Association between benign cardiac tumors and thromboembolic events: Analysis of the 2018-2022 National Inpatient Sample.

Abstract

e24008 Background: Benign cardiac tumors, while rare, represent significant cardiac neoplasms with potential thromboembolic complications. Despite their clinical importance, population-level data examining their association with arterial thromboembolism and the impact of concurrent conditions remain limited. This study aimed to examine this relationship and its effect modification by comorbidity burden and anticoagulation status. Methods: We conducted a retrospective cohort analysis using the 2018-2022 National Inpatient Sample, including all admitted inpatients in the NIS data that were identified to have benign cardiac tumors (ICD-10: D15.1). The primary endpoint was arterial thromboembolism (ICD-10: I74.x). To minimize confounding, we performed propensity score matching (1:4 ratio) using logistic regression, adjusting for demographics (age, sex, race, income quartile), clinical characteristics (Charlson Comorbidity Index, atrial fibrillation), and anticoagulation status. Missing data were handled through multiple imputation. Effect modification was assessed through interaction terms in multivariable logistic regression models. Results: Among 33,905,592 hospitalizations analyzed, 4,776 patients had benign cardiac tumors (0.01%). Median follow-up was throughout hospitalization (mean length of stay: 7.48 vs 5.18 days). Key demographics: mean age 58.4 vs 49.9 years, female 61.5% vs 55.8%, p<0.001. After propensity matching (4,551/4,776 successfully matched), tumor presence independently predicted increased arterial thromboembolism risk (adjusted OR 3.29, 95% CI 1.64-6.60, p=0.001). Stratified analyses revealed highest risk in medium CCI (2-4) patients (aOR 3.52, 95% CI 1.45-8.51, p=0.005) and those with AF on anticoagulation (aOR 5.52, 95% CI 1.36-22.37, p=0.017). Conclusions: In this large retrospective analysis, benign cardiac tumors demonstrated significant independent association with arterial thromboembolism risk, particularly in patients with moderate comorbidity burden and concurrent AF. The persistence of elevated risk despite anticoagulation suggests tumor-specific mechanisms requiring targeted preventive strategies. These findings support enhanced surveillance and risk-stratified management approaches for this unique patient population. Risk of arterial thromboembolism by patient subgroups. Risk Category Odds Ratio (95% CI) P-value Overall Matched Cohort 3.29 (1.64-6.60) 0.001 Medium CCI (2-4) 3.52 (1.45-8.51) 0.005 AF + Anticoagulation 5.52 (1.36-22.37) 0.017 No AF + Anticoagulation 4.86 (1.52-15.54) 0.008 AF = Atrial Fibrillation; CCI = Charlson Comorbidity Index; CI = Confidence Interval.