Trends, Predictors and Outcomes of Ischemic Stroke Among Patients Hospitalized with Takotsubo Cardiomyopathy

• Published in: Journal of stroke and cerebrovascular diseases 2021-10, Vol.30 (10), p.106005-106005, Article 106005
• Main Authors: Abe, Temidayo, Olanipekun, Titilope, Igwe, Joseph, Khoury, Mtanis, Busari, Olukayode, Musonge-Effoe, Joffi, Valery, Effoe, Egbuche, Obiora, Mather, Paul, Ghali, Jalal
• Format: Article
• Language: English
• Subjects: Cardioembolic Stroke; Ischemic Stroke; Stress induced cardiomyopathy; Takotsubo cardiomyopathy; Thrombotic Stroke
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2021.106005

•Thrombotic stroke is a more common etiology of stroke among hospitalized patient with TCM compared to cardioembolic stroke.•An increase was noted in the incidence of thrombotic stroke among hospitalized patients with TCM, while it was unchanged for cardioembolic stroke from 2008–2017.•Ischemic stroke (thrombotic and cardioembolic) in TCM was associated with poor outcomes including higher rates of in-hospital mortality, increased utilization of health care resources.•Trends in In-hospital mortality and the utility of thrombolysis, cerebral angiography, and mechanical thrombectomy among patients with TCM and ischemic stroke was unchanged from 2008 to 2017. This study assessed the temporal trends in the incidence of ischemic stroke among patients hospitalized with takotsubo cardiomyopathy (TCM) stratified by the subtypes of ischemic stroke (cardioembolic versus thrombotic). Predictors of each stroke subtype, the association with atrial fibrillation (AF), the occurrence of ventricular fibrillation/ventricular tachycardia (VF/VT), cardiogenic shock (CS), in-hospital mortality, length of stay (LOS), and total healthcare cost were also assessed. Ischemic stroke in TCM is thought to be primarily cardioembolic from left ventricular mural thromboembolism. Limited data are available on the incidence of thrombotic ischemic stroke in TCM. We identified 27,970 patients hospitalized with the primary diagnosis of TCM from the 2008 to 2017 National Inpatient Sample, of which 751 (3%) developed ischemic stroke. Of those with ischemic stroke, 571 (76%) had thrombotic stroke while 180 (24%) had cardioembolic stroke. Cochrane armitage test was used to assess the incidence of thrombotic and cardioembolic strokes and multivariate regression was used to identify risk factors associated with each stroke subtype. We compared the incidence of AF, VF/VT, CS, LOS, in-hospital mortality and total cost between hospitalized patients with TCM alone to those with cardioembolic and thrombotic strokes. From 2008 – 2017, the incidence of thrombotic stroke (4.7%–9.5% (p< 0.0001) increased while it was unchanged for cardioembolic stroke (0.5%–0.7% P=0.5). In the multivariate regression, peripheral artery disease, prior history of stroke, and hyperlipidemia were significantly associated with thrombotic stroke, while CS, AF, and Asian race (compared to White race) were associated with cardioembolic stroke. Both cardioembolic and thrombotic strokes were associated with higher odds of IHM, AF, CS,