Stroke patients with psychiatric comorbidities have lower carotid revascularization rates

Objective: We investigated whether mental illness is associated with lower rates of CEA/CAS after stroke due to carotid stenosis.
Methods: In this retrospective cross-sectional study, ischemic stroke cases due to carotid stenosis were identified in the 2007-2014 Nationwide (National) Inpatient Sample. Psychiatric conditions were identified by secondary ICD9-CM diagnosis codes for schizophrenia/psychoses, bipolar disorder, depression, anxiety, or substance use disorders. Using logistic regression, we tested the association between psychiatric conditions and CEA/CAS, controlling for demographic, clinical, and hospital factors.
Results: Among 37,474 included stroke cases, 6,922 (18.5%) had a psychiatric comorbidity. The presence of any psychiatric condition was associated with lower odds of CEA/CAS (adjusted OR 0.84, 95% CI 0.78-0.90). Schizophrenia/psychoses (OR 0.72, 95% CI 0.55-0.93), depression (OR 0.83, 95% CI 0.75-0.91), and substance use disorders (OR 0.73, 95% CI 0.65-0.83) were ...

研究目的：本研究旨在探究精神疾病是否与颈动脉狭窄所致卒中后颈动脉内膜切除术（CEA）/颈动脉支架置入术（CAS）的实施率偏低存在关联。
研究方法：本项回顾性横断面研究中，我们从2007至2014年全国住院患者样本内筛选出因颈动脉狭窄引发的缺血性卒中病例。通过精神分裂症/精神病性障碍、双相障碍、抑郁障碍、焦虑障碍或物质使用障碍的国际疾病分类第9版临床修订本（ICD-9-CM）次要诊断编码，识别研究对象的精神疾病状况。采用logistic回归分析精神疾病与CEA/CAS实施情况之间的关联，并对人口统计学特征、临床及医院相关因素进行校正。
研究结果：纳入分析的37474例卒中病例中，共计6922例（18.5%）存在精神共病。存在任意类型精神疾病与CEA/CAS实施率降低显著相关（校正后OR=0.84，95%置信区间CI：0.78-0.90）。其中精神分裂症/精神病性障碍（OR=0.72，95%CI：0.55-0.93）、抑郁障碍（OR=0.83，95%CI：0.75-0.91）及物质使用障碍（OR=0.73，95%CI：0.65-0.83）……