Reperfusion Therapy for Acute Ischemic Stroke in Cardiomyopathy Patients with Heart Failure: A National Inpatient Sample-based Analysis
Serena Wong1, Brittany Russo1, Aiden Liu2, Maya Pandit2, Fawaz Al-Mufti1
1Westchester Medical Center, 2New York Medical College
Objective:
We aim to investigate the safety of intravenous tissue plasminogen activator (IV tPA), and mechanical thrombectomy (MT) for acute ischemic stroke (AIS), and compare the functional outcome in cardiomyopathy patients with and without heart failure.
Background:
Cardioembolic stroke is the most severe ischemic stroke subtype as it is associated with a high mortality. Hypertrophic and dilated cardiomyopathy are recognized as risk factors for cardioembolic stroke as well as heart failure. The risk of ischemic stroke is 2 to 3-fold higher in patients with heart failure. The pathophysiologic mechanism is thrombus formation resulting from atrial fibrillation or left ventricular hypokinesia. Additionally, the activation of the sympathetic nervous system and/or the renin-angiotensin-aldosterone system in heart failure contributes to platelet aggregation and fibrinolysis dysfunction.
Design/Methods:
In this retrospective study, we utilized the International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD-9/10-CM) to select cardiomyopathy patients with heart failure from the National Inpatient Sample database from 2012 to 2018.
Results:
A higher proportion of patients with cardiomyopathy and heart failure were treated with IV tPA (7.01% vs. 5.63%, p < 0.01) as well as MT (1.77% vs. 1.03%, p < 0.01); however, decompressive hemicraniectomy (0.16% vs. 0.22%, p < 0.01) was found to be lower in this group. Heart failure was a predictor of poor functional outcome (aOR = 1.44; 95% CI 1.41, 1.47; p < 0.01), higher in-hospital mortality (aOR = 1.48; 95% CI 1.43, 1.54; p < 0.01), and extended hospital stay (aOR = 2.05; 95% CI 2.01, 2.09; p < 0.01), but the association between severe cardiomyopathy and poor functional outcome was not significant after propensity-score matching.
Conclusions:
Our study demonstrates that both IV tPA and MT are safe in cardiomyopathy patients, and heart failure is associated with a higher rate of systemic complications, leading to a higher in-hospital mortality and extended hospitalization.