Risk Factors and Systemic Outcomes in Patients with Retinal Artery Occlusion

Summary

The rate of CVA or MI around the time of RAO was low (1.5% at 1 week). No difference in CVA, MI, or death if stroke protocol in ER or outpatient. Cleveland Clinic retrospective of 596 patients.

Abstract

Purpose: To assess the association of strokes, myocardial infarctions (MIs), and systemic outcomes after acute retinal artery occlusion (RAO).

Design: Retrospective case series of patients from a single academic center with a diagnosis of an acute RAO.

Participants: Five hundred ninety-six adult patients (mean age, 70 years; 52% men; 82% White) with a diagnosis of acute RAO.

Methods: Patients from a single academic center with a diagnosis of RAO from 2007 to 2020 were reviewed. Acute RAOs were verified, and subsequent stroke, MIs, and death events were recorded. Univariate analysis assessed risk factors with Holm-Bonferroni correction for primary outcomes and Benjamini-Hochberg correction for descriptive analyses.

Main outcome measures: The rate of strokes, MIs, and deaths after acute RAO.

Results: Nine patients (1.51%) had a stroke or MI within 1 week of RAO diagnosis and 13 (2.01%) within 1 month. Of note, 13.3% (N = 79) of patients with RAO were eventually diagnosed with stroke or MI at a mean of 19 months; 51.2% (N = 305) of patients were evaluated in the emergency room. Of these, 73.4% (N = 222) were admitted. Carotid imaging, cardiac imaging, computed tomography head, and magnetic resonance brain imaging were obtained more in emergency room versus outpatient evaluations (91.8% vs 70.1%, P ≤ 0.001; 94.8% vs 72.5%, P ≤ 0.001; 79 % vs 28.9%, P ≤ 0.001; 52.1% vs 24.9%, P ≤ 0.001, respectively). Significantly more interventions occurred in emergency room evaluations (73.1% vs 63.9%, P ≤ 0.017), but the number of subsequent strokes, MIs, and deaths were not different (8.5% vs 6.3%, P = 0.35; 6.2% vs 6.7 %, P = 1; 19.7% vs 21.6%, P = 0.61, respectively).

Conclusions: In this large cohort of patients with acute RAO, the rate of a stroke or MI within 1 year was 0.08 events per person-years and rarely occurred around the time of RAO. More imaging and interventions were performed on those evaluated in the emergency room setting versus those evaluated in the outpatient setting, but the incidence proportion of stroke, MI, and death was not different between groups.