RT Journal Article
SR Electronic
T1 In-Hospital Outcomes and Recurrence of Acute Ischemic Stroke in Patients With Solid Organ Malignancy
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e393
OP e401
DO 10.1212/WNL.0000000000200601
VO 99
IS 4
A1 Garg, Aayushi
A1 Chopra, Saurav
A1 Starr, Matthew
A1 Rocha, Marcelo
A1 Dawod, Judy
A1 Leira, Enrique
A1 Shaban, Amir
YR 2022
UL http://n.neurology.org/content/99/4/e393.abstract
AB Background and Objectives The aim of this work was to evaluate the influence of solid organ malignancies on the in-hospital outcomes and recurrent strokes among patients hospitalized with acute ischemic stroke (AIS).Methods Adult hospitalizations with a primary diagnosis of AIS were identified from the Nationwide Readmissions Database from 2016 to 2018. Logistic regression was used to compare the differences in the use of acute stroke interventions and clinical outcomes in patients with and without malignancy. Survival analysis was used to evaluate the risk of readmission due to recurrent stroke after discharge.Results There were 1,385,840 hospitalizations due to AIS (mean ± SD age 70.4 ± 14.0 years, female 50.2%). Of these, 50,553 (3.7%) had a concurrent diagnosis of solid organ malignancy. The 5 most common malignancies included lung cancer (24.6%), prostate cancer (13.2%), breast cancer (9.3%), pancreatic cancer (6.5%), and colorectal cancer (6.2%). After adjustment for baseline differences, patients with malignancy were more likely to have intraparenchymal hemorrhage (odds ratio [OR] 1.11, 95% CI 1.04–1.19), in-hospital mortality (OR 2.15, 95% CI 2.04–2.28), and discharge disposition other than to home (OR 1.70, 95% CI 1.64–1.75). Patients with malignancy were less likely to receive IV thrombolysis (tissue plasminogen activator [tPA]) and were more likely to undergo mechanical thrombectomy (MT). Among the subgroups of patients treated with tPA or MT, the outcomes were comparable between patients with and without malignancy, except patients with lung cancer remained at a higher risk of mortality and adverse disposition despite these acute stroke interventions. Patients with malignancy were at a higher risk of readmission due to recurrent AIS within 1 year of discharge (hazards ratio 1.18, 95% CI 1.11–1.25), and this risk was driven specifically by the lung and pancreatic cancers.Discussion While patients with malignancy generally have worse in-hospital outcomes compared to those without, there is considerable variation in these outcomes according to the different cancer types and the use of acute stroke interventions. The use of tPA and MT is generally safe for eligible patients with an underlying malignancy. Patients with lung and pancreatic cancers have a higher early risk of recurrent stroke and might need more intensive surveillance and careful institution of the optimal secondary prevention measures.AIS=acute ischemic stroke; aOR=adjusted odds ratio; HR=hazards ratio; ICD-10=International Statistical Classification of Diseases and Related Health Problems, 10th revision; IPH=intraparenchymal hemorrhage; MT=mechanical thrombectomy; NRD=Nationwide Readmissions Database; SAH=subarachnoid hemorrhage; SASI=Stroke Administrative Severity Index; tPA=tissue plasminogen activator