Hironori Ishiguchi, Bi Huang, Wahbi K El-Bouri, Jesse Dawson, Gregory Y H Lip, Azmil H Abdul-Rahim
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Using Cox proportional hazards models, we assessed the risk trajectories for developing SHS and its presentations associated with initial blood pressure. We also explored the risk trajectories for 90-day mortality related to initial blood pressure.</p><p><strong>Results: </strong>From 16,095 patients with acute ischaemic stroke, 14,965 (mean age 69 ± 12 years; 55% male) were analysed. Of these, 1774 (11.8%) developed SHS. The risk of SHS and initial blood pressure showed a U-shaped relationship. The lowest blood pressures (⩽130 mmHg systolic and ⩽55 mmHg diastolic) were associated with the highest risks (adjusted hazard ratio [95%confidence interval]: 1.40 [1.21-1.63]; <i>p</i> < 0.001, 1.71 [1.39-2.10]; <i>p</i> < 0.001, respectively, compared to referential blood pressure range).Cardiorespiratory arrest posed the greatest risk at higher blood pressure levels (2.34 [1.16-4.73]; <i>p</i> = 0.017 for systolic blood pressure >190 mmHg), whereas other presentations exhibited the highest risk at lower pressures. 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引用次数: 0
摘要
背景：缺血性卒中后的不良心脏事件（卒中-心脏综合征，SHS）是一项临床挑战。我们研究了中风发病时的初始血压与 SHS 风险之间的关系：我们利用了虚拟国际卒中试验档案（VISTA）中的数据。我们将 SHS 定义为缺血性卒中后 30 天内心脏并发症的发生率。这些并发症包括急性冠状动脉综合征，包括心肌损伤、心力衰竭/左心室功能障碍、心房颤动/扑动、其他心律失常/心电图异常和心肺骤停。我们使用 Cox 比例危险模型评估了罹患 SHS 的风险轨迹及其与初始血压相关的表现。我们还探讨了与初始血压相关的 90 天死亡率风险轨迹：对 16095 名急性缺血性脑卒中患者中的 14965 人（平均年龄 69 ± 12 岁；55% 为男性）进行了分析。其中，1774 人（11.8%）出现 SHS。SHS 风险与初始血压呈 U 型关系。最低血压（收缩压 ⩽130 mmHg 和舒张压 ⩽55 mmHg）与最高风险相关（调整后危险比[95%置信区间]：1.40 [1.21-1.21] ）：1.40 [1.21-1.63] ；收缩压大于 190 mmHg 时 p p = 0.017），而其他表现形式的患者在较低血压时风险最高。90 天死亡率风险也呈 U 型分布，血压阈值越高，风险越大：结论：缺血性卒中发病时的初始血压与随后的 SHS 风险之间存在 U 型关系。
Initial blood pressure and adverse cardiac events following acute ischaemic stroke: An individual patient data pooled analysis from the VISTA database.
Background: Adverse cardiac events following ischaemic stroke (stroke-heart syndrome, SHS) pose a clinical challenge. We investigated the association between initial blood pressure at stroke presentation and the risk of SHS.
Methods: We utilised data from the Virtual International Stroke Trials Archive (VISTA). We defined SHS as the incidence of cardiac complications within 30 days post-ischaemic stroke. These presentations included acute coronary syndrome encompassing myocardial injury, heart failure/left ventricular dysfunction, atrial fibrillation/flutter, other arrhythmia/electrocardiogram abnormalities, and cardiorespiratory arrest. Using Cox proportional hazards models, we assessed the risk trajectories for developing SHS and its presentations associated with initial blood pressure. We also explored the risk trajectories for 90-day mortality related to initial blood pressure.
Results: From 16,095 patients with acute ischaemic stroke, 14,965 (mean age 69 ± 12 years; 55% male) were analysed. Of these, 1774 (11.8%) developed SHS. The risk of SHS and initial blood pressure showed a U-shaped relationship. The lowest blood pressures (⩽130 mmHg systolic and ⩽55 mmHg diastolic) were associated with the highest risks (adjusted hazard ratio [95%confidence interval]: 1.40 [1.21-1.63]; p < 0.001, 1.71 [1.39-2.10]; p < 0.001, respectively, compared to referential blood pressure range).Cardiorespiratory arrest posed the greatest risk at higher blood pressure levels (2.34 [1.16-4.73]; p = 0.017 for systolic blood pressure >190 mmHg), whereas other presentations exhibited the highest risk at lower pressures. The 90-day mortality risk also followed a U-shaped distribution, with greater risks observed at high blood pressure thresholds.
Conclusions: There is a U-shaped relationship between initial blood pressure at ischaemic stroke presentation and the risk of subsequent SHS.
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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