June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Risk Factors of Ischemic Stroke in Patient Presenting with Amaurosis Fugax
Author Affiliations & Notes
  • Tony Chen
    Rutgers New Jersey Medical School Department of Ophthalmology & Visual Science, Newark, New Jersey, United States
  • Aditya Uppuluri
    Rutgers New Jersey Medical School Department of Ophthalmology & Visual Science, Newark, New Jersey, United States
  • Marco A Zarbin
    Rutgers New Jersey Medical School Department of Ophthalmology & Visual Science, Newark, New Jersey, United States
  • Neelakshi Bhagat
    Rutgers New Jersey Medical School Department of Ophthalmology & Visual Science, Newark, New Jersey, United States
  • Footnotes
    Commercial Relationships   Tony Chen, None; Aditya Uppuluri, None; Marco Zarbin, None; Neelakshi Bhagat, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 3181. doi:
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      Tony Chen, Aditya Uppuluri, Marco A Zarbin, Neelakshi Bhagat; Risk Factors of Ischemic Stroke in Patient Presenting with Amaurosis Fugax. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3181.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Amaurosis fugax (AF) is associated with increased cerebrovascular morbidities and mortalities. Better risk stratification of AF is crucial in recognizing those at highest risk of developing ischemic stroke. We performed a retrospective, cross-sectional study using a national database to evaluate the risk factors for ischemic stroke in patients with acute AF.

Methods : The National Inpatient Sample database from 2002–2014 was used. All patients 21 years old and above with a primary admission diagnosis of AF were identified using ICD-9 codes 362.34. Patients were further stratified into two age cohorts: 21-50 years and over 50 years. The primary outcome was to evaluate comorbidities associated with in-hospital ischemic stroke. Chi-square and Firth logistic regression analyses were performed using IBM SPSS 25 and R package version 3.4.3, respectively. p<0.05 was considered significant for Chi-square and univariate analyses, whereas p<0.005 was considered significant for multivariable analysis.

Results : A weighted total of 12,142 patients were identified. The average age of patients was 66±14 years, where 87% of cases were over 50 years of age. Whites accounted for 62.1% of cases. The most common comorbidities included hypertension (66.1%), dyslipidemia (44.7%), tobacco use (23.6%), coronary artery disease (CAD) (23.0%), and diabetes mellitus (19.6%). Tobacco use, alcohol use, and hypercoagulable state were statistically more prevalent in the younger group (p<0.001). Surprisingly, ischemic stroke (p=0.033) and myocardial infarction (p=0.008) were significantly more prevalent in the younger cohort.

Multivariable logistic regression analysis detected the followings comorbidities to be independent risk factors for ischemic stroke: Hypercoagulable state (OR 8.98, p<0.001), systemic vasculitis (OR 4.16, p=0.003), CAD (OR 4.05, p<0.001), and atherosclerosis (OR 3.60, p<0.001). In contrast, dyslipidemia was associated with a decreased risk (OR 0.54, p=0.003). Asian/Pacific Islander ethnicity conferred a 5-fold increased risk in stroke compared to Whites (p<0.001).

Conclusions : In-hospital systemic thrombotic complications occurred in 0.3%-0.9% of acute AF cases (average length of stay was 2.62±2.17 days). Presence of hypercoagulable state, systemic vasculitis, CAD, and atherosclerosis increased the risk of ischemic stroke by over 3-fold. Thus, patients should be closely monitored for stroke within the first week of AF diagnosis.

This is a 2021 ARVO Annual Meeting abstract.

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