Buckley Benjamin J R, Harrison Stephanie L, Hill Andrew, Underhill Paula, Lane Deirdre A, Lip Gregory Y H
Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital (B.J.R.B, S.L.H., D.A.L., G.Y.H.L.), University of Liverpool, United Kingdom.
Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences (B.J.R.B., S.L.H., D.A.L., G.Y.H.L.), University of Liverpool, United Kingdom.
Stroke. 2022 May;53(5):1759-1763. doi: 10.1161/STROKEAHA.121.037316. Epub 2022 Mar 31.
The risk of major adverse cardiovascular events is substantially increased following a stroke. Although exercise-based cardiac rehabilitation has been shown to improve prognosis following cardiac events, it is not part of routine care for people following a stroke. We, therefore, investigated the association between cardiac rehabilitation and major adverse cardiovascular events for people following a stroke. Following a stroke, individuals have an increased risk of new-onset cardiovascular complications. However, the incidence and long-term clinical consequence of newly diagnosed cardiovascular complications following a stroke is unclear. The aim of the present study was to investigate the incidence and long-term clinical outcomes of newly diagnosed cardiovascular complications following incident ischemic stroke.
A retrospective cohort study was conducted using anonymized electronic medical records from 53 participating health care organizations. Patients with incident ischemic stroke aged ≥18 years with 5 years of follow-up were included. Patients who were diagnosed with new-onset cardiovascular complications (heart failure, severe ventricular arrhythmia, atrial fibrillation, ischemic heart disease, Takotsubo syndrome) within 4-weeks (exposure) of incident ischemic stroke were 1:1 propensity score-matched (age, sex, ethnicity, comorbidities, cardiovascular care) with ischemic stroke patients who were not diagnosed with a new-onset cardiovascular complication (control). Logistic regression models produced odds ratios (OR) with 95% CIs for 5-year incidence of all-cause mortality, recurrent stroke, hospitalization, and acute myocardial infarction.
Of 365 383 patients with stroke with 5-year follow-up: 11.1% developed acute coronary syndrome; 8.8% atrial fibrillation/flutter; 6.4% heart failure; 1.2% severe ventricular arrythmias; and 0.1% Takotsubo syndrome within 4 weeks of incident ischemic stroke. Following propensity score matching, odds of 5-year all-cause mortality were significantly higher in stroke patients with acute coronary syndrome (odds ratio, 1.49 [95% CI, 1.44-1.54]), atrial fibrillation/flutter (1.45 [1.40-1.50]), heart failure (1.83 [1.76-1.91]), and severe ventricular arrhythmias (2.08 [1.90-2.29]), compared with matched controls. Odds of 5-year rehospitalization and acute myocardial infarction were also significantly higher for patients with stroke diagnosed with new-onset cardiovascular complications. Takotsubo syndrome was associated with significantly higher odds of 5-year composite major adverse cardiovascular events (1.89 [1.29-2.77]). Atrial fibrillation/flutter was the only new-onset cardiac complication associated with significantly higher odds of recurrent ischemic stroke at 5 years (1.10 [1.07-1.14]).
New-onset cardiovascular complications diagnosed following an ischemic stroke are very common and associate with significantly worse 5-year prognosis in terms of major adverse cardiovascular events. People with stroke and newly diagnosed cardiovascular complications had >50% prevalence of recurrent stroke at 5 years.
中风后发生重大心血管不良事件的风险显著增加。尽管基于运动的心脏康复已被证明可改善心脏事件后的预后，但它并非中风患者常规护理的一部分。因此，我们调查了心脏康复与中风患者重大心血管不良事件之间的关联。中风后，个体新发心血管并发症的风险增加。然而，中风后新诊断的心血管并发症的发生率和长期临床后果尚不清楚。本研究的目的是调查缺血性中风后新诊断的心血管并发症的发生率和长期临床结局。
使用来自53个参与医疗保健机构的匿名电子病历进行了一项回顾性队列研究。纳入年龄≥18岁且有5年随访的缺血性中风患者。在缺血性中风发病后4周内（暴露期）被诊断为新发心血管并发症（心力衰竭、严重室性心律失常、心房颤动、缺血性心脏病、应激性心肌病）的患者与未被诊断为新发心血管并发症的缺血性中风患者（对照组）进行1:1倾向评分匹配（年龄、性别、种族、合并症、心血管护理）。逻辑回归模型得出了全因死亡率、复发性中风、住院和急性心肌梗死5年发生率的比值比（OR）及95%置信区间。
在365383例有5年随访的中风患者中，11.1%在缺血性中风发病后4周内发生急性冠状动脉综合征；8.8%发生心房颤动/扑动；6.4%发生心力衰竭；1.2%发生严重室性心律失常；0.1%发生应激性心肌病。倾向评分匹配后，与匹配对照组相比，患有急性冠状动脉综合征（比值比，1.49[95%置信区间，1.44 - 1.54]）、心房颤动/扑动（1.45[1.40 - 1.50]）、心力衰竭（1.83[1.76 - 1.91]）和严重室性心律失常（2.08[1.90 - 2.29]）的中风患者5年全因死亡率的比值显著更高。诊断为新发心血管并发症的中风患者5年再住院和急性心肌梗死的比值也显著更高。应激性心肌病与5年复合重大心血管不良事件的比值显著更高相关（1.89[1.29 - 2.77]）。心房颤动/扑动是唯一与5年复发性缺血性中风比值显著更高相关的新发心脏并发症（1.10[1.07 - 1.14]）。
缺血性中风后新诊断的心血管并发症非常常见，且在重大心血管不良事件方面与5年预后显著更差相关。中风且新诊断有心血管并发症的患者5年复发性中风的患病率>50%。
