急性缺血性卒中后的初始血压与不良心脏事件：来自VISTA数据库的个体患者数据汇总分析

Initial blood pressure and adverse cardiac events following acute ischaemic stroke: An individual patient data pooled analysis from the VISTA database.

作者信息

Ishiguchi Hironori, Huang Bi, El-Bouri Wahbi K, Dawson Jesse, Lip Gregory Y H, Abdul-Rahim Azmil H

机构信息

Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.

Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan.

出版信息

Eur Stroke J. 2024 Oct 30:23969873241296391. doi: 10.1177/23969873241296391.

DOI:10.1177/23969873241296391

PMID:39475369

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11556537/

Abstract

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]; < 0.001, 1.71 [1.39-2.10]; < 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]; = 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.

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。我们调查了卒中发作时的初始血压与SHS风险之间的关联。

方法

我们使用了虚拟国际卒中试验档案（VISTA）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。这些表现包括急性冠状动脉综合征，涵盖心肌损伤、心力衰竭/左心室功能障碍、心房颤动/扑动、其他心律失常/心电图异常以及心肺骤停。使用Cox比例风险模型，我们评估了发生SHS及其与初始血压相关表现的风险轨迹。我们还探讨了与初始血压相关的90天死亡率风险轨迹。

结果

对16,095例急性缺血性卒中患者中的14,965例（平均年龄69±12岁；55%为男性）进行了分析。其中，1774例（11.8%）发生了SHS。SHS风险与初始血压呈U形关系。最低血压（收缩压≤130 mmHg和舒张压≤55 mmHg）与最高风险相关（调整后的风险比[95%置信区间]：与参考血压范围相比，分别为1.40[1.21 - 1.63]；P < 0.001，1.71[1.39 - 2.10]；P < 0.001）。在较高血压水平时，心肺骤停风险最大（收缩压>190 mmHg时为2.34[1.16 - 4.73]；P = 0.017），而其他表现在较低血压时风险最高。90天死亡率风险也呈U形分布（在高血压阈值时观察到更高风险）。