Abstract Body: Background
Migraine with aura (MA) is recognized as an independent risk factor for acute ischemic stroke (AIS). However, the short-term risk of stroke, particularly within 90 days of hospitalization, has not been thoroughly evaluated on a national scale. This study aims to address this gap by examining the association between MA and 90-day AIS readmission.
Methods
Using the National Readmission Database between 2016 and 2019, we identified patients admitted with a principal or non-principal diagnosis of migraine. The reference group for analysis contained all adult patients admitted during the study period without migraine. The primary outcome was subsequent AIS admission within 90 days. Diagnoses were identified using standard ICD-10-CM codes. A multivariable Cox regression model was employed to assess the risk of AIS readmission risk in patients with MA, adjusted for significant cardiovascular risk factors. Interaction analyses were conducted to determine whether traditional cardiovascular risk factors influenced the association between MA and subsequent AIS risk.
Results
Among 106,608,073 patients (mean age 46.48, 57.86% female) admitted during the study period, 1,711,841 (1.61%) patients were admitted with any migraine diagnosis and 101,278 (0.10%) were admitted with MA. Within 90 days, 411,850 (0.39%) patients had a subsequent admission for AIS. After adjusting for sex, coronary artery disease, atrial fibrillation, hypertension, hyperlipidemia, diabetes mellitus, and smoking, patients with MA demonstrated an elevated risk for 90-day AIS (adjusted hazard ratio [aHR] 1.76, 95% CI 1.56-1.99, p < 0.001). Migraine without aura was not associated with increased AIS risk (aHR 1.02, 95% CI 0.84-1.23, p=0.846). Significant interactions were observed with age, sex, hypertension, and atrial fibrillation (Figure).
Conclusions
In this large patient cohort, migraine with aura was associated with an increased risk of AIS readmission within 90 days, particularly in patients without traditional cardiovascular risk factors. These findings underscore the need for potentially more aggressive stroke prevention strategies in patients with MA. Future research should investigate the pathomechanisms underlying this association.