颅内出血后早期心脏并发症患者的发病率和结局：来自 VISTA 的报告。
Incidence and Outcomes of Patients With Early Cardiac Complications After Intracerebral Hemorrhage: A Report From VISTA.
机构信息
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, United Kingdom (H.I., B.H., W.K.E.-B., G.Y.H.L., A.H.A.-R.).
Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan (H.I.).
出版信息
Stroke. 2024 Nov;55(11):2669-2676. doi: 10.1161/STROKEAHA.124.048189. Epub 2024 Oct 2.
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]; =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 (<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]; <0.001).
CONCLUSIONS
Cardiac events are common and negatively affect prognosis in patients with ICH, just as seen in AIS.
背景
脑出血（ICH）患者早期心脏并发症的发生率和转归尚不清楚。这些心脏并发症可能是ICH 患者所谓的卒中-心脏综合征的一部分。我们在国际临床试验数据存储库的个体患者数据汇总分析中研究了这一问题。
方法
我们使用虚拟国际卒中试验档案（Virtual International Stroke Trials Archive）调查了ICH 后或急性缺血性卒中（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/心房扑动、其他心律失常/心电图异常和心肺骤停。我们使用倾向评分匹配比较了 ICH 患者和 AIS 患者卒中-心脏综合征的发生率。在 ICH 队列中，使用多变量逻辑回归分析评估了 90 天死亡率的相关因素。
结果
我们汇总了来自急性卒中试验的 8698 名参与者的数据（平均年龄 68±12 岁；56%为男性），其中 914（11%）为 ICH 患者。在 ICH 患者中，有 123（13%）例发生卒中-心脏综合征。在进行倾向评分匹配后，共分析了 1828 名患者（ICH 组和 AIS 组各 914 名）。虽然与 AIS 组相比，ICH 组的心脏事件总发生率较低（无事件的累积发生率，86.3%[95%CI，84.1-88.6]与 83.6%[95%CI，81.2-86.0]；=0.100），但两组匹配患者除心房颤动/心房扑动以外的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（<0.001）。多变量调整分析发现，ICH 患者的卒中-心脏综合征与 90 天死亡率相关（调整后的优势比，1.12[95%CI，1.06-1.19]；<0.001）。
结论
心脏事件在 ICH 患者中很常见，并对预后产生负面影响，就像在 AIS 中一样。
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