Abstract 9885: Possible Risk Factors of In-Hospital Death Among Acute Ischemic Stroke Patients With Atrial Septal Defect; A Study From the 2019 National Inpatient Sample

Abstract

Introduction: Atrial septal defect (ASD) is one of the most common congenital cardiac defects. It can also allow paradoxical emboli to move into the cerebral vasculature leading to Acute Ischemic Stroke (AIS). As there is a lack of adequate information on the additional risk factors for mortality in ASD patients following AIS, we queried the largest inpatient database in the United States for answers. Methods: Patients with ASD were identified among patients of ages 25 and more admitted with a principal diagnosis of AIS ICD-10 code (I63.x) in 2019 from the National Inpatient Sample(NIS). Various patient characteristics and procedures were also studied. A Multivariate regression model adjusting for several factors allowed our study to further evaluate potential risk factors for mortality among ASD patients. Results: Our study found 551,385 cases of AIS, amongst which 19,670 (3.6%) also had a diagnosis of ASD. ASD patients had a higher risk of requiring mechanical thrombectomy (aOR 1.239, 95% CI 1.167- 1.316, p<0.01) and intravenous tissue plasminogen activator (IV tPA) (aOR 1.177, 95% CI 1.125-1.230, p<0.01). Unfortunately, 1.5% (295 cases) of patients with ASD died. A higher risk of mortality among ASD patients was seen if they had also undergone mechanical thrombectomy (aOR 2.839, 95% CI 2.033-3.936), while a lower risk of mortality was seen among those ages 25-60 (aOR 0.695, 95% CI 0.540-0.894, p<0.01) compared to those above 60, among those who underwent tPA (aOR 0.485, 95% CI 0.306-0.769, p<0.01), smokers (aOR 0.550, 95% CI 0.423-0.715), and those with hyperlipidemia (aOR 0.374, 95% CI 0.290-0.482, p<0.01). A lower overall mortality risk among ASD patients following AIS (1.5% vs 3.8%) was also seen (aOR 0.393, 95% CI 0.349-0.441, p<0.01). Conclusions: While several studies have shown that ASD predisposes to a higher risk of developing AIS, our study found that the risk of mortality among ASD patients following admission for AIS was lower than non-ASD patients. However, mechanical thrombectomy was associated with a higher risk of death among these patients. Further studies to understand the associated reasons, pathways, and methods to improve their outcomes should thus be encouraged.