Acute ischaemic stroke in active cancer versus non‐cancer patients: stroke characteristics, mechanisms and clinical outcomes

Abstract

AbstractBackground and purposeDemographics, clinical characteristics, stroke mechanisms and long‐term outcomes were compared between acute ischaemic stroke (AIS) patients with active cancer (AC) versus non‐cancer patients.MethodsUsing data from 2003 to 2021 in the Acute STroke Registry and Analysis of Lausanne, a retrospective cohort study was performed comparing patients with AC, including previously known and newly diagnosed cancers, with non‐cancer patients. Patients with inactive cancer were excluded. Outcomes were the modified Rankin Scale (mRS) score at 3 months, death and cerebrovascular recurrences at 12 months before and after propensity score matching.ResultsAmongst 6686 patients with AIS, 1065 (15.9%) had a history of cancer. After excluding 700 (10.4%) patients with inactive cancer, there were 365 (5.5%) patients with AC and 5621 (84%) non‐cancer AIS patients. Amongst AC patients, 154 (42.2%) strokes were classified as cancer related. In multivariable analysis, patients with AC were older (adjusted odds ratio [aOR] 1.02, 95% confidence interval [CI] 1.00–1.03), had fewer vascular risk factors and were 48% less likely to receive reperfusion therapies (aOR 0.52, 95% CI 0.35–0.76). Three‐month mRS scores were not different in AC patients (aOR 2.18, 95% CI 0.96–5.00). At 12 months, death (adjusted hazard ratio 1.91, 95% CI 1.50–2.43) and risk of cerebrovascular recurrence (sub‐distribution hazard ratio 1.68, 95% CI 1.22–2.31) before and after propensity score matching were higher in AC patients.ConclusionsIn a large institutional registry spanning nearly two decades, AIS patients with AC had less past cerebrovascular disease but a higher 1‐year risk of subsequent death and cerebrovascular recurrence compared to non‐cancer patients. Antithrombotic medications at discharge may reduce this risk in AC patients.