Clinical outcomes and epidemiology of acute ischemic stroke in breast cancer patients admitted to U.S. hospital.

Abstract

e13165 Background: Breast cancer (BCA) patients face an elevated risk of acute ischemic stroke (AIS) due to mechanisms such as cancer-associated hypercoagulability and therapies like tamoxifen. However, data on the epidemiology and clinical impact of AIS in BCA patients remains limited. This study investigates the epidemiology and inpatient outcomes of AIS in BCA patients, addressing a critical gap in current knowledge. Methods: Hospitalizations for BCA were extracted from the National Inpatient Sample (2019–2021) using ICD-10 codes. Patients were stratified based on AIS status, and sociodemographic factors, comorbid conditions, and clinical outcomes were analyzed. The primary outcome was all-cause mortality, while secondary outcomes included complications, length of stay (LOS), and hospitalization costs. Statistical analyses were conducted using STATA version 18, with multivariate regression models employed to evaluate differences in outcomes between the groups. Statistical significance was defined as a p-value < 0.05. Results: We identified 143,590 BCA hospitalizations, of whom 419 (0.29%) had concurrent AIS. AIS patients were older (mean 66.96 vs. 60.43 years, p < 0.001), predominantly insured by Medicare (60.71%, p = 0.0019), and more frequently from households with a median income in the 25th to 50th percentile nationally (34.94%, p = 0.0043). A higher Charlson Comorbidity Index (CCI ≥ 3) was observed in the AIS group (100% vs. 61.3%, p < 0.001). AIS was associated with significantly increased all-cause mortality (aOR 2.54, 95% CI 1.18–5.47) and higher odds of complications, including aspiration pneumonia (aOR 7.60, 95% CI 2.70–21.35), sepsis (aOR 3.75, 95% CI 1.46–9.64), shock (aOR 3.61, 95% CI 1.18–10.98), pulmonary embolism (aOR 6.54, 95% CI 2.62–16.28), deep venous thrombosis (aOR 4.77, 95% CI 2.14–10.62), acute kidney injury (aOR 3.93, 95% CI 2.31–6.69), acute metabolic encephalopathy (aOR 7.16, 95% CI 3.95–12.96), and new-onset seizures (aOR 3.90, 95% CI 1.54–9.89). AIS was further associated with prolonged hospital stays (9.49 vs. 3.63 days; aIRR 2.10, 95% CI 1.59–2.76) and higher costs ($114,862 vs. $69,725; aIRR 1.83, 95% CI 1.29–2.60). No significant differences were found between groups for acute heart failure, acute respiratory failure, or gastrointestinal hemorrhage. Additionally, rates of home health service needs upon discharge were comparable between AIS and non-AIS patients. Conclusions: BCA patients with AIS face significantly higher risks of mortality and adverse outcomes, including severe complications, prolonged hospitalizations, and increased healthcare costs. These findings emphasize the importance of targeted management strategies to mitigate the impact of AIS in this vulnerable population.