Acute Ischemic Stroke Risk Following Cardiac Interventions in the United States From 2016 to 2021.

Abstract

Background and objectives: Ischemic stroke following cardiac intervention is a serious complication. However, there are limited data comparing stroke risk and severity among patients undergoing different types of cardiac interventions. We examined the incidence of ischemic stroke among patients undergoing cardiac interventions and identified variables associated with risk and severity of ischemic stroke.

Methods: We included cardiac intervention hospitalizations for adults within the United States from 2016 to 2021 in the National Inpatient Sample. We constructed a cross-sectional cohort of cardiac intervention hospitalizations comprising all hospitalizations within a Centers for Medicare & Medicaid Services-defined "Cardiac Surgery" Diagnosis-Related Group. The exposure was category of cardiac intervention, and primary outcome was ischemic stroke in any coding position. After survey weighting, we examined the frequency and factors associated with ischemic stroke, stroke severity, and inpatient mortality. A secondary analysis was performed in a subset of patients with documented NIH Stroke Scale (NIHSS).

Results: After survey weighting, among 6,083,899 cardiac intervention hospitalizations (mean age: 67.8 years, 34.5% female), ischemic stroke was diagnosed in 75,280 (1.24%). A higher risk of stroke was associated with female sex (vs male, adjusted odds ratio [OR] 1.25, 95% CI 1.20-1.29), age 75 or older (vs 18-54, OR 1.33, 95% CI 1.23-1.42), and non-Hispanic Black ethnicity (vs White, OR 1.32, 95% CI 1.24-1.39). Compared with percutaneous interventions, open cardiac surgery was associated with higher incidence of stroke (adjusted OR 2.47, 95% CI 2.39-2.55) and the strokes were significantly more severe (NIHSS median: 5 vs 3, mean 8.7 vs 5.6, respectively, p < 0.001). Among patients undergoing a cardiac intervention, the rate of ischemic stroke increased from 1.10% in 2016 to 1.33% in 2021 (p < 0.001) and ischemic stroke increased the risk of in-hospital death 5-fold (OR 5.07, 95% CI 4.77-5.39).

Discussion: Ischemic stroke during hospitalizations for cardiac interventions in the United States varies by type of intervention and shows an increasing trend from 2016 to 2021. Cardiac intervention patients sustaining an ischemic stroke are 5 times as likely to have in-hospital death as those without stroke. Further research is needed to identify high-risk populations that could benefit from specific postoperative monitoring strategies and/or specific therapeutic interventions.