Koo Andrew B, Zhou Lily, Hameed Irbaz, Rivier Cyprien A, Clocchiatti-Tuozzo Santiago, Kamel Hooman, Falcone Guido J, Ney John, Sharma Richa, Matouk Charles, Yaghi Shadi, Sheth Kevin Navin, de Havenon Adam
Department of Neurosurgery, Yale School of Medicine, New Haven, CT.
Department of Neurology, University of British Columbia, Vancouver, Canada.
Neurology. 2025 Jul 8;105(1):e213766. doi: 10.1212/WNL.0000000000213766. Epub 2025 Jun 10.
Ischemic stroke following cardiac intervention is a serious complication. However, there are limited data comparing stroke risk and severity among patients undergoing different types of cardiac interventions. We examined the incidence of ischemic stroke among patients undergoing cardiac interventions and identified variables associated with risk and severity of ischemic stroke.
We included cardiac intervention hospitalizations for adults within the United States from 2016 to 2021 in the National Inpatient Sample. We constructed a cross-sectional cohort of cardiac intervention hospitalizations comprising all hospitalizations within a Centers for Medicare & Medicaid Services-defined "Cardiac Surgery" Diagnosis-Related Group. The exposure was category of cardiac intervention, and primary outcome was ischemic stroke in any coding position. After survey weighting, we examined the frequency and factors associated with ischemic stroke, stroke severity, and inpatient mortality. A secondary analysis was performed in a subset of patients with documented NIH Stroke Scale (NIHSS).
After survey weighting, among 6,083,899 cardiac intervention hospitalizations (mean age: 67.8 years, 34.5% female), ischemic stroke was diagnosed in 75,280 (1.24%). A higher risk of stroke was associated with female sex (vs male, adjusted odds ratio [OR] 1.25, 95% CI 1.20-1.29), age 75 or older (vs 18-54, OR 1.33, 95% CI 1.23-1.42), and non-Hispanic Black ethnicity (vs White, OR 1.32, 95% CI 1.24-1.39). Compared with percutaneous interventions, open cardiac surgery was associated with higher incidence of stroke (adjusted OR 2.47, 95% CI 2.39-2.55) and the strokes were significantly more severe (NIHSS median: 5 vs 3, mean 8.7 vs 5.6, respectively, < 0.001). Among patients undergoing a cardiac intervention, the rate of ischemic stroke increased from 1.10% in 2016 to 1.33% in 2021 ( < 0.001) and ischemic stroke increased the risk of in-hospital death 5-fold (OR 5.07, 95% CI 4.77-5.39).
Ischemic stroke during hospitalizations for cardiac interventions in the United States varies by type of intervention and shows an increasing trend from 2016 to 2021. Cardiac intervention patients sustaining an ischemic stroke are 5 times as likely to have in-hospital death as those without stroke. Further research is needed to identify high-risk populations that could benefit from specific postoperative monitoring strategies and/or specific therapeutic interventions.
心脏介入术后发生缺血性卒中是一种严重的并发症。然而，比较不同类型心脏介入患者卒中风险和严重程度的数据有限。我们研究了接受心脏介入治疗患者的缺血性卒中发生率，并确定了与缺血性卒中风险和严重程度相关的变量。
我们纳入了2016年至2021年美国国家住院患者样本中成年患者的心脏介入住院病例。我们构建了一个心脏介入住院病例的横断面队列，包括医疗保险和医疗补助服务中心定义的“心脏手术”诊断相关组内的所有住院病例。暴露因素为心脏介入类别，主要结局为任何编码位置的缺血性卒中。经过调查加权后，我们研究了与缺血性卒中、卒中严重程度和住院死亡率相关的频率和因素。对一部分有美国国立卫生研究院卒中量表（NIHSS）记录的患者进行了二次分析。
经过调查加权后，在6083899例心脏介入住院病例（平均年龄：67.8岁，34.5%为女性）中，75280例（1.24%）被诊断为缺血性卒中。女性（与男性相比，调整后的优势比[OR]为1.25，95%CI为1.20-1.29）、75岁及以上（与18-54岁相比，OR为1.33，95%CI为1.23-1.42）以及非西班牙裔黑人种族（与白人相比，OR为1.32，95%CI为1.24-1.39）与卒中风险较高相关。与经皮介入相比，心脏直视手术与更高的卒中发生率相关（调整后的OR为2.47，95%CI为2.39-2.55），且卒中明显更严重（NIHSS中位数：分别为5对3，平均值为8.7对5.6，P<0.001）。在接受心脏介入治疗的患者中，缺血性卒中发生率从2016年的1.10%上升至2021年的1.33%（P<0.001），缺血性卒中使住院死亡风险增加了5倍（OR为5.07，95%CI为4.77-5.39）。
在美国，心脏介入住院期间发生的缺血性卒中因介入类型而异，且在2016年至2021年呈上升趋势。发生缺血性卒中的心脏介入患者住院死亡的可能性是未发生卒中患者的5倍。需要进一步研究以确定可能从特定的术后监测策略和/或特定的治疗干预中获益的高危人群。
