Prevalence and Outcome of Cardio-Embolic Stroke Patients Admitted at Referral Neurology Hospital in Bangladesh

Background Stroke is the second leading cause of mortality worldwide; where the majority of stroke is ischemic. Among ischemic stroke, cardio-embolic has both higher severity and mortality. Objective To find out clinical outcomes and determine predictors of mortality related to cardio-embolic stroke. Methodology This prospective cohort study was conducted among patients of acute ischemic stroke of cardiac origin admitted at the National Institute of Neurosciences and Hospital, Bangladesh from 1 st October 2020 to 30 September, 2021. Patients were kept under follow-up to 90 days from discharge. Results A total of 689 ischemic stroke patients were screened, 156 had confirmed Cardio-embolic stroke. So, the frequency of cardio-embolic stroke was 22.64%. Male to female ratio was 1.3:1, mean age of 63 years. Hypertension 119 (76.3%), atrial fibrillation 107 (68.6%), and IHD 40 (25.6%) were most common comorbidities. Interestingly, we found only 23 (14.7%) patients with chronic rheumatic heart diseases. NIH Stroke scale score (median, IQR) during admission was 13 [7- 19]. Overall mortality was 47 (29.9%), among them 30 (19.2%) died within 48 hours of hospital admission while 17 (10.9%) within 90 days of hospital discharge. Modified Rankin score at 90 days was 2 [min 0, max 5] those who survived. Cumulative incidence of recurrent stroke was 9 (7.1%) and incidence of anticoagulant induced hemorrhage were 5 (3.2%) among them. Risk factors associated with mortality (odds ratio, [95% CI], p value) were acute myocardial infarction (1.6 [1.14 - 2.52] , 0.04), raised Troponin (1.89 [1.16-2.99], 0.01), reduced ejection fraction (3.38 [2.17-5.27], <0.001), hypotension (3.12 [2.07 - 4.68], < 0.001), chronic kidney disease (1.82 [1.06 - 3.10], 0.04), raised Creatinine (2.41 [1.52 -3.84], 0.01), raised blood sugar ( 1.82 [1.14 - 2.89], 0.02) , severe stroke (9.45 [3.57 - 25.03] , <0.001), large infarct (53.67 [7.59 - 379.47] , < 0.001), hemorrhagic transformation (4.43 [2.89 - 6.84] , < 0.001) and aspiration pneumonia (1.9 [1.28-2.39], 0.01) . Conclusion Overall frequency, severity, functional disability, and mortality in cardio-embolic stroke are higher. Acute myocardial infarction, severe stroke, presence of hyperglycemia, hypotension, renal impairment, low ejection fraction, large infarct, hemorrhagic transformations, and aspiration pneumonia are both clinically and statistically significantly associated with mortality in cardio-embolic stroke.