Importance of cardiovascular risk profile for in-hospital mortality due to cerebral infarction
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Published on: September 26, 2018
Adrià Arboix1, Lluís García-Eroles, Emili Comes
1Unidad de Enfermedades Vasculares Cerebrales, Servicio de Neurología, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Spain. aarboix@hscor.com
Insights
Cardiovascular risk profiles and mortality risks differ across cerebral infarction subtypes. Identifying these specific risk factors is crucial for improving patient outcomes in stroke care.
Area of Science:
- Neurology
- Cardiology
- Public Health
Background:
- Cerebral infarction (CI) encompasses various subtypes, each potentially linked to distinct cardiovascular risk factors.
- Understanding these subtype-specific profiles is essential for targeted prevention and management strategies.
- Previous research has not fully elucidated the differential impact of cardiovascular risks on mortality across CI etiologies.
Purpose of the Study:
- To investigate the unique cardiovascular risk profiles associated with different subtypes of cerebral infarction.
- To determine the prognostic implications of these cardiovascular risk profiles on in-hospital mortality.
- To compare the influence of various risk factors on mortality across thrombotic, cardioembolic, lacunar, undetermined, and atypical CI subtypes.
Main Methods:
- Retrospective analysis of 2704 consecutive cerebral infarction patients from a hospital stroke registry (1986-2004).
- Classification of CI into thrombotic, cardioembolic, lacunar, undetermined, and atypical subtypes.
- Multivariate analysis to compare cardiovascular risk profiles and assess their association with in-hospital mortality.
Main Results:
- Common cardiovascular risk factors included arterial hypertension (55.5%), atrial fibrillation (29.8%), and diabetes mellitus (23.4%).
- Overall in-hospital mortality was 12.9%, independently associated with atrial fibrillation and heart failure.
- Specific mortality-associated risks varied by CI subtype: thrombotic stroke linked to heart failure and AF; cardioembolic stroke to peripheral vascular disease and prior CI; undetermined stroke to arterial hypertension.
Conclusions:
- Each etiological subtype of cerebral infarction possesses a distinct cardiovascular risk profile.
- The cardiovascular risk factors influencing in-hospital mortality are significantly different depending on the ischemic stroke subtype.
- Tailored risk factor management strategies are warranted for each specific cerebral infarction subtype to improve patient prognosis.
Introduction And Objectives:
To investigate cardiovascular risk profiles and their prognostic implications in patients with different subtypes of cerebral infarction.
Methods:
The study involved the retrospective analysis of data from a hospital stroke registry on 2704 consecutive CI patients who were admitted between 1986 and 2004. Of the 2704 strokes recorded, 770 were classified as thrombotic, 763 as cardioembolic, 733 as lacunar, 324 as undetermined and 114 as atypical. Multivariate analysis was used to compare cardiovascular risk profiles in each subtype and their influence on inhospital mortality.
Results:
Arterial hypertension (AH) was present in 55.5%, atrial fibrillation (AF) in 29.8%, and diabetes mellitus in 23.4%. The in-hospital mortality rate was 12.9%, and in-hospital mortality was independently associated with AF (odds ratio [OR]=2.33; 95% confidence interval [CI], 1.84-2.96), and heart failure (HF) (OR=1.96; 95% CI, 1.33-2.89). In patients with thrombotic stroke, the cardiovascular risk factors associated with in-hospital mortality were HF (OR=2.87; 95% CI, 1.45-5.71), AF (OR=1.80; 95% CI, 1.09-2.96) and age (OR=1.06; 95% CI, 1.04-1.08). In patients with cardioembolic stroke, they were peripheral vascular disease (OR=2.18; 95% CI, 1.17-4.05), previous cerebral infarction (OR=1.75; 95% CI, 1.16-2.63), HF (OR=1.71; 95% CI, 1.01-2.90), and age (OR=1.06; 95% CI, 1.04-1.08). In those with undetermined stroke, they were AH (OR=3.68; 95% CI, 1.78-7.62) and age (OR=1.05; 95% CI, 1.01-1.09).
Conclusions:
Each cerebral infarction etiologic subtype was associated with its own cardiovascular risk profile. Consequently, the cardiovascular risk factors associated with mortality were also different for each ischemic stroke subtype.
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