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Predictors of early cardiac morbidity and mortality after ischemic stroke
Jane Prosser1, Lachlan MacGregor, Kennedy R Lees
1Department of Neurology, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia.
Insights
Serious cardiac events are common after ischemic stroke, with risk peaking early. Identifying high-risk patients using factors like heart failure history and diabetes can guide targeted prevention strategies to improve survival.
Area of Science:
- Cardiology
- Neurology
- Clinical Medicine
Background:
- Cardiac complications are a significant cause of mortality in the initial months following acute ischemic stroke.
- These events may stem from pre-existing cardiac conditions or the acute stress response to stroke.
Purpose of the Study:
- To investigate the temporal pattern of cardiac risk after ischemic stroke.
- To develop a predictive model for serious cardiac adverse events (SCAEs) using baseline patient data.
Main Methods:
- Utilized data from a Virtual International Stroke Trials Archive trial meeting specific criteria.
- Employed survival analysis to map the timeline of cardiac events post-stroke.
- Assessed prognostic factors using multivariable logistic regression to create a risk score.
Main Results:
- Out of 846 patients, 4.1% died from cardiac causes and 19.0% experienced at least one SCAE.
- Cardiac death hazard peaked in the second week; SCAE hazard peaked between days 2-3.
- Key predictors of SCAEs included heart failure history, diabetes, elevated creatinine, stroke severity, and ECG abnormalities (long QTc, ventricular extrasystoles).
Conclusions:
- Serious cardiac events frequently occur in the acute phase post-stroke.
- A significant proportion of patients (up to 62.2%) face elevated risk based on identifiable factors.
- Early identification of high-risk individuals can enable more aggressive interventions to enhance patient survival.
Background And Purpose:
In the first 3 months after acute ischemic stroke, 2% to 6% of patients die from cardiac causes. This may reflect preexisting cardiac disease, cardiac dysfunction related to the acute neurohumoral and autonomic stress response to stroke, or both. Delineation of a high-risk group could facilitate prevention strategies. We aimed to describe the temporal profile of cardiac risk after stroke and develop a predictive model of serious cardiac adverse events (SCAEs) using baseline variables.
Methods:
We used data from the one trial in the Virtual International Stroke Trials Archive that matched prespecified criteria. Survival analysis was used to describe the temporal profile of cardiac events after stroke. Prognostic determinants were assessed with multivariable logistic regression, and a risk score was derived from the key predictor variables.
Results:
Of 846 ischemic stroke patients, 35 (4.1%) died from cardiac causes and 161 (19.0%) suffered at least one SCAE. The hazard of cardiac death was highest (0.001/d) in the second week. Hazard of a first SCAE peaked at 0.02/d between day 2 and 3. The 5 factors most predictive of SCAEs were a history of heart failure (OR 3.33 [2.28, 4.89], P<0.001), diabetes (OR 2.11 [1.39, 3.21], P<0.001), baseline creatinine >115 micromol/L (OR 1.77 [1.16, 2.70], P=0.008), severe stroke (OR 1.98 [1.34,2.91], P=0.001), and a long QTc or ventricular extrasystoles on ECG (OR 1.93 [1.31, 2.85], P=0.001). Risk of SCAEs ranged from 6.3% (no predictors) to 62.2% (> or =4 predictors).
Conclusions:
Serious cardiac events are common in the acute period after stroke. Patients at highest risk are identifiable and may benefit from more aggressive strategies to improve survival.
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