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The Effect of Race on Stroke Incidence and Post-Stroke Mortality - The Stroke Paradox in LVAD Patients

2020; Elsevier BV; Volume: 39; Issue: 4 Linguagem: Inglês

10.1016/j.healun.2020.01.942

1557-3117

Sriram Rao, Vien T. Truong, Eugene S. Chung, W.S. Mazur, D. Goldstien, Ulrich P. Jorde, J. Teuteberg, Steven R. Messé, Chris Hayward, Gregory F. Egnaczyk, Michael A. Acker, S Sreenivas, J. Eduardo Rame,

Heart Failure Treatment and Management

Purpose Stroke is considered one of the major hurdles in applying Left Ventricular Assist Device (LVAD) technology to a broader population, and remains a leading cause of mortality and morbidity despite advances in both technology and management. In the general population, incidence of stroke in African Americans (AA) has been reported to be twice that of their Caucasian counterparts, and the mortality following stroke higher in AA. We sought to assess the effect of race on both rate of stroke, as well as post stroke survival in the LVAD population. Methods Using the publically available NIH INTERMACS data, we identified and assessed stroke rates in a total of 14,573 patients support by continuous flow durable LVAD (cf-LVAD). We performed a univariate analysis based on gender and race, followed by a stepwise multivariate analysis adjusting for 20 commonly reported risk factors for stroke. We also applied Bayesian analyses to determine the significant variables impacting stroke in patients with and without self-reported Black ancestry Results There were 3916 patients with AA ancestry (26.8 %) and 3139 Females (21.5%). The overall stroke rate was 14.9%. There was no difference in the stroke rates between the AA and Caucasian CF-LVAD patients (15.3% vs. 14.7%, p=0.37), but there was an improved stroke free survival in the AA population (Figure 1,p < 0.001). Female patients were found to have an increased risk of stroke when compared to males (HR, 1.30, 95%CI, 1.19-1.43, p<0.01), without any heterogeneity by ethnicity. Post Stroke mortality was higher in the Caucasian population (Figure 2, p = 0.001). Conclusion This study shows that patients with self-reported AA ancestry appears to be protected in regards to the time to first stroke, even when adjusted for gender. After a stroke occurs, AA patients also appear to have better survival when compared to Caucasians. This is paradoxical when compared to the non cf-LVAD population merits and avenue of further investigation into the mechanisms of stroke cf-LVAD patients. Stroke is considered one of the major hurdles in applying Left Ventricular Assist Device (LVAD) technology to a broader population, and remains a leading cause of mortality and morbidity despite advances in both technology and management. In the general population, incidence of stroke in African Americans (AA) has been reported to be twice that of their Caucasian counterparts, and the mortality following stroke higher in AA. We sought to assess the effect of race on both rate of stroke, as well as post stroke survival in the LVAD population. Using the publically available NIH INTERMACS data, we identified and assessed stroke rates in a total of 14,573 patients support by continuous flow durable LVAD (cf-LVAD). We performed a univariate analysis based on gender and race, followed by a stepwise multivariate analysis adjusting for 20 commonly reported risk factors for stroke. We also applied Bayesian analyses to determine the significant variables impacting stroke in patients with and without self-reported Black ancestry There were 3916 patients with AA ancestry (26.8 %) and 3139 Females (21.5%). The overall stroke rate was 14.9%. There was no difference in the stroke rates between the AA and Caucasian CF-LVAD patients (15.3% vs. 14.7%, p=0.37), but there was an improved stroke free survival in the AA population (Figure 1,p < 0.001). Female patients were found to have an increased risk of stroke when compared to males (HR, 1.30, 95%CI, 1.19-1.43, p<0.01), without any heterogeneity by ethnicity. Post Stroke mortality was higher in the Caucasian population (Figure 2, p = 0.001). This study shows that patients with self-reported AA ancestry appears to be protected in regards to the time to first stroke, even when adjusted for gender. After a stroke occurs, AA patients also appear to have better survival when compared to Caucasians. This is paradoxical when compared to the non cf-LVAD population merits and avenue of further investigation into the mechanisms of stroke cf-LVAD patients.