Predictors of early cardiac morbidity and mortality after ischemic stroke

Prosser, J., MacGregor, L., Lees, K.R., Diener, H.-C., Hacke, W. and Davis, S. (2007) Predictors of early cardiac morbidity and mortality after ischemic stroke. Stroke, 38(8), pp. 2295-2302. (doi: 10.1161/STROKEAHA.106.471813)

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Publisher's URL: http://dx.doi.org/10.1161/STROKEAHA.106.471813

Abstract

<p><b>Background and Purpose:</b> In the first 3 months after acute ischemic stroke, 2% to 6% of patients die from cardiac causes. This may reflect preexisting cardiac disease, cardiac dysfunction related to the acute neurohumoral and autonomic stress response to stroke, or both. Delineation of a high-risk group could facilitate prevention strategies. We aimed to describe the temporal profile of cardiac risk after stroke and develop a predictive model of serious cardiac adverse events (SCAEs) using baseline variables.</p> <p><b>Methods:</b> We used data from the one trial in the Virtual International Stroke Trials Archive that matched prespecified criteria. Survival analysis was used to describe the temporal profile of cardiac events after stroke. Prognostic determinants were assessed with multivariable logistic regression, and a risk score was derived from the key predictor variables.</p> <p><b>Results:</b> Of 846 ischemic stroke patients, 35 (4.1%) died from cardiac causes and 161 (19.0%) suffered at least one SCAE. The hazard of cardiac death was highest (0.001/d) in the second week. Hazard of a first SCAE peaked at 0.02/d between day 2 and 3. The 5 factors most predictive of SCAEs were a history of heart failure (OR 3.33 [2.28, 4.89], P<0.001), diabetes (OR 2.11 [1.39, 3.21], P<0.001), baseline creatinine >115μmol/L (OR 1.77 [1.16, 2.70], P=0.008), severe stroke (OR 1.98 [1.34,2.91], P=0.001), and a long QTc or ventricular extrasystoles on ECG (OR 1.93 [1.31, 2.85], P=0.001). Risk of SCAEs ranged from 6.3% (no predictors) to 62.2% (≥4 predictors).</p> <p><b>Conclusion:</b> Serious cardiac events are common in the acute period after stroke. Patients at highest risk are identifiable and may benefit from more aggressive strategies to improve survival.</p>

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Lees, Professor Kennedy
Authors: Prosser, J., MacGregor, L., Lees, K.R., Diener, H.-C., Hacke, W., and Davis, S.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Stroke
ISSN:0039-2499
ISSN (Online):1524-4628
Copyright Holders:Copyright © 2007 American Heart Association
First Published:First published in Stroke 38(8):2295-2302
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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