In-Hospital Stroke in Patients with Cardiac Conditions: Do Cardiac Procedures Impact Stroke Outcomes?

BACKGROUND AND AIMS: It is unclear if stroke occurring after cardiac procedures is more severe than stroke associated with cardiac conditions without procedures. We compared in-hospital acute ischemic stroke patients admitted with a cardiac diagnosis who did versus did not undergo cardiac procedures. METHODS: In this retrospective cohort study, we analyzed adults with in-hospital stroke admitted with a primary cardiac diagnosis in Alberta (2018-2022). Patients were categorized into no prior cardiac procedure, cardiac procedure, or cardiac surgery within 30 days of stroke diagnosis. Multivariable logistic regression was used to assess associations between exposure groups and outcomes. RESULTS: Among 499 patients (median age 70 years IQR [62-77], 36.7% women), 116 (23.2%) underwent a cardiac procedure, and 227 (45.5%) underwent cardiac surgery prior to stroke diagnosis. Median time from procedure to stroke diagnosis was 1.75 days (IQR 0.87-3.83). In-hospital mortality was 34.6%, 24.1% and 22.5% in patients with no prior procedure, cardiac procedures and cardiac surgery, respectively. After adjustment for age, sex, facility level and comorbidities, no significant differences were observed in mortality (cardiac procedure vs no procedure: aOR 0.73, 95% confidence interval (CI) 0.40-1.33; cardiac surgery vs no procedure: aOR 0.78, 95% CI 0.42-1.45). Among procedural patients, strokes recognized ≥2 days post-procedure were associated with higher mortality (2-7 days: OR 2.31, [1.18-4.52]; 8-30 days: OR 3.23, [1.59-6.59]). CONCLUSIONS: Adjusted mortality did not differ by cardiac procedural status, although residual confounding is possible. Later stroke recognition after cardiac procedures was associated with higher mortality, identifying a high-risk monitoring window.