Incident dementia in ischaemic stroke patients with early cardiac complications: A propensity-score matched cohort study.

IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY European Stroke Journal Pub Date : 2024-11-02 DOI:10.1177/23969873241293573
Tommaso Bucci, Sylvia E Choi, Christopher Tw Tsang, Kai-Hang Yiu, Benjamin Jr Buckley, Pasquale Pignatelli, Jan F Scheitz, Gregory Yh Lip, Azmil H Abdul-Rahim
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Abstract

Introduction: The risk of dementia in patients with stroke-heart syndrome (SHS) remains unexplored.

Patients and methods: Retrospective analysis using the TriNetX network, including patients with ischaemic stroke from 2010 to 2020. These patients were categorised into two groups: those with SHS (heart failure, myocardial infarction, ventricular fibrillation, or Takotsubo cardiomyopathy within 30 days post-stroke) and those without SHS. The primary outcome was the 1-year risk of dementia (vascular dementia, dementia in other disease, unspecified dementia, or Alzheimer's disease). The secondary outcome was the 1-year risk of all-cause death. Cox regression analysis after 1:1 propensity score matching (PSM) was performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the outcomes.

Results: We included 52,971 patients with SHS (66.6 ± 14.6 years, 42.2% females) and 854,232 patients without SHS (64.7 ± 15.4 years, 48.2% females). Following PSM, 52,970 well-balanced patients were considered in each group. Patients with SHS had a higher risk of incident dementia compared to those without SHS (HR 1.28, 95%CI 1.20-1.36). The risk was the highest during the first 31 days of follow-up (HR 1.51, 95%CI 1.31-1.74) and was mainly driven by vascular and mixed forms. The increased risk of dementia in patients with SHS, was independent of oral anticoagulant use, sex and age but it was the highest in those aged <75 years compared to ⩾75 years.

Discussion and conclusion: SHS is associated with increased risk of dementia. Future studies are needed to develop innovative strategies for preventing complications associated with stroke-heart syndrome and improving the long-term prognosis of these patients.

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伴有早期心脏并发症的缺血性中风患者中的痴呆病例:倾向分数匹配队列研究。
导言:中风-心脏综合征(SHS)患者患痴呆症的风险仍有待研究:利用 TriNetX 网络进行回顾性分析,包括 2010 年至 2020 年的缺血性中风患者。这些患者被分为两组:SHS患者(卒中后30天内出现心衰、心肌梗死、心室颤动或Takotsubo心肌病)和非SHS患者。主要结果是痴呆(血管性痴呆、其他疾病痴呆、不明痴呆或阿尔茨海默病)的1年风险。次要结果是一年内全因死亡的风险。在进行1:1倾向得分匹配(PSM)后,进行了Cox回归分析,以计算出结果的危险比(HRs)和95%置信区间(CIs):我们纳入了 52971 名 SHS 患者(66.6 ± 14.6 岁,42.2% 为女性)和 854232 名非 SHS 患者(64.7 ± 15.4 岁,48.2% 为女性)。经过 PSM 筛选,每组中均有 52 970 名体质均衡的患者。与没有SHS的患者相比,SHS患者发生痴呆症的风险更高(HR 1.28,95%CI 1.20-1.36)。这种风险在随访的前31天内最高(HR 1.51,95%CI 1.31-1.74),主要由血管性和混合性痴呆引起。SHS患者患痴呆症的风险增加与口服抗凝剂的使用、性别和年龄无关,但讨论和结论年龄段的患者患痴呆症的风险最高:SHS与痴呆症风险增加有关。今后的研究需要制定创新策略,以预防与中风-心脏综合征相关的并发症,并改善这些患者的长期预后。
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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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