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. 2024 Nov;55(11):2669-2676.
doi: 10.1161/STROKEAHA.124.048189. Epub 2024 Oct 2.

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

Hironori Ishiguchi  1   2   3 , Bi Huang  1   3 , Wahbi K El-Bouri  1   3 , Jesse Dawson  4 , Gregory Y H Lip  1   5 , Azmil H Abdul-Rahim  1   3   6 ; VISTA Collaborators
Collaborators, Affiliations

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

Hironori Ishiguchi et al. Stroke. 2024 Nov.

Abstract

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.

Keywords: atrial fibrillation; cerebral hemorrhage; heart failure; intracranial hemorrhages; ischemic stroke.

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Conflict of interest statement

Dr Dawson received speaker fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, Medtronic, and Pfizer and a travel fee from MicroTransponder, Inc. Dr Dawson also received investigator-initiated research funding grant from the Stroke Association United Kingdom. Dr Lip is a consultant and a speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi Sankyo, and Anthos. No fees are received personally. He is a National Institute for Health and Care Research Senior Investigator and a co-principal investigator of the AFFIRMO project on multimorbidity in AF (grant agreement 899871), the TARGET project on digital twins for personalized management of atrial fibrillation and stroke (grant agreement 101136244), and the ARISTOTELES project on artificial intelligence for management of chronic long-term conditions (grant agreement 101080189), which are all funded by the Horizon Europe Research and Innovation Programme of the European Union. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.
Study flow diagram. AF indicates atrial fibrillation; AIS, acute ischemic stroke; eGFR, estimated glomerular filtration rate; ICH, intracranial hemorrhage; MI, myocardial infarction; NIHSS, National Institutes of Health Stroke Scale; PSM, propensity score matching; and VISTA, Virtual International Stroke Trials Archive.
Figure 2.
Figure 2.
Kaplan-Meier curves comparing the cumulative incidence of stroke-heart syndrome (SHS) and each manifestation. A, SHS. B, Acute coronary syndrome (ACS)/myocardial injury. C, Heart failure (HF)/left ventricular (LV) dysfunction. D, Atrial fibrillation (AF)/atrial flutter (AFL). E, Other arrhythmia/ECG abnormalities. F, Cardiorespiratory arrest. Each plot is expressed as cumulative incidence freedom from the event with 95% CI. **Statistical significance (P<0.001). AIS indicates acute ischemic stroke; and ICH, intracranial hemorrhage.
See this image and copyright information in PMC

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