Keller Karsten, Schmitt Volker H, Hahad Omar, Hobohm Lukas
Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany.
Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany.
J Clin Med. 2024 May 7;13(10):2730. doi: 10.3390/jcm13102730.
Ischemic stroke is the second, and pulmonary embolism (PE) is the third most common cardiovascular cause of death after myocardial infarction. Data regarding risk factors for ischemic stroke in patients with acute PE are limited. Patients were selected by screening the German nationwide in-patient sample for PE (ICD-code I26) and were stratified by ischemic stroke (ICD code I63) and compared. The nationwide in-patient sample comprised 346,586 hospitalized PE patients (53.3% females) in Germany from 2011 to 2014; among these, 6704 (1.9%) patients had additionally an ischemic stroke. PE patients with ischemic stroke had a higher in-hospital mortality rate than those without (28.9% vs. 14.5%, < 0.001). Ischemic stroke was independently associated with in-hospital death (OR 2.424, 95%CI 2.278-2.579, < 0.001). Deep venous thrombosis and/or thrombophlebitis (DVT) combined with heart septal defect (OR 24.714 [95%CI 20.693-29.517], < 0.001) as well as atrial fibrillation/flutter (OR 2.060 [95%CI 1.943-2.183], < 0.001) were independent risk factors for stroke in PE patients. Systemic thrombolysis was associated with a better survival in PE patients with ischemic thrombolysis who underwent cardio-pulmonary resuscitation (CPR, OR 0.55 [95%CI 0.36-0.84], = 0.006). Ischemic stroke did negatively affect the survival of PE. Combination of DVT and heart septal defect and atrial fibrillation/flutter were strong and independent risk factors for ischemic stroke in PE patients. In PE patients with ischemic stroke, who had to underwent CPR, systemic thrombolysis was associated with improved survival.
缺血性中风是继心肌梗死后第二常见的心血管死亡原因，肺栓塞（PE）是第三常见的原因。关于急性PE患者缺血性中风危险因素的数据有限。通过筛查德国全国住院患者样本中的PE（国际疾病分类代码I26）来选择患者，并根据缺血性中风（国际疾病分类代码I63）进行分层并比较。全国住院患者样本包括2011年至2014年德国346,586例住院PE患者（53.3%为女性）；其中，6704例（1.9%）患者还患有缺血性中风。患有缺血性中风的PE患者的院内死亡率高于未患缺血性中风的患者（28.9%对14.5%，<0.001）。缺血性中风与院内死亡独立相关（比值比2.424，95%置信区间2.278 - 2.579，<0.001）。深静脉血栓形成和/或血栓性静脉炎（DVT）合并心脏间隔缺损（比值比24.714[95%置信区间20.693 - 29.517]，<0.001）以及心房颤动/扑动（比值比2.060[95%置信区间1.943 - 2.183]，<0.001）是PE患者中风的独立危险因素。全身溶栓与接受心肺复苏（CPR）的缺血性溶栓PE患者的更好生存相关（比值比0.55[95%置信区间0.36 - 0.84]，=0.006）。缺血性中风对PE患者的生存有负面影响。DVT与心脏间隔缺损以及心房颤动/扑动的组合是PE患者缺血性中风的强且独立的危险因素。在必须接受CPR的缺血性中风PE患者中，全身溶栓与生存改善相关。
