In-Hospital Stroke in Patients with Cardiac Conditions: Do Cardiac Procedures Impact Stroke Outcomes?

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: In-hospital acute ischemic stroke in patients admitted with a primary cardiac diagnosis (n=499). Intervention: Cardiac procedure within 30 days prior to stroke recognition vs. No prior cardiac procedure or surgery. Primary outcome: In-hospital mortality (OR 0.73, 95% CI 0.40-1.33).

Q: What does this research mean for the field?

In patients hospitalized with cardiac conditions who experience acute ischemic stroke, undergoing prior cardiac procedures or surgery is not significantly associated with altered adjusted in-hospital mortality compared to having no procedure. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ameen Alizada; Rana Abdalrahman; Chitapa Kaveeta; Mohamad Mehdi; Dana Harris; Jillian M. Stang; Robert Moore; Mohamed A AlShamrani; Beatrice Agnelli; Jessalyn K. Holodinsky; Bijoy K. Menon; Michael D. Hill; Mohammed Almekhlafi; Katrina Hannah D. Ignacio

doi:10.1017/cjn.2026.10707

November 5, 2026Canadian Journal of Neurological Sciences / Journal Canadien des Sciences NeurologiquesOpen Access

In-Hospital Stroke in Patients with Cardiac Conditions: Do Cardiac Procedures Impact Stroke Outcomes?

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Key result

Prior cardiac procedures (aOR 0.73, 95% CI 0.40-1.33) and surgery (aOR 0.78, 95% CI 0.42-1.45) did not significantly alter adjusted in-hospital stroke mortality compared to no procedure.

Why the study?

It was unclear whether acute ischemic stroke occurring after cardiac procedures is more severe than stroke associated with cardiac conditions without procedures.

Does undergoing a cardiac procedure or cardiac surgery within 30 days impact in-hospital mortality and complications in patients admitted with a primary cardiac diagnosis who experience in-hospital acute ischemic stroke?

Key Points

To assess whether in-hospital acute ischemic stroke severity and mortality differ between cardiac patients who undergo cardiac procedures or surgeries and those managed without procedures.
Retrospective cohort study analyzing 499 adults with in-hospital acute ischemic stroke admitted with a primary cardiac diagnosis in Alberta between 2018 and 2022.
Patients were categorized by exposure within 30 days of stroke: no cardiac procedure (n=156), cardiac procedure (n=116), or cardiac surgery (n=227).
Multivariable logistic regression evaluated associations between procedural status, stroke timing, and in-hospital mortality after adjusting for demographics, facility level, and comorbidities.
In-hospital mortality was 34.6% (54/156) without procedures, 24.1% (28/116) after cardiac procedures, and 22.5% (51/227) after cardiac surgery, showing no significant difference after adjustment (cardiac procedure aOR 0.73, 95% CI 0.40–1.33; cardiac surgery aOR 0.78, 95% CI 0.42–1.45).
Among procedural patients, stroke recognition occurring 2 to 7 days post-procedure (OR 2.31, 95% CI 1.18–4.52) and 8 to 30 days post-procedure (OR 3.23, 95% CI 1.59–6.59) was associated with significantly higher mortality compared to earlier recognition.
Acute reperfusion therapies were administered in only 9.0% of patients overall (3.5% after surgery vs 15.4% without procedures; p=0.003), most commonly withheld due to recent surgery (46.8%) or presentation beyond the treatment time window (29.3%).

Study Design

Type

Cohort (n=499)

Multicenter

Yes

Structured PICO

Does undergoing a cardiac procedure or cardiac surgery within 30 days impact in-hospital mortality and complications in patients admitted with a primary cardiac diagnosis who experience in-hospital acute ischemic stroke?

P

Population

499 adults (median age 70 years, 36.7% female) admitted with a primary cardiac diagnosis who developed in-hospital acute ischemic stroke across hospitals in Alberta, Canada, followed until hospital discharge (median stay 18 days).

E

Exposure

Prior cardiac procedure (n=116, 23.2%; including PCI with or without stenting, coronary angiography, device implantation, ablation or cardioversion, and drainage/minor procedures) or cardiac surgery (n=227, 45.5%; including CABG, aortic or mitral valve repair or replacement, VAD implantation, ECMO, and other open cardiac repairs) within 30 days prior to stroke recognition.

C

Comparator

No prior cardiac procedure or cardiac surgery within 30 days prior to stroke diagnosis (n=156, 31.3%) among patients admitted with a primary cardiac diagnosis.

O

Outcome

In-hospital mortalityhard clinical

Main Result

Odds Ratio: 0.73 (95% CI 0.4–1.33)

Absolute Event Rate: 24.14% vs 34.62%

In cardiac inpatients who suffer an acute ischemic stroke, prior cardiac procedures or surgeries do not independently increase adjusted in-hospital mortality compared to medical management alone, but strokes recognized two or more days post-procedure carry a significantly higher mortality risk.

Limitations

Retrospective observational design precludes causal inference and carries risk of residual confounding
Selection bias and confounding by indication between procedural and non-procedural groups
Anticoagulation status at the time of stroke onset was not available for adjustment
Potential misclassification of diagnoses, procedures, and complications in administrative data
Only the most proximal procedure was considered without assessing the impact of multiple procedures
Inability to distinguish between routine post-procedure ICU care and clinically driven ICU admission
Limited generalizability to healthcare systems with different organizations of cardiac and stroke care
Observational retrospective design
Residual confounding by indication (differences in underlying cardiac pathology, procedural indications, periprocedural antithrombotic therapy, and clinical complexity not fully captured)
Exact time of ischemic stroke onset was not directly observable; time intervals were based on time of stroke recognition rather than true onset
Delay in stroke diagnosis among patients requiring anesthesia, making timing of stroke diagnosis imprecise to the hour or minute

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Implication

Does not support modifying stroke mortality expectations after cardiac procedures; leaves open timing effects for prospective study.

Abstract

BACKGROUND AND AIMS: It is unclear if stroke occurring after cardiac procedures is more severe than stroke associated with cardiac conditions without procedures. We compared in-hospital acute ischemic stroke patients admitted with a cardiac diagnosis who did versus did not undergo cardiac procedures. METHODS: In this retrospective cohort study, we analyzed adults with in-hospital stroke admitted with a primary cardiac diagnosis in Alberta (2018-2022). Patients were categorized into no prior cardiac procedure, cardiac procedure, or cardiac surgery within 30 days of stroke diagnosis. Multivariable logistic regression was used to assess associations between exposure groups and outcomes. RESULTS: Among 499 patients (median age 70 years IQR [62-77], 36.7% women), 116 (23.2%) underwent a cardiac procedure, and 227 (45.5%) underwent cardiac surgery prior to stroke diagnosis. Median time from procedure to stroke diagnosis was 1.75 days (IQR 0.87-3.83). In-hospital mortality was 34.6%, 24.1% and 22.5% in patients with no prior procedure, cardiac procedures and cardiac surgery, respectively. After adjustment for age, sex, facility level and comorbidities, no significant differences were observed in mortality (cardiac procedure vs no procedure: aOR 0.73, 95% confidence interval (CI) 0.40-1.33; cardiac surgery vs no procedure: aOR 0.78, 95% CI 0.42-1.45). Among procedural patients, strokes recognized ≥2 days post-procedure were associated with higher mortality (2-7 days: OR 2.31, [1.18-4.52]; 8-30 days: OR 3.23, [1.59-6.59]). CONCLUSIONS: Adjusted mortality did not differ by cardiac procedural status, although residual confounding is possible. Later stroke recognition after cardiac procedures was associated with higher mortality, identifying a high-risk monitoring window.

Discussion

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Cite This Study

Alizada et al. (2026) conducted a cohort in In-hospital acute ischemic stroke in patients admitted with a primary cardiac diagnosis (n=499). Cardiac procedure within 30 days prior to stroke recognition vs. No prior cardiac procedure or surgery was evaluated on In-hospital mortality (OR 0.73, 95% CI 0.40-1.33). Prior cardiac procedures (aOR 0.73, 95% CI 0.40-1.33) and surgery (aOR 0.78, 95% CI 0.42-1.45) did not significantly alter adjusted in-hospital stroke mortality compared to no procedure.

synapsesocial.com/papers/6aee6bd871a7594806220c31 https://doi.org/10.1017/cjn.2026.10707

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In-Hospital Stroke in Patients with Cardiac Conditions: Do Cardiac Procedures Impact Stroke Outcomes?

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

In-Hospital Stroke in Patients with Cardiac Conditions: Do Cardiac Procedures Impact Stroke Outcomes?

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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