Abstract P677: Ischemic Stroke, Depressed Ejection Fraction, and Sinus Rhythm: Prevalence, Practice Patterns, and Outcomes
Sharma, R; Sugeng, L; Sheth, KN; Jasne, A; Baker, A; Mac Grory, BC; Stretz, C; Furie, KL; yaghi, S; Schwamm, LH; Kleindorfer, D; Sucharew, H ...
Published in: Stroke
After WARCEF, there is limited data about the epidemiology and treatment strategies for patients after an acute ischemic stroke (AIS) with existing or new left ventricular cardiomyopathy (CM) and sinus rhythm (SR). We aim to estimate prevalence, describe treatment practice, and analyze antithrombotic strategies.
We calculated the prevalence of CM (ejection fraction or EF ≤40%) and SR among AIS patients with EF measurements and the frequency of anticoagulation upon discharge at Massachusetts General Hospital (MGH), Rhode Island Hospital (RIH), Yale-New Haven Hospital (YNHH), and the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS). We collected longitudinal outcome data for patients with AIS, CM, and SR at RIH and YNHH spanning 2014-2018 and computed the hazard of a combined outcome of AIS, intracranial hemorrhage, major hemorrhage, myocardial infarction, and death up to 12 months after AIS by anticoagulation status.
Of 11,996 AIS patients with documented EF at the 4 sites, 693 had CM and SR (MGH N=333/5481, GCNKSS N=250/3284, RIH N=30/1549, YNHH N=80/1682). The pooled percentage of AIS patients with CM and SR was 5% (95% C.I. 3-7%, I
=96.5%). Mean age was 67 years (SD 14.2), 47.1% were female, 31.9% had pre-stroke CM, and mean NIHSS was 7.1 (SD 7.1). Among survivors, 241 were discharged on anticoagulation, 326 on antiplatelet, and 38 on neither. There was heterogeneity by site in the proportion discharged with an anticoagulant versus an antiplatelet only (MGH 49.8%, GCNKSS 29.6%, RIH 32.3%, YNHH 36.7%, p<0.0001). Patients discharged with an anticoagulant versus antiplatelet were significantly more likely to be male, privately insured, have no history of hypertension, hyperlipidemia, or peripheral arterial disease, have a lower EF, have a mural thrombus, and a higher NIHSS scale. In the longitudinal cohort (N=85, 32 anticoagulated, outcomes=12), patients discharged on anticoagulation were less likely to have a composite outcome (log-rank p=0.0409).
AIS patients have concomitant cardiomyopathy and post-stroke antithrombotic prescription practice varies. Further study is needed to determine the association between post-stroke anticoagulation and subsequent ischemic and hemorrhagic events.
