Predictors of early cardiac morbidity and mortality after ischemic stroke.
OBJECTIVE
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.


METHODS
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.


RESULTS
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 >115 micromol/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% (> or =4 predictors).


CONCLUSIONS
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.
Prosser
Jane
J
Department of Neurology, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia.
MacGregor
Lachlan
L
Lees
Kennedy R
KR
Diener
Hans-Christoph
HC
Hacke
Werner
W
Davis
Stephen
S
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000401:mortality* / Q000503:physiopathology; D015984:Causality; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D003643:Death; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D006331:Heart Diseases / Q000401:mortality* / Q000503:physiopathology*; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors; D020521:Stroke / Q000401:mortality* / Q000503:physiopathology; D016019:Survival Analysis; D013997:Time Factors; D018879:Ventricular Premature Complexes / Q000453:epidemiology / Q000503:physiopathology
D003404:Creatinine