Prevalence and In-Hospital Outcomes Associated with Cardiomyopathy Subtypes in Patients with Acute Ischemic Stroke
Abstract Body: Introduction: Cardiomyopathy (CM) can occur in patients hospitalized with acute ischemic stroke (AIS). The epidemiology of AIS and concomitant CM subtypes is not well-described. Methods: Adult hospitalizations in the National Inpatient Sample (NIS) from 2018-2020 with diagnosis of AIS and concomitant CM were characterized by CM etiologies using International Classification of Diseases-10 codes. Demographic characteristics and clinical outcome rates were computed among patients with each CM subtype. The outcomes of interest are detailed in Table 1. Further statistical analyses within CM etiology subgroups were not performed given that the encoded subgroups were not mutually exclusive. Results: Of 1,918,985 weighted AIS hospitalizations, there were 144,875 (7.6%) patients with concomitant CM diagnosis, one-third due to ischemic etiology and two-thirds were non-ischemic (CM etiologies not mutually exclusive,Table 1). Patients with CM etiologies such as ischemic and amyloid-induced CM were older (mean ages 70.5 and 72.3 years, respectively) versus those with peripartum and sarcoidosis-related CM (mean ages 33.5 and 48.5 years, respectively). There were sex differences, as patients with concomitant ischemic CM were more likely to be male (71%) versus those with concomitant stress CM (24.9%). Patients with stress CM (72%) and ischemic CM (68%) identified as White, and those with sarcoid-induced (88%) and peripartum (54%) CM were mostly Black. Intracardiac thrombus was detected in decreasing order by CM subtype: drug-induced (13.6%), alcohol-induced (7.7%), dilated (6.2%), restrictive (5.9%), and ischemic (5.2%). Circulatory support was most common with restrictive CM (2.4% IABP). Thrombolysis use was most frequent in patients with peripartum (18%), dilated (9.3%), drug-induced (8.8%), and ischemic CM (8.2%). EVT rates in decreasing order by CM subtype were: Chagas-associated, wet Beriberi, and sarcoidosis-induced CMs (88-100%), drug-induced (10.1%), and stress-induced (7.7%). Stress-induced CM was associated with highest in-hospital mortality rate (17%) and lowest frequency of routine discharge (18%). Conclusions: We describe the epidemiology of CM subtypes among patients hospitalized with AIS, the cardiac and stroke-related procedures that these patients undergo, and their clinical outcomes. Understanding the demographic and in-hospital outcomes specific to each CM etiology may provide insight into multidisciplinary management of this vulnerable population.
Mcnamara, Katelyn
( Yale University
, Guilford
, Connecticut
, United States
)
Sharma, Richa
( Yale School of Medicine
, Hamden
, Connecticut
, United States
)
Peyravi, Reza
( Yale University
, Guilford
, Connecticut
, United States
)
Parikh, Ohm
( Yale University
, Guilford
, Connecticut
, United States
)
Tirschwell, David
( HARBORVIEW MEDICAL CENTER
, Seattle
, Washington
, United States
)
Bhatt, Deepak
( Mount Sinai Fuster Heart Hospital
, Scarsdale
, New York
, United States
)
Furie, Karen
( Alpert Medical School of Brown University
, Providence
, Rhode Island
, United States
)
Kasner, Scott
( University of Pennsylvania School of Medicine
, Philadelphia
, Pennsylvania
, United States
)
Merkler, Alexander
( Feil Family Brain & Mind Res Inst
, New York
, New York
, United States
)
Otite, Fadar
( SUNY Upstate Medical University
, Syracuse
, New York
, United States
)
Author Disclosures:
Katelyn McNamara:DO NOT have relevant financial relationships
| Richa Sharma:DO NOT have relevant financial relationships
| Reza Peyravi:No Answer
| Ohm Parikh:DO NOT have relevant financial relationships
| David Tirschwell:DO have relevant financial relationships
;
Consultant:AbbVie:Past (completed)
; Research Funding (PI or named investigator):Abbott:Active (exists now)
| Deepak Bhatt:DO have relevant financial relationships
;
Advisor:Angiowave, Bayer, Boehringer Ingelheim, CellProthera, Cereno Scientific, Elsevier Practice Update Cardiology, High Enroll, Janssen, Level Ex, McKinsey, Medscape Cardiology, Merck, MyoKardia, NirvaMed, Novo Nordisk, PhaseBio, PLx Pharma, Stasys:Active (exists now)
; Other (please indicate in the box next to the company name):Honoraria cont: Journal of the American College of Cardiology (Guest Editor; Associate Editor), K2P (Co-Chair, interdisciplinary curriculum), Level Ex, Medtelligence/ReachMD (CME steering committees), MJH Life Sciences, Oakstone CME (Course Director, Comprehensive Review of Interventional Cardiology), Piper Sandler, Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), WebMD (CME steering committees), Wiley (steering committee);:Active (exists now)
; Other (please indicate in the box next to the company name):Trustee: American College of Cardiology; Unfunded Research: FlowCo.:Active (exists now)
; Other (please indicate in the box next to the company name):Site Co-Investigator: Abbott, Biotronik, Boston Scientific, CSI, Endotronix, St. Jude Medical (now Abbott), Philips, SpectraWAVE, Svelte, Vascular Solutions;:Active (exists now)
; Royalties/Patent Beneficiary:Royalties: Elsevier (Editor, Braunwald’s Heart Disease);:Active (exists now)
; Research Funding (PI or named investigator):Abbott, Acesion Pharma, Afimmune, Aker Biomarine, Alnylam, Amarin, Amgen, AstraZeneca, Bayer, Beren, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, Cardax, CellProthera, Cereno Scientific, Chiesi, CinCor, Cleerly, CSL Behring, Eisai, Ethicon, Faraday Pharmaceuticals, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Garmin, HLS Therapeutics, Idorsia, Ironwood, Ischemix, Janssen, Javelin, Lexicon, Lilly, Medtronic, Merck, Moderna, MyoKardia, NirvaMed, Novartis, Novo Nordisk, Otsuka, Owkin, Pfizer, PhaseBio, PLx Pharma, Recardio, Regeneron, Reid Hoffman Foundation, Roche, Sanofi, Stasys, Synaptic, The Medicines Company, Youngene, 89Bio;:Active (exists now)
; Royalties/Patent Beneficiary:Sotagliflozin (named on a patent for sotagliflozin assigned to Brigham and Women's Hospital who assigned to Lexicon; neither I nor Brigham and Women's Hospital receive any income from this patent);:Active (exists now)
; Other (please indicate in the box next to the company name):Other: Clinical Cardiology (Deputy Editor);:Active (exists now)
; Other (please indicate in the box next to the company name):American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Chair, ACC Accreditation Oversight Committee), Arnold and Porter law firm (work related to Sanofi/Bristol-Myers Squibb clopidogrel litigation), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Canadian Medical and Surgical Knowledge Translation Research Group (clinical trial steering committees), CSL Behring (AHA lecture), Cowen and Company, Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (Editor in Chief, Journal of Invasive Cardiology),:Active (exists now)
; Other (please indicate in the box next to the company name):Data Monitoring Committees: Acesion Pharma, Assistance Publique-Hôpitaux de Paris, Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Boston Scientific (Chair, PEITHO trial), Cleveland Clinic, Contego Medical (Chair, PERFORMANCE 2), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo; for the ABILITY-DM trial, funded by Concept Medical; for ALLAY-HF, funded by Alleviant Medical), Novartis, Population Health Research Institute; Rutgers University (for the NIH-funded MINT Trial);:Active (exists now)
; Consultant:Broadview Ventures, GlaxoSmithKline, Hims, SFJ, Youngene:Active (exists now)
; Individual Stocks/Stock Options:Board of Directors: Angiowave (stock options), Bristol Myers Squibb (stock), DRS.LINQ (stock options), High Enroll (stock):Active (exists now)
; Other (please indicate in the box next to the company name):Board of Directors: American Heart Association New York City, Angiowave (stock options), Bristol Myers Squibb (stock), DRS.LINQ (stock options), High Enroll (stock):Active (exists now)
| Karen Furie:DO have relevant financial relationships
;
Consultant:Janssen/BMS:Active (exists now)
| Scott Kasner:DO have relevant financial relationships
;
Researcher:WL Gore:Active (exists now)
; Consultant:Bristol-Myers Squibb:Active (exists now)
; Researcher:DiaMedica:Active (exists now)
; Researcher:Bayer:Active (exists now)
; Royalties/Patent Beneficiary:UpToDate:Active (exists now)
| Alexander Merkler:No Answer
| Fadar Otite:No Answer
