脑出血后早期心脏并发症患者的发病率和预后：来自 VISTA 的报告。

IF 7.8 1区医学 Q1 CLINICAL NEUROLOGY Stroke Pub Date : 2024-11-01 Epub Date: 2024-10-02 DOI:10.1161/STROKEAHA.124.048189

Hironori Ishiguchi, Bi Huang, Wahbi K El-Bouri, Jesse Dawson, Gregory Y H Lip, Azmil H Abdul-Rahim

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引用次数: 0

摘要

背景：人们对脑内出血（ICH）患者早期心脏并发症的发生率和后果知之甚少。这些心脏并发症可能是 ICH 患者所谓的中风-心脏综合征的一部分。我们通过对国际临床试验数据储存库中的单个患者数据进行汇总分析，对这一问题进行了研究：我们利用虚拟国际卒中试验档案库调查了 ICH 或急性缺血性卒中（AIS）后 30 天内心脏并发症的发生率。这些并发症包括急性冠脉综合征（包括心肌损伤）、心力衰竭/左心室功能障碍、心房颤动/心房扑动、其他心律失常/心电图异常以及心肺功能骤停。我们采用倾向评分匹配法比较了 ICH 患者与 AIS 患者中风-心脏综合征的发生率。在 ICH 队列中，我们使用多变量逻辑回归分析评估了与 90 天死亡率相关的因素：我们汇总了急性卒中试验招募的 8698 名参与者（平均年龄为 68±12 岁；56% 为男性）的数据，其中 914 人（11%）为 ICH 患者。在 ICH 患者中，123 人（13%）患有中风-心脏综合征。经过倾向评分匹配后，共对 1828 名患者（每组 914 人）进行了分析。虽然与 AIS 组相比，ICH 组心脏事件的总发生率较低（无事件的累积发生率为 86.3% [95% CI, 84.1-88.6] 对 83.6% [95% CI, 81.2-86.0]; P=0.100），但两个匹配组除心房颤动/心房扑动外的其他心脏事件发生率相当。ICH 组心房颤动/心房扑动的发生率明显低于 AIS 组（PPConclusions：心脏事件很常见，对 ICH 患者的预后有负面影响，这与 AIS 患者的情况相同。

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Incidence and Outcomes of Patients With Early Cardiac Complications After Intracerebral Hemorrhage: A Report From VISTA.

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.

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来源期刊

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.