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Published on: June 18, 2021
Adverse Cardiovascular Events in Non-Traumatic Intracranial Hemorrhage and Ischemic Stroke Survivors
Marco Pasi1, Grégoire Boulouis2, Arnaud Bisson3
1Neurology Department, CHU de Tours et Université François Rabelais, 37000 Tours, France.
Insights
Intracranial hemorrhage (ICrH) survivors face higher risks of death and major adverse cardiovascular events compared to ischemic stroke (IS) survivors. Atrial fibrillation (AF) exacerbates these risks, particularly for new-onset heart failure (HF) after ICrH.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Non-traumatic intracranial hemorrhage (ICrH) and ischemic stroke (IS) are significant cerebrovascular events.
- Atrial fibrillation (AF) is a common comorbidity impacting cardiovascular outcomes.
- Comparative analysis of adverse events between ICrH and IS survivors, with and without AF, is crucial for risk stratification and management.
Purpose of the Study:
- To evaluate and compare adverse cardiovascular events in survivors of non-traumatic intracranial hemorrhage (ICrH) versus ischemic stroke (IS).
- To assess the impact of atrial fibrillation (AF) on these outcomes in both ICrH and IS survivor groups.
- To identify specific risks and event frequencies following ICrH and IS, considering the presence of AF.
Main Methods:
- Utilized a national hospitalization database for comparative analysis.
- Compared incidences and risks of in-hospital death (all-cause, cardiovascular, non-cardiovascular), MACE-HF, and new cerebrovascular events.
- Employed propensity-score matching to control for confounding factors between groups.
Main Results:
- ICrH survivors without AF exhibited higher risks of all-cause death, cardiovascular death, MACE-HF, and new cerebrovascular events compared to IS survivors without AF.
- ICrH survivors without AF had a lower risk of myocardial infarction, major bleeding, and new-onset heart failure (HF) than IS survivors without AF.
- Similar trends were observed in patients with AF, although myocardial infarction and new-onset HF risks were comparable between ICrH and IS survivors with AF.
Conclusions:
- Adverse cardiovascular events are demonstrably more frequent in intracranial hemorrhage survivors compared to ischemic stroke survivors.
- New-onset heart failure (HF) represents a significant and relatively frequent complication following intracranial hemorrhage, particularly in patients with coexisting atrial fibrillation.
- Findings underscore the heightened vulnerability of ICrH survivors to cardiovascular complications, necessitating tailored management strategies, especially in the presence of AF.
Background:
We aimed to evaluate different measures of adverse cardiovascular events between non-traumatic intracranial hemorrhage (ICrH) and ischemic stroke (IS) survivors with and without atrial fibrillation (AF).
Methods:
Using a national hospitalization database we compared incidences and risks of all-cause in-hospital death, cardiovascular death, non-cardiovascular death, MACE-HF (in-hospital cardiovascular death, myocardial infarction, IS or new-onset heart failure [HF]) between ICrH and IS survivors with and without AF. Propensity-score matching was also performed.
Results:
We identified 40,523 survivors of IS and 12,028 survivors of an ICrH without AF, and 20,449 IS survivors and 3574 ICrH survivors with AF. In unadjusted, adjusted and matched analyses, ICrH patients without AF had a higher risk of all-cause in-hospital death (Hazard Ratio (HR; for matched analyses) 1.80; 95% confidence interval (CI) 1.74-1.86), cardiovascular death (HR; 2.79; CI 2.64-2.94), MACE-HF (HR 1.97; CI 1.89-2.06) and new cerebrovascular events (HR 1.75; CI 1.57-1.96) but with lower risk of myocardial infarction (HR 0.81; CI 0.70-0.94), major bleeding (HR 0.92; CI 0.87-0.98) and new onset HF (HR 0.85; CI 0.79-0.91) compared to IS survivors without AF. Similar results were found for ICrH and IS survivors with AF except for myocardial infarction (HR 1.05; CI 0.79-1.34) and new onset HF (HR 0.94; CI 0.84-1.06) that were similar between the two groups.
Conclusions:
Adverse cardiovascular events are more frequent in ICrH survivors compared to IS survivors. New onset HF is a relatively frequent event after ICrH, especially in those patients with comorbid atrial fibrillation.
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