.4 days (95% CI: 3.7\u20139.2,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    &lt; 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.\n                  <\/jats:p>","DOI":"10.1177\/08977151251367384","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:50:15Z","timestamp":1788173415000},"page":"1961-1968","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Myocardial Infarction and In-Hospital Complications in Cervical Spinal Cord Injury: A Retrospective Cohort Study"],"prefix":"10.1177","volume":"43","author":[{"given":"Vishwathsen","family":"Karthikeyan","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada."},{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Canada."},{"name":"Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Husain","family":"Shakil","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada."},{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Canada."},{"name":"Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambika","family":"Tejpal","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of Toronto, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jetan H.","family":"Badhiwala","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada."},{"name":"Division of Neurosurgery, Sunnybrook Health Sciences Center, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Profant","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Toronto, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armaan K.","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada."},{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Canada."},{"name":"Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher S.","family":"Lozano","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada."},{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Canada."},{"name":"Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Essa","sequence":"additional","affiliation":[{"name":"Division of Orthopedics, Department of Surgery, Shamir Medical Center (Assaf Hoarofeh), Zerifin, Tzrifin, Israel."},{"name":"Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva Y.","family":"Yuan","sequence":"additional","affiliation":[{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingshi","family":"He","sequence":"additional","affiliation":[{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Srbely","sequence":"additional","affiliation":[{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jefferson R.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada."},{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Canada."},{"name":"Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C.","family":"Sklar","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada."},{"name":"Department of Anesthesia, St Michael\u2019s Hospital, Toronto, Canada."},{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3999-7632","authenticated-orcid":false,"given":"Christopher D.","family":"Witiw","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada."},{"name":"Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Toronto, Canada."},{"name":"Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, 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