Abstract
Objective: To determine prevalence, mechanism of action, and outcome of stroke with SU.
Background: Illicit substance use (SU) is an important contributor for global disease burden and an increasingly identified risk factor for stroke in young adults. Epidemics, mechanisms of stroke, and outcomes are sparse.
Design/Methods: Retrospective chart review of 264 adults hospitalized with acute stroke, including acute ischemic stroke (AIS), intracranial hemorrhage (ICH), and subarachnoid hemorrhage (SAH), between January 2015 and December 2019 with confirmed urine drug screening (UDS) for SU (excluding cannabis, tobacco, and alcohol). Subjects were compared to 525 SU-negative stroke patients during the same timeframe matched for age (± 5 years) and stroke type. Logistic regression was used to compare mortality and disposition outcome, defined as good (home/acute rehabilitation), or poor (subacute rehabilitation/long term care facility/hospice/death).
Results: Out of 5088 acute strokes, 264 (19%) were substance users, of which 53% were AIS, 34% ICH, and 12% SAH. Illicit drugs used were cocaine (70%), opiates (26%), and the rest were amphetamines, phencyclidine, ecstasy, or multiple substances. Subjects in the cohort were younger as compared to controls, [55.9±10.6 years vs 64.5±14.61 (p<0.001), men [61% vs 47; (p=0.0007)], and Black [67% vs 44%; p=0.000)]. AIS etiology was classified as embolic stroke of unknown origin (ESUS) 41% (n=58), cardioembolic 23% (n=33), and small vessel disease 20% (n=29). Hypertension was the leading cause of ICH (n=66). Aneurysmal SAH occurred in 24. SU was associated with no difference in mortality rate among SU and control groups (SU 11.4% vs 14.1%), or poor discharge disposition (29.9% vs 27.3%).
Conclusions: Patients with acute stroke and SU were younger, mainly men and Black. Majority of AIS were ESUS or cardioembolic, while hypertension was the leading cause of ICH. We found no difference in mortality or disposition outcome in our cohort.
Disclosure: Dr. Hall has nothing to disclose. Dr. Grewal has nothing to disclose. Dr. Quinn has nothing to disclose. Anjali Asthana has received personal compensation for serving as an employee of Rush University Medical Center. Dr. Vargas has nothing to disclose. Dr. Da Silva has nothing to disclose. Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eli Lilly. Dr. Dafer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Anderson, Rasor, and partners.
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