Trends, Predictors and Outcomes of Ischemic Stroke Among Patients Hospitalized with Takotsubo Cardiomyopathy
Temidayo Abe1, Titilope Olanipekun1, Joseph Igwe1
1Department of Medicine, Morehouse School of Medicine, 720 Westview Drive S.W., Atlanta, GA 30310, United States.
Insights
Thrombotic stroke is more common than cardioembolic stroke in takotsubo cardiomyopathy (TCM) patients. Ischemic stroke in TCM is linked to worse outcomes, including higher mortality and increased healthcare costs.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Ischemic stroke in takotsubo cardiomyopathy (TCM) is often attributed to cardioembolic events from left ventricular mural thromboembolism.
- Limited data exist on the incidence and characteristics of thrombotic ischemic stroke in TCM patients.
Purpose of the Study:
- To assess temporal trends in ischemic stroke incidence among hospitalized TCM patients, stratified by stroke subtype (cardioembolic vs. thrombotic).
- To identify predictors of each stroke subtype and their association with atrial fibrillation (AF), ventricular arrhythmias, cardiogenic shock (CS), mortality, length of stay (LOS), and healthcare costs.
Main Methods:
- Analysis of 27,970 patients hospitalized with TCM from the 2008-2017 National Inpatient Sample.
- Stratification of 751 ischemic stroke cases into thrombotic (76%) and cardioembolic (24%) subtypes.
- Use of Cochrane-Armitage test for incidence trends and multivariate regression for risk factor identification.
Main Results:
- The incidence of thrombotic stroke increased from 4.7% to 9.5% (p<0.0001), while cardioembolic stroke remained stable (0.5%-0.7%).
- Peripheral artery disease, prior stroke, and hyperlipidemia predicted thrombotic stroke; CS, AF, and Asian race predicted cardioembolic stroke.
- Both stroke subtypes were associated with higher in-hospital mortality, AF, CS, longer LOS, and increased costs.
Conclusions:
- Thrombotic stroke is more prevalent than cardioembolic stroke in TCM patients.
- Ischemic stroke in TCM is associated with significantly poorer clinical outcomes and increased healthcare resource utilization.
Objectives:
This study assessed the temporal trends in the incidence of ischemic stroke among patients hospitalized with takotsubo cardiomyopathy (TCM) stratified by the subtypes of ischemic stroke (cardioembolic versus thrombotic). Predictors of each stroke subtype, the association with atrial fibrillation (AF), the occurrence of ventricular fibrillation/ventricular tachycardia (VF/VT), cardiogenic shock (CS), in-hospital mortality, length of stay (LOS), and total healthcare cost were also assessed.
Background:
Ischemic stroke in TCM is thought to be primarily cardioembolic from left ventricular mural thromboembolism. Limited data are available on the incidence of thrombotic ischemic stroke in TCM.
Materials And Methods:
We identified 27,970 patients hospitalized with the primary diagnosis of TCM from the 2008 to 2017 National Inpatient Sample, of which 751 (3%) developed ischemic stroke. Of those with ischemic stroke, 571 (76%) had thrombotic stroke while 180 (24%) had cardioembolic stroke. Cochrane armitage test was used to assess the incidence of thrombotic and cardioembolic strokes and multivariate regression was used to identify risk factors associated with each stroke subtype. We compared the incidence of AF, VF/VT, CS, LOS, in-hospital mortality and total cost between hospitalized patients with TCM alone to those with cardioembolic and thrombotic strokes.
Results:
From 2008 - 2017, the incidence of thrombotic stroke (4.7%-9.5% (p< 0.0001) increased while it was unchanged for cardioembolic stroke (0.5%-0.7% P=0.5). In the multivariate regression, peripheral artery disease, prior history of stroke, and hyperlipidemia were significantly associated with thrombotic stroke, while CS, AF, and Asian race (compared to White race) were associated with cardioembolic stroke. Both cardioembolic and thrombotic strokes were associated with higher odds of IHM, AF, CS, longer LOS and increased cost. Trends in in-hospital mortality and the utilization of thrombolysis, cerebral angiography, and mechanical thrombectomy among patients with TCM and ischemic stroke were unchanged from 2008 to 2017.
Conclusion:
Among patients with TCM and ischemic stroke, thrombotic stroke was more common compared to cardioembolic stroke. Ischemic stroke was associated with poorer outcomes, including higher in-hospital mortality and increased healthcare resource utilization in TCM.
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