Research Unit for Neurology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
Department of Radiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
JAMA Netw Open. 2023 Apr 3;6(4):e235882. doi: 10.1001/jamanetworkopen.2023.5882.
Survivors of spontaneous (ie, nontraumatic and with no known structural cause) intracerebral hemorrhage (ICH) have an increased risk of major cardiovascular events (MACEs), including recurrent ICH, ischemic stroke (IS), and myocardial infarction (MI). Only limited data are available from large, unselected population studies assessing the risk of MACEs according to index hematoma location.
To examine the risk of MACEs (ie, the composite of ICH, IS, spontaneous intracranial extra-axial hemorrhage, MI, systemic embolism, or vascular death) after ICH based on ICH location (lobar vs nonlobar).
DESIGN, SETTING, AND PARTICIPANTS: This cohort study identified 2819 patients in southern Denmark (population of 1.2 million) 50 years or older hospitalized with first-ever spontaneous ICH from January 1, 2009, to December 31, 2018. Intracerebral hemorrhage was categorized as lobar or nonlobar, and the cohorts were linked to registry data until the end of 2018 to identify the occurrence of MACEs and separately recurrent ICH, IS, and MI. Outcome events were validated using medical records. Associations were adjusted for potential confounders using inverse probability weighting.
Location of ICH (lobar vs nonlobar).
The main outcomes were MACEs and separately recurrent ICH, IS, and MI. Crude absolute event rates per 100 person-years and adjusted hazard ratios (aHRs) with 95% CIs were calculated. Data were analyzed from February to September 2022.
Compared with patients with nonlobar ICH (n = 1255; 680 [54.2%] men and 575 [45.8%] women; mean [SD] age, 73.5 [11.4] years), those with lobar ICH (n = 1034; 495 [47.9%] men and 539 [52.1%] women, mean [SD] age, 75.2 [10.7] years) had higher rates of MACEs per 100 person-years (10.84 [95% CI, 9.51-12.37] vs 7.91 [95% CI, 6.93-9.03]; aHR, 1.26; 95% CI, 1.10-1.44) and recurrent ICH (3.74 [95% CI, 3.01-4.66] vs 1.24 [95% CI, 0.89-1.73]; aHR, 2.63; 95% CI, 1.97-3.49) but not IS (1.45 [95% CI, 1.02-2.06] vs 1.77 [95% CI, 1.34-2.34]; aHR, 0.81; 95% CI, 0.60-1.10) or MI (0.42 [95% CI, 0.22-0.81] vs 0.64 [95% CI, 0.40-1.01]; aHR, 0.64; 95% CI, 0.38-1.09).
In this cohort study, spontaneous lobar ICH was associated with a higher rate of subsequent MACEs than nonlobar ICH, primarily due to a higher rate of recurrent ICH. This study highlights the importance of secondary ICH prevention strategies in patients with lobar ICH.
自发性（即非外伤性且无已知结构原因）脑出血（ICH）幸存者发生重大心血管事件（MACE）的风险增加，包括复发性 ICH、缺血性中风（IS）和心肌梗死（MI）。只有有限的数据来自大型、未选择人群研究，评估根据指数血肿位置的 MACE 风险。
根据 ICH 位置（叶性与非叶性），检查 ICH 后 MACE（即 ICH、IS、自发性颅内外轴外出血、MI、系统性栓塞或血管死亡的复合事件）的风险。
设计、设置和参与者：这项队列研究在丹麦南部（人口 120 万）确定了 2819 名 50 岁及以上的首次自发性 ICH 住院患者，研究时间为 2009 年 1 月 1 日至 2018 年 12 月 31 日。ICH 分为叶性或非叶性，两个队列与登记数据相关联，直到 2018 年底，以确定 MACE 和分别的复发性 ICH、IS 和 MI 的发生情况。使用病历验证结局事件。使用逆概率加权法调整潜在混杂因素的关联。
ICH 位置（叶性与非叶性）。
主要结果是 MACE 和分别的复发性 ICH、IS 和 MI。计算每 100 人年的粗绝对事件率和调整后的危害比（aHR）及其 95%置信区间。数据于 2022 年 2 月至 9 月进行分析。
与非叶性 ICH（n=1255；680 [54.2%] 名男性和 575 [45.8%] 名女性；平均[SD]年龄 73.5[11.4]岁）相比，叶性 ICH（n=1034；495 [47.9%] 名男性和 539 [52.1%] 名女性，平均[SD]年龄 75.2[10.7]岁）患者的每 100 人年 MACE 发生率更高（10.84 [95%CI，9.51-12.37] vs 7.91 [95%CI，6.93-9.03]；aHR，1.26；95%CI，1.10-1.44）和复发性 ICH（3.74 [95%CI，3.01-4.66] vs 1.24 [95%CI，0.89-1.73]；aHR，2.63；95%CI，1.97-3.49），但 IS（1.45 [95%CI，1.02-2.06] vs 1.77 [95%CI，1.34-2.34]；aHR，0.81；95%CI，0.60-1.10）或 MI（0.42 [95%CI，0.22-0.81] vs 0.64 [95%CI，0.40-1.01]；aHR，0.64；95%CI，0.38-1.09）发生率无差异。
在这项队列研究中，自发性叶性 ICH 与较高的后续 MACE 发生率相关，而非非叶性 ICH，主要原因是复发性 ICH 的发生率较高。这项研究强调了在叶性 ICH 患者中进行继发性 ICH 预防策略的重要性。
