title: Cardiac Arrest in Acute Ischemic Stroke: Incidence, Predisposing Factors, and Clinical Outcomes.
abstract: BACKGROUND
  Cardiac arrest is a devastating complication of acute ischemic stroke, but little is known about its incidence and characteristics. We studied a large ischemic stroke inpatient population and compared patients with and without cardiac arrest.
  
  
  METHODS
  We studied consecutive patients from the Ontario Stroke Registry who had an ischemic stroke between July 2003 and June 2008 at 11 tertiary care stroke centers in Ontario. Multivariable analyses were used to determine independent predictors of cardiac arrest and associated outcomes. Adjusted survival curves were computed, and hazard ratios for mortality at 30 days and 1 year were determined for cardiac arrest and other major outcomes.
  
  
  RESULTS
  Among the 9019 patients with acute ischemic stroke, 352 had cardiac arrest, for an overall incidence of 3.9%. In a sensitivity analysis with palliative patients removed, the incidence of cardiac arrest was 2.5%. Independent predictors of cardiac arrest were as follows: older age, greater stroke severity, preadmission dependence, and a history of diabetes, myocardial infarction, congestive heart failure, and atrial fibrillation. Systemic complications associated with cardiac arrest were as follows: myocardial infarction, pulmonary embolism, sepsis, gastrointestinal hemorrhage, and pneumonia. Patients with cardiac arrest had higher disability at discharge, and a markedly increased 30-day mortality of 82.1% compared with 9.3% without cardiac arrest.
  
  
  CONCLUSIONS
  Cardiac arrest had a high incidence and was associated with poor outcomes after ischemic stroke, including multiple medical complications and very high mortality. Predictors of cardiac arrest identified in this study could help risk stratify ischemic stroke patients for cardiac investigations and prolonged cardiac monitoring.
authors.affiliation: Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Raed A
authors.initials: RA
authors.lastname: Joundi
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.affiliation: Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Davar
authors.initials: D
authors.lastname: Nikneshan
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada; Division of Cardiology, Sunnybrook Schulich Heart Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada.
authors.forename: Jiming
authors.initials: J
authors.lastname: Fang
authors.affiliation: Department of Neurology, University of Rochester Medical Center, Rochester, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Holloway
authors.affiliation: Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada; Neuroeconomics and Social Neuroscience, Department of Economics, University of Zurich, Zurich, Switzerland. Electronic address: saposnikg@smh.ca.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saposnik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016009:Chi-Square Distribution; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D062606:Tertiary Care Centers; D013997:Time Factors; D055815:Young Adult
keywords: Ischemic stroke; cardiac arrest; outcomes and process measures; stroke complications