Predictors of Mortality in Patients Suffering Stroke after Left Heart Catheterization
Presenter
Apas Aggarwal, M.D., Indiana University Health Methodist Hospital, Indianapolis, IN
Apas Aggarwal, M.D., Indiana University Health Methodist Hospital, Indianapolis, IN and Rolf Peter Kreutz, M.D., FSCAI, Indiana University School of Medicine, Indianapolis, IN
Keywords: Complications, Embolic Protection and Hemodynamic support
Background
Stroke remains a significant complication associated with left heart catheterization.
Methods
We performed a retrospective analysis of subjects who suffered a stroke among subjects identified in the multicenter Indiana University Health cardiac cath registry (n=17,840). We categorized stroke as hemorrhagic or ischemic based on review of imaging (CT head and/or MRI brain). Clinical variables and in hospital outcomes were assessed by review of electronic medical records.
Results
We identified 29 patients with in-hospital stroke following cardiac catheterization. Thirteen patients died (44.9%) during the index hospitalization. Patients who died were more likely to have suffered hemorrhagic stroke, whereas survivors were more likely to have suffered ischemic stroke alone (p=0.001). None of the patients underwent catheter based intervention or thrombolysis for treatment of stroke. Patients who died during index hospitalization were more likely to be on Impella or ECMO support (p=0.017). Left heart catheterization access (radial vs femoral; p=0.02) and in-hospital cardiac arrest (p=0.023) were found to be significant predictors of in-hospital mortality following stroke in multivariate logistic regression analysis.
Conclusions
Stroke remains a rare complication associated with cardiac catheterization, but is associated with high in-hospital mortality. Advanced hemodynamic support devices, arterial access, and in-hospital cardiac arrest are associated with poor survival after stroke.