Prognosis of Acute Ischaemic Stroke Patients with Cancer: A National Inpatient Sample Study

SIMPLE SUMMARY: The impact of cancer on the acute prognosis of stroke patients remains largely unknown. Furthermore, the usage of interventions aiming to restore cerebral blood flow in ischaemic stroke, such as thrombolysis and thrombectomy, remains uncharacterised in cancer patients. We aimed to delineate these relationships using a sample representative of 1,106,045 acute ischaemic stroke admissions across the US between 2015–2017, 3.51% of whom had cancer. We found that non-metastatic and metastatic cancers were associated with significantly increased odds of in-hospital mortality, prolonged hospitalisation and decreased odds of home discharge. We also determined that both thrombolysis and thrombectomy offset the association between non-metastatic cancer and in-hospital mortality. Thrombectomy offset the association between metastatic cancer and in-hospital mortality. We conclude that cancer patients warrant robust stroke prevention, given their increased odds of adverse outcomes. Thrombolysis and thrombectomy should be considered routinely in stroke patients with cancer unless otherwise contraindicated. ABSTRACT: Whilst cancer is a risk factor for acute ischaemic stroke (AIS), its impact on AIS prognosis between metastatic and non-metastatic (MC and NMC) disease is poorly understood. Furthermore, the receipt of intravenous thrombolysis (IVT) and endovascular thrombectomy (ET) and their outcomes is poorly researched. AIS admissions from the National Inpatient Sample (NIS) were included (October 2015–December 2017). Multivariable logistic regressions adjusting for a wide range of confounders analysed the relationship between NMC and MC and AIS in-hospital outcomes (mortality, prolonged hospitalisation >4 days and routine home discharge). Interaction terms with IVT and ET were also computed to explore their impact amongst cancer patients. A total of 221,249 records representative of 1,106,045 admissions were included. There were 38,855 (3.51%) AIS admissions with co-morbid cancer: NMC = 53.78% and MC = 46.22%. NMC was associated with 23% increased odds of in-hospital mortality (odds ratio (95% confidence interval) = 1.23 (1.07–1.42)), which was mainly driven by pancreatic and respiratory cancers. This association was entirely offset by both IVT and ET. MC was associated with two-fold increased odds of in-hospital mortality (2.16 (1.90–2.45)), which was mainly driven by respiratory, pancreatic and colorectal cancers. This association was only offset by ET. Both NMC and MC were significantly associated with prolonged hospitalisation and decreased odds of routine discharge. Cancer patients are at higher odds of acute adverse outcomes after AIS and warrant robust primary prevention. IVT and ET improve these outcomes and should thus be offered routinely unless otherwise contraindicated in this group of stroke patients.