EVT Less Likely in Patients With Ischemic Stroke After Cardiac Intervention

Patients hospitalized with ischemic stroke with vs without cardiac intervention may be less likely to receive endovascular treatment (EVT), according to study results published in JAMA Neurology.

There is currently a knowledge gap regarding the use of EVT treatment for stroke after cardiac interventions. Therefore, for the study, researchers used data from National Inpatient Sample (NIS) to determine rates of EVT in stroke hospitalizations with vs without cardiac intervention.

Eligible study participants were adults with a history of hospitalization for ischemic stroke, diagnosed using the International Classification of Diseases (ICD) codes. The study exposure was cardiac intervention during hospital admission. Primary study outcome was undergoing EVT; secondary outcomes included discharge after cardiac intervention.

A total of 634,407 stroke hospitalizations, with 12,093 patients (1.9%) with a comorbid cardiac intervention and 218,576 (34.5%) with a National Institutes of Health Stroke Scale (NIHSS) score, were included in the analysis. Of those with an available NIHSS score, 216,035 (34.7%) did not have cardiac intervention. The study population was a mean age of 68.8; 50.2% were men. Median time from hospitalization to cardiac intervention was 1 day. Overall, 23,854 patients (3.8% without a cardiac intervention and 1.6% with a cardiac intervention) received EVT.

Patients with stroke with vs without cardiac intervention were less likely to receive EVT (odds ratio [OR], 0.27; 95% CI, 0.23-0.31), even after adjustment for NIHSS score (OR, 0.28; 95% CI, 0.22-0.35).

Among patients with an NIHSS score of greater than 10, EVT was less likely to be performed in patients with vs without cardiac intervention (OR, 0.27; 95% CI, 0.21-0.35).

The researchers found that the adjusted probability of EVT without cardiac intervention was 3.8% (95% CI, 3.8%-3.9%). With cardiac interventions, including open heart surgery and cutaneous cardiac procedures, the probability of EVT was lower at 0.8% (95% CI, 0.6%-1.0%) and 1.4% (95% CI, 1.2%-1.7%), respectively.

The association between cardiac intervention and NIHSS score was found to be significant (P =.01). In patients with ischemic stroke with an NIHSS score of greater than 15, the odds of receiving EVT were higher in those without vs with cardiac intervention (24.2% [95% CI, 23.8%-24.7%] vs 9.9% [95% CI, 7.5%-12.3%], respectively).

Among patients with cardiac intervention and an NIHSS score, EVT was associated with increased odds of hospital discharge (OR, 2.21; 95% CI, 1.14-4.29).

“[P]atients hospitalized with ischemic stroke and cardiac intervention may be less than half as likely to receive EVT as those without cardiac intervention,” the researchers wrote. They concluded, “Given the known benefit of EVT, there is a need to better understand the reasons for lower rates of EVT in this patient population.”

Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the authors’ disclosures.