Effect of Comorbidity Burden and Polypharmacy on Poor Functional Outcome in Acute Ischemic Stroke

Abstract

Purpose: Comorbidities and polypharmacy are risk factors for worse outcome in stroke. However, comorbidities and polypharmacy are mostly studied separately with various approaches to assess them. We aimed to analyze the impact of comorbidity burden and polypharmacy on functional outcome in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT).

Methods: Acute ischemic stroke patients with large vessel occlusion (LVO) treated with MT from a prospective observational study were analyzed. Relevant comorbidity burden was defined as a Charlson Comorbidity Index (CCI) score ≥ 2, polypharmacy as the intake of ≥ 5 medications at time of stroke onset. Favorable outcome was a score of 0-2 on the modified Rankin scale at 90 days after stroke. The effect of comorbidity burden and polypharmacy on favorable outcome was studied via multivariable regression analysis.

Results: Of 903 patients enrolled, 703 AIS patients (mean age 73.4 years, 54.9% female) with anterior circulation LVO were included. A CCI ≥ 2 was present in 226 (32.1%) patients, polypharmacy in 315 (44.8%) patients. Favorable outcome was less frequently achieved in patients with a CCI ≥ 2 (47, 20.8% vs. 172, 36.1%, p < 0.001), and in patients with polypharmacy (69, 21.9% vs. 150, 38.7%, p < 0.001). In multivariable regression analysis including clinical covariates, a CCI ≥ 2 was associated with lower odds of favorable outcome (odds ratio, OR 0.52, 95% confidence interval, 95% CI 0.33-0.82, p = 0.005), while polypharmacy was not (OR 0.81, 95% CI 0.52-1.27, p = 0.362).

Conclusion: Relevant comorbidity burden and polypharmacy are common in AIS patients with LVO, with comorbidity burden being a risk factor for poor outcome.

Keywords: Acute stroke; Charlson Comorbidity Index; Clinical outome; Large vessel occlusion; Thrombectomy.

Fig. 1

Distribution of individual diseases. The most prevalent comorbidities comprised by the Charlson Comorbidity Index (CCI) were coronary heart disease in 148 (21.1%) patients, diabetes in 85 (12.1%) patients and renal diseases in 73 (10.4%) patients (all left of the vertical line). Not captured by the CCI (right of the vertical line) were arterial hypertension, atrial fibrillation and dyslipidemia, present in 470 (66.9%), 338 (48.1%) and 84 (12.1%) patients. CHD Coronary Heart Disease, AIDS Acquired Immune Deficiency Syndrome

Fig. 2

Number of patients taking at least one medication from different medication classes. 507 (72.1%) patients were taking at least one antihypertensive drug making it the most common type of medication, followed by antiplatelets (230 [32.7%] patients), statins (218 [31.9%] patients) and anticoagulants (191 [27.2%] patients), antidiabetics and antidepressants/antipsychotics