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Updated: Jun 11, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Incidence and Outcomes of Patients With Early Cardiac Complications After Intracerebral Hemorrhage: A Report From
Hironori Ishiguchi1,2,3, Bi Huang1,3, Wahbi K El-Bouri1,3
1Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, United Kingdom (H.I., B.H., W.K.E.-B., G.Y.H.L., A.H.A.-R.).
Insights
Cardiac complications, or stroke-heart syndrome, are common in patients with intracerebral hemorrhage (ICH) and significantly increase the risk of 90-day mortality, similar to acute ischemic stroke (AIS).
Area of Science:
- Neurology
- Cardiology
- Clinical Research
Background:
- Early cardiac complications in intracerebral hemorrhage (ICH) patients are poorly understood.
- These events may constitute the stroke-heart syndrome.
- This study investigates their incidence and outcomes.
Purpose of the Study:
- To determine the incidence of cardiac complications within 30 days post-ICH.
- To compare these events with those in acute ischemic stroke (AIS) patients.
- To identify factors associated with 90-day mortality in ICH patients.
Main Methods:
- Pooled analysis of individual patient data from the Virtual International Stroke Trials Archive.
- Inclusion of patients with ICH and AIS.
- Propensity score matching for cohort comparison.
- Multivariate logistic regression for mortality analysis.
Main Results:
- 13% of 914 ICH patients experienced stroke-heart syndrome.
- Cardiac event incidence was similar between ICH and AIS groups, except for lower atrial fibrillation/flutter in ICH.
- Stroke-heart syndrome in ICH patients was linked to increased 90-day mortality (aOR 1.12).
Conclusions:
- Cardiac events are frequent in ICH patients.
- These events negatively impact prognosis, mirroring findings in AIS.
- Stroke-heart syndrome is a significant predictor of mortality in ICH.
Background:
The incidence and outcomes of early cardiac complications in patients with intracerebral hemorrhage (ICH) are poorly understood. These cardiac complications may be part of the so-called stroke-heart syndrome in patients with ICH. We investigated this issue in an individual patient data pooled analysis from an international repository of clinical trial data.
Methods:
We used the Virtual International Stroke Trials Archive to investigate the incidence of cardiac complications within 30 days post-ICH or acute ischemic stroke (AIS). These complications included acute coronary syndrome encompassing myocardial injury, heart failure/left ventricular dysfunction, atrial fibrillation/atrial flutter, other arrhythmia/ECG abnormalities, and cardiorespiratory arrest. We used propensity score matching to compare the incidence of patients with stroke-heart syndrome in patients with ICH with those following AIS. Factors associated with 90-day mortality were evaluated using multivariate logistic regression analysis in the ICH cohort.
Results:
We pooled data from 8698 participants recruited in acute stroke trials (mean age, 68±12 years; 56% male), of whom 914 (11%) were patients with ICH. Among the patients with ICH, 123 (13%) had stroke-heart syndrome in patients with ICH. Following propensity score matching, a total of 1828 patients (914 for each of the cohorts) were analyzed. While the overall incidence of cardiac events tended to be lower in the ICH group compared with the AIS group (the cumulative incidence freedom from the event, 86.3% [95% CI, 84.1-88.6] versus 83.6% [95% CI, 81.2-86.0]; P=0.100), the incidences cardiac events other than atrial fibrillation/atrial flutter were comparable between the 2 matched groups. The incidence of atrial fibrillation/atrial flutter was significantly lower in the ICH group than in the AIS group (P<0.001). The multivariate-adjusted analysis found that stroke-heart syndrome in patients with ICH was associated with 90-day mortality (adjusted odds ratio, 1.12 [95% CI, 1.06-1.19]; P<0.001).
Conclusions:
Cardiac events are common and negatively affect prognosis in patients with ICH, just as seen in AIS.
