In-Hospital Outcomes and Recurrence of Acute Ischemic Stroke in Patients With Solid Organ Malignancy

Aayushi Garg; Saurav Chopra; Matthew Starr; Marcelo Rocha; Judy Dawod; Enrique Leira; Amir Shaban

doi:10.1212/WNL.0000000000200601

In-Hospital Outcomes and Recurrence of Acute Ischemic Stroke in Patients With Solid Organ Malignancy

Neurology. 2022 Apr 29;10.1212/WNL.0000000000200601. doi: 10.1212/WNL.0000000000200601. Online ahead of print.

Authors

Aayushi Garg¹, Saurav Chopra², Matthew Starr³, Marcelo Rocha³, Judy Dawod³, Enrique Leira⁴, Amir Shaban⁴

Affiliations

¹ Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA aayushi-garg@uiowa.edu.
² Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA.
³ Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA.
⁴ Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA.

PMID: 35487697
DOI: 10.1212/WNL.0000000000200601

Abstract

Objective: 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 2016-2018. Logistic regression was used to compare the differences in the utilization 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 1385840 hospitalizations due to AIS (mean±SD age 70.4±14.0 years, female 50.2%). Of these, 50553 (3.7%) had a concurrent diagnosis of solid organ malignancy. The five 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 (IPH) [odds ratio (OR): 1.11, 95% confidence interval (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 intravenous thrombolysis (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 specifically driven by the lung and pancreatic cancers.

Conclusion: While patients with malignancy generally have worse in-hospital outcomes as 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.