NATIONAL OBSERVATIONS OF ISCHEMIC AND HEMORRHAGIC CEREBROVASCULAR ACCIDENTS (CVA) IN TAKOTSUBO CARDIOMYOPATHY

Abstract

SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Takotsubo Cardiomyopathy (TTC) or stress-induced cardiomyopathy has been speculated to increase the risk of stroke with literature suggesting an incidence ranging up to 7.7% in this population. TTC can occur as a cause or a complication of stroke (CVA) and the temporal relationship between the two events is often unclear. We sought to evaluate the incidence of ischemic vs hemorrhagic CVA in patients diagnosed with TTC. We also sought to assess the comorbidities serving as predictors, the demographics and health care utilization in these groups. METHODS: We queried the National Inpatient Sample (NIS) dataset from 2007 to 2014 to identify a diagnosis of TTC with the International Classification of Disease (ICD) Code 429.83. We then identified the two groups: patients without CVA and those with CVA which was further divided into ischemic CVA with ICD codes 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434x, 436x and hemorrhagic CVA with ICD codes 430.x, 431x, 432x. Multivariate and Chi-square analysis were done by using the statistical software, SAS. RESULTS: A total of 154,880 cases of TTC were diagnosed from the year 2007 to 2014 in the United States, with a 4.3% incidence of CVA with ischemic being 64% of total CVA. Mortality was higher in hemorrhagic CVA patients than ischemic (23.5% vs 16.1%, p < 0.05). Patients with ischemic CVA were more likely to have hypertension (65.3% vs 56.8% p<0.05), renal failure (10.6% vs 6.8% p<0.05) and diabetes (20.3% vs 11.5% p<0.05) than hemorrhagic CVA. There was almost a two-fold rise in patients with Valvular disease in those with both ischemic and hemorrhagic CVA than no stroke (10% vs 9.4% vs 4.6% p<0.05). Interestingly, a higher incidence of hypothyroidism was seen in patients without CVA than those with ischemic and hemorrhagic CVA respectively (17.7% vs 12.7% vs 9.48% p<0.05). Coagulopathy was more associated with hemorrhagic CVA than without CVA (23.6% vs 4.08% p<0.05). Length of stay and cost were higher in both types of CVA. There was an increased proportion of males developing ischemic and hemorrhagic CVA than those without CVA (17.4% and 19.7% vs 12.9% p<0.05). CONCLUSIONS: TTC was associated with a higher incidence of ischemic CVA than hemorrhagic. Preexisting cardiac risk factors were more associated with development of stroke. This included hypertension, diabetes and renal failure. Although females were more likely to have TTC, the proportion that developed CVA dropped in comparison. Outcome measures were worse in hemorrhagic stroke, likely attributed to the disease process itself. CLINICAL IMPLICATIONS: It is prudent to believe an increased risk of stroke in TTC, calling for further prospective trials to evaluate the predictors. By identifying at-risk populations, targeted interventions such as anti-platelet therapy, tighter glycemic control, may be used. DISCLOSURES: No relevant relationships by Ayesha Azmeen, source=Web Response No relevant relationships by ayesha shaik, source=Web Response No relevant relationships by Varun Tandon, source=Web Response