Department of Medicine, Morehouse School of Medicine, 720 Westview Drive S.W., Atlanta, GA 30310, United States.
Department of Medicine, Mount Sinai Hospital, 1500 S California Ave, Chicago, IL 60608, United States.
J Stroke Cerebrovasc Dis. 2021 Oct;30(10):106005. doi: 10.1016/j.jstrokecerebrovasdis.2021.106005. Epub 2021 Jul 28.
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.
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.
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.
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.
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.
本研究评估了因 Takotsubo 心肌病（TCM）住院患者中不同类型缺血性卒中（心源性栓塞型与血栓型）的发病率随时间的变化趋势。评估了每种卒中亚型的预测因素、与心房颤动（AF）的关联、心室颤动/室性心动过速（VF/VT）、心源性休克（CS）、院内死亡率、住院时间（LOS）和总医疗保健费用的发生情况。
TCM 中的缺血性卒中被认为主要是由左心室壁血栓栓塞导致的心源性栓塞。关于 TCM 中血栓性缺血性卒中的发病率数据有限。
我们从 2008 年至 2017 年全国住院患者样本中确定了 27970 例原发性 TCM 住院患者，其中 751 例（3%）发生了缺血性卒中。在发生缺血性卒中的患者中，571 例（76%）为血栓性卒中，180 例（24%）为心源性栓塞性卒中。采用 Cochrane -armitage 检验评估血栓性和心源性栓塞性卒中的发生率，采用多变量回归分析确定与每种卒中亚型相关的危险因素。我们比较了 TCM 单独住院患者与心源性栓塞和血栓性卒中住院患者之间 AF、VF/VT、CS、LOS、院内死亡率和总费用的发生率。
2008 年至 2017 年期间，血栓性卒中的发病率（4.7%-9.5%（p<0.0001）增加，而心源性栓塞性卒中的发病率保持不变（0.5%-0.7%，p=0.5）。多变量回归分析显示，外周动脉疾病、既往卒中史和高脂血症与血栓性卒中显著相关，而 CS、AF 和亚洲种族（与白种人相比）与心源性栓塞性卒中相关。心源性栓塞和血栓性卒中均与更高的院内死亡率、AF、CS、更长的 LOS 和更高的费用相关。2008 年至 2017 年期间，TCM 合并缺血性卒中患者的院内死亡率和溶栓、脑血管造影、机械血栓切除术的应用趋势保持不变。
在因 TCM 合并缺血性卒中的患者中，与心源性栓塞性卒中相比，血栓性卒中更为常见。缺血性卒中与较差的结局相关，包括更高的院内死亡率和 TCM 中更高的医疗资源利用。
