Shahreyar M, et al. - This research was executed in order to identify the risk factors and outcomes associated with ischemic stroke (IS) and intracranial hemorrhage (ICH) in patients with left ventricular assist device (LVAD). A prominent rise was noted in the risk of IS and ICH with LVAD due to the increasing comorbidity burden. It was determined that the incidence of IS and ICH increased the mortality 4- and 18-fold, respectively. In LVAD patients with IS, renal disease, liver disease and abnormal coagulation profile were discovered to be independent predictors of mortality.

Methods

• From the U.S. Nationwide Inpatient Sample (NIS) database, experts selected all patients >18 years of age with an LVAD between 2007 to 2011.
• They undertook a comparative analysis of patients with a discharge diagnosis of IS to those without IS.
• Subjects with a discharge diagnosis of ICH were contrasted against candidates without ICH in a separate analysis.
• A multivariate regression model was used to investigate the trends, predictors and outcomes of IS and ICH.

Results

• Among 17,323 discharges with a primary diagnosis of heart failure with LVAD, 624 (3.6%) patients presented with a co-diagnosis of IS and 387 (2.2%) patients with a co-diagnosis of ICH.
• A rise was reported in the discharge diagnosis of heart failure with LVAD from 946 to 5,540 between 2007 to 2011.
• However, the proportion of patients with IS was found to be approximately 3.4%, alongside a decrease in incidence of ICH from 3.8% in 2007 to a plateau of around 2.2% in the following years.
• Increasing Charlson Comorbidity Index (CCI) score served as an independent predictor of IS and ICH, after adjusting for potential confounders.
• In the IS group, the in-hospital mortality was disclosed to be four-fold higher (odds ratio: 4.2; 95% CI: 2.3-7.6; P < 0.0001) and 18-fold higher in the ICH group (OR: 18; 95% CI: 9-34, P < 0.0001).
• The independent predictors of mortality were revealed to be as follows in LVAD patients with IS: Renal disease (OR: 5.3; CI: 1.3-22.1; P=0.02), liver disease (OR: 4.9; CI: 1.1-21.2; P=0.03) and abnormal coagulation profile (OR: 4.8; CI: 1.6-14.4; P=0.01).
• In LVAD patients with ICH, trends were illustrated towards the speculation of mortality via the presence of diabetes mellitus (OR 4.3, P=0.1) and liver disease (or 2.8, P=0.2), which, however, did not reach statistical significance.