ImportanceIschemic stroke is a serious complication of cardiac intervention, including surgery and percutaneous procedures. Endovascular thrombectomy (EVT) is an effective treatment for ischemic stroke and may be particularly important for cardiac intervention patients who often cannot receive intravenous thrombolysis.ObjectiveTo examine trends in EVT for ischemic stroke during hospitalization of patients with cardiac interventions vs those without in the United States.Design, Setting, and ParticipantsThis cohort study involved a retrospective analysis using data for 4888 US hospitals from the 2016-2020 National Inpatient Sample database. Participants included adults (age ≥18 years) with ischemic stroke (per codes from the International Statistical Classification of Diseases, Tenth Revision, Clinical Modification), who were organized into study groups of hospitalized patients with cardiac interventions vs without. Individuals were excluded from the study if they had either procedure prior to admission, EVT prior to cardiac intervention, EVT more than 3 days after admission or cardiac intervention, or endocarditis. Data were analyzed from April 2023 to October 2023.ExposuresCardiac intervention during admission.Main Outcomes and MeasuresThe odds of undergoing EVT by cardiac intervention status were calculated using multivariable logistic regression. Adjustments were made for stroke severity in the subgroup of patients who had a National Institutes of Health Stroke Scale (NIHSS) score documented. As a secondary outcome, the odds of discharge home by EVT status after cardiac intervention were modeled.ResultsAmong 634 407 hospitalizations, the mean (SD) age of the patients was 69.8 (14.1) years, 318 363 patients (50.2%) were male, and 316 044 (49.8%) were female. A total of 12 093 had a cardiac intervention. An NIHSS score was reported in 218 576 admissions, 216 035 (34.7%) without cardiac intervention and 2541 (21.0%) with cardiac intervention (P < .001). EVT was performed in 23 660 patients (3.8%) without cardiac intervention vs 194 (1.6%) of those with cardiac intervention (P < .001). After adjustment for potential confounders, EVT was less likely to be performed in stroke patients with cardiac intervention vs those without (adjusted odds ratio [aOR], 0.27; 95% CI, 0.23-0.31), which remained consistent after adjusting for NIHSS score (aOR, 0.28; 95% CI, 0.22-0.35). Among individuals with a cardiac intervention, receiving EVT was associated with a 2-fold higher chance of discharge home (aOR, 2.21; 95% CI, 1.14-4.29).Conclusions and RelevanceIn this study, patients hospitalized with ischemic stroke and cardiac intervention may be less than half as likely to receive EVT as those without cardiac intervention. Given the known benefit of EVT, there is a need to better understand the reasons for lower rates of EVT in this patient population.

中文翻译：

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美国心脏介入治疗后急性缺血性中风的血管内治疗

重要性缺血性中风是心脏介入治疗（包括手术和经皮手术）的严重并发症。血管内血栓切除术（EVT）是缺血性卒中的有效治疗方法，对于经常无法接受静脉溶栓的心脏介入患者可能尤其重要。目的探讨美国接受心脏介入治疗的患者与未接受心脏介入治疗的患者住院期间缺血性卒中的 EVT 趋势设计、设置和参与者这项队列研究使用 2016-2020 年国家住院患者样本数据库中 4888 家美国医院的数据进行回顾性分析。参与者包括患有缺血性中风的成年人（年龄≥18岁）（根据代码国际疾病统计分类，第十次修订，临床修改），他们被分为接受心脏介入治疗与未接受心脏介入治疗的住院患者的研究组。如果个体在入院前接受过手术、在心脏介入治疗前进行过 EVT、入院或心脏介入治疗后 3 天以上进行了 EVT，或心内膜炎，则被排除在研究之外。分析了 2023 年 4 月至 2023 年 10 月的数据。暴露入院期间的心脏干预。主要结果和措施使用多变量逻辑回归计算根据心脏干预状态接受 EVT 的几率。对记录有美国国立卫生研究院中风量表 (NIHSS) 评分的患者亚组中的中风严重程度进行了调整。作为次要结果，对心脏介入治疗后根据 EVT 状态出院回家的几率进行了建模。结果 在 634 407 例住院患者中，患者的平均 (SD) 年龄为 69.8 (14.1) 岁，318 363 例患者 (50.2%) 为男性， 316 044 人（49.8%）为女性。共有 12 093 人接受了心脏介入治疗。218 576 例入院患者报告了 NIHSS 评分，其中 216 035 例（34.7%）没有进行心脏介入治疗，2541 例（21.0%）进行了心脏介入治疗（磷< .001）。没有心脏介入治疗的患者中有 23 660 名患者（3.8%）接受了 EVT，而接受心脏介入治疗的患者则有 194 名患者（1.6%）接受了 EVT（磷< .001）。调整潜在的混杂因素后，与未进行心脏介入治疗的卒中患者相比，接受心脏介入治疗的卒中患者进行 EVT 的可能性较小（调整后的比值比 [aOR]，0.27；95% CI，0.23-0.31），在调整 NIHSS 评分后仍保持一致（ aOR，0.28；95% CI，0.22-0.35）。在接受心脏介入治疗的个体中，接受 EVT 出院回家的几率增加 2 倍（aOR，2.21；95% CI，1.14-4.29）。结论和相关性在这项研究中，因缺血性卒中和心脏介入治疗住院的患者可能会出现以下情况：接受 EVT 的可能性不到未进行心脏介入治疗的一半。鉴于 EVT 的已知益处，有必要更好地了解该患者群体中 EVT 发生率较低的原因。