Presentation Details
| Trends of Acute Ischemic Stroke in Hereditary Hemorrhagic Telangiectasia: A Decade Study Ayobami Olafimihan1, Stanley ozogbo2, Praise fawehinmi3, Gbolahan Olatunji4, Emmanuel Kokori4, Aderinto Nicholas5, Ekrem Turk1, Lina George1, Shaka Hafeez1. 1John H.Stroger Jr Hospital, Chicago, IL, USA.2Mercy Health- St.Elizabeth Hospital, Youngstown, OH, USA.3Southern Illinois University Edwardsville, Chicago, IL, USA.4University of Ilorin, Ilorin, Nigeria.5Ladoke Akintola University of Technology, Ogbomosho, Nigeria |
Abstract
Background: Acute ischemic stroke (AIS) is a recognized complication of hereditary hemorrhagic telangiectasia (HHT). This is mostly attributed to paradoxical embolism in the presence of pulmonary arteriovenous fistulas (PAVF), a cause of pathological right-to-left shunt. Our study aims to establish the incidence trend of AIS in hospitalized patients with HHF in the United States, and the associated sociodemographic. Methods: This is a retrospective study using the Nationwide Inpatient Sample (NIS) database (2010-2019). Using ICD-9 and ICD-10 codes, we identified hospitalized patients with HHF and stratified them based on having a primary diagnosis of AIS. Trend in the incidence of AIS was assessed using the annual percentage change (APC) by joinpoint regression. The groups were compared for socio-demographic differences and comorbidities. Statistical analysis was performed using t-test, univariate and multivariate logistic regression. Results: There was a total of 32,913 admissions in patients with HHT. The incidence rate of acute ischemic stroke in the population was 1.9% (618), and the prevalence of PAVF was 3.2% (1,044). Over the decade, the incidence of AIS was similar (P= 0.6). Majority of HHT patients admitted with AIS were older (65.3 vs 62.2 years; p= 0.024) and had higher (≥3) Charlson comorbidity indices (52.0 vs 28.6%; P<0.001) compared to those without stroke. Both cohorts were similar by being mostly females (59.2 vs 59.8%) and Caucasian (71.3 vs 72.1%) with Medicare coverage (59 vs 59.2%), admitted to urban (94.3 vs 91.07%) and teaching (62.6 vs 62.4%) hospitals. Patient with AIS had higher prevalence of PAVF (9.7 vs 3 %; P<0.001), HTN (44.6 vs 34.3%; p=0.0189) and intracranial hemorrhage (4.9 vs 0.3%; P<0.001). They had lower proportion of obesity (1.6 vs 11.5%; P<0.001) compared to their counterparts without stroke. On multivariate adjusted analysis, patients with PAVF had over triple odds of having AIS compared to those without PAVF (adjusted odds ratio (AOR): 3.6, 95% confidence interval (CI): 1.94-6.77) Conclusion: The incidence of acute ischemic stroke in patients with hereditary hemorrhagic telangiectasia has been unchanged over the decade in view. PAVF is a significant predictor of AIS in HHT patients. Further studies are needed on possible interventions to improve the incidence of AIS in this population.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.