Endovascular Treatment of Acute Ischemic Stroke After Cardiac Interventions in the United States.
JAMA Neurol
; 81(3): 264-272, 2024 Mar 01.
Article
em En
| MEDLINE
| ID: mdl-38285452
ABSTRACT
Importance Ischemic stroke is a serious complication of cardiac intervention, including surgery and percutaneous procedures. Endovascular thrombectomy (EVT) is an effective treatment for ischemic stroke and may be particularly important for cardiac intervention patients who often cannot receive intravenous thrombolysis. Objective:
To examine trends in EVT for ischemic stroke during hospitalization of patients with cardiac interventions vs those without in the United States. Design, Setting, andParticipants:
This cohort study involved a retrospective analysis using data for 4888 US hospitals from the 2016-2020 National Inpatient Sample database. Participants included adults (age ≥18 years) with ischemic stroke (per codes from the International Statistical Classification of Diseases, Tenth Revision, Clinical Modification), who were organized into study groups of hospitalized patients with cardiac interventions vs without. Individuals were excluded from the study if they had either procedure prior to admission, EVT prior to cardiac intervention, EVT more than 3 days after admission or cardiac intervention, or endocarditis. Data were analyzed from April 2023 to October 2023. Exposures Cardiac intervention during admission. Main Outcomes andMeasures:
The odds of undergoing EVT by cardiac intervention status were calculated using multivariable logistic regression. Adjustments were made for stroke severity in the subgroup of patients who had a National Institutes of Health Stroke Scale (NIHSS) score documented. As a secondary outcome, the odds of discharge home by EVT status after cardiac intervention were modeled.Results:
Among 634â¯407 hospitalizations, the mean (SD) age of the patients was 69.8 (14.1) years, 318â¯363 patients (50.2%) were male, and 316â¯044 (49.8%) were female. A total of 12â¯093 had a cardiac intervention. An NIHSS score was reported in 218â¯576 admissions, 216â¯035 (34.7%) without cardiac intervention and 2541 (21.0%) with cardiac intervention (P < .001). EVT was performed in 23â¯660 patients (3.8%) without cardiac intervention vs 194 (1.6%) of those with cardiac intervention (P < .001). After adjustment for potential confounders, EVT was less likely to be performed in stroke patients with cardiac intervention vs those without (adjusted odds ratio [aOR], 0.27; 95% CI, 0.23-0.31), which remained consistent after adjusting for NIHSS score (aOR, 0.28; 95% CI, 0.22-0.35). Among individuals with a cardiac intervention, receiving EVT was associated with a 2-fold higher chance of discharge home (aOR, 2.21; 95% CI, 1.14-4.29). Conclusions and Relevance In this study, patients hospitalized with ischemic stroke and cardiac intervention may be less than half as likely to receive EVT as those without cardiac intervention. Given the known benefit of EVT, there is a need to better understand the reasons for lower rates of EVT in this patient population.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Isquemia Encefálica
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Acidente Vascular Cerebral
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Procedimentos Endovasculares
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AVC Isquêmico
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adolescent
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Adult
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Aged
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Female
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Humans
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Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
JAMA Neurol
Ano de publicação:
2024
Tipo de documento:
Article