Stroke-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications Following Stroke
Stroke-Heart Syndrome: Incidence and Clinical Outcomes of Cardiac Complications Following Stroke
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DOI：
10.1161/strokeaha.121.037316
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发表时间：
2022-05-01
期刊：
影响因子：
8.3
通讯作者：
Lip, Gregory Y. H.
中科院分区：
文献类型：
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作者：
Buckley, Benjamin J. R.;Harrison, Stephanie L.;Lip, Gregory Y. H.
背景：卒中后主要不良心血管事件的风险显著增加。虽然基于运动的心脏康复已被证明可以改善心脏事件后的预后，但它并不是中风患者常规护理的一部分。因此，我们调查了心脏康复和中风后主要不良心血管事件之间的关系。中风后，个体新发心血管并发症的风险增加。然而，卒中后新诊断的心血管并发症的发生率和长期临床后果尚不清楚。本研究的目的是调查缺血性卒中后新诊断的心血管并发症的发生率和长期临床结局。方法：使用来自53个参与医疗保健机构的匿名电子病历进行回顾性队列研究。入选年龄≥ 18岁、随访5年的缺血性卒中患者。在缺血性卒中事件发生4周（暴露）内诊断为新发心血管并发症（心力衰竭、重度室性心律失常、房颤、缺血性心脏病、Takotsubo综合征）的患者与未诊断为新发心血管并发症的缺血性卒中患者（对照）的倾向评分（年龄、性别、种族、合并症、心血管护理）为1：1匹配。Logistic回归模型得出全因死亡率、复发性卒中、住院和急性心肌梗死5年发生率的比值比（OR）和95%CI。结果如下：在365383例5年随访的卒中患者中：11.1%在缺血性卒中发生4周内发生急性冠状动脉综合征; 8.8%发生房颤/房扑; 6.4%发生心力衰竭; 1.2%发生重度室性心律失常; 0.1%发生Takotsubo综合征。倾向评分匹配后，急性冠状动脉综合征卒中患者的5年全因死亡率明显更高（比值比，1.49 [95% CI，1.44-1.54]），房颤/房扑（1.45 [1.40-1.50]）、心力衰竭（1.83 [1.76-1.91]）和严重室性心律失常（2.08 [1.90-2.29]）。诊断为新发心血管并发症的卒中患者5年再住院和急性心肌梗死的几率也显著较高。Takotsubo综合征与5年复合主要不良心血管事件的几率显著较高相关（1.89 [1.29-2.77]）。房颤/房扑是与5年时缺血性卒中复发几率显著较高相关的唯一新发心脏并发症（1.10 [1.07-1.14]）。结论：缺血性中风后诊断出的新发心血管并发症非常常见，并且与主要心血管不良事件的5年预后显着恶化相关。患有中风和新诊断的心血管并发症的人在5年时复发中风的患病率>50%。
Background: The risk of major adverse cardiovascular events is substantially increased following a stroke. Although exercise-based cardiac rehabilitation has been shown to improve prognosis following cardiac events, it is not part of routine care for people following a stroke. We, therefore, investigated the association between cardiac rehabilitation and major adverse cardiovascular events for people following a stroke. Following a stroke, individuals have an increased risk of new-onset cardiovascular complications. However, the incidence and long-term clinical consequence of newly diagnosed cardiovascular complications following a stroke is unclear. The aim of the present study was to investigate the incidence and long-term clinical outcomes of newly diagnosed cardiovascular complications following incident ischemic stroke. Methods: A retrospective cohort study was conducted using anonymized electronic medical records from 53 participating health care organizations. Patients with incident ischemic stroke aged >= 18 years with 5 years of follow-up were included. Patients who were diagnosed with new-onset cardiovascular complications (heart failure, severe ventricular arrhythmia, atrial fibrillation, ischemic heart disease, Takotsubo syndrome) within 4-weeks (exposure) of incident ischemic stroke were 1:1 propensity score-matched (age, sex, ethnicity, comorbidities, cardiovascular care) with ischemic stroke patients who were not diagnosed with a new-onset cardiovascular complication (control). Logistic regression models produced odds ratios (OR) with 95% CIs for 5-year incidence of all-cause mortality, recurrent stroke, hospitalization, and acute myocardial infarction. Results: Of 365 383 patients with stroke with 5-year follow-up: 11.1% developed acute coronary syndrome; 8.8% atrial fibrillation/flutter; 6.4% heart failure; 1.2% severe ventricular arrythmias; and 0.1% Takotsubo syndrome within 4 weeks of incident ischemic stroke. Following propensity score matching, odds of 5-year all-cause mortality were significantly higher in stroke patients with acute coronary syndrome (odds ratio, 1.49 [95% CI, 1.44-1.54]), atrial fibrillation/flutter (1.45 [1.40-1.50]), heart failure (1.83 [1.76-1.91]), and severe ventricular arrhythmias (2.08 [1.90-2.29]), compared with matched controls. Odds of 5-year rehospitalization and acute myocardial infarction were also significantly higher for patients with stroke diagnosed with new-onset cardiovascular complications. Takotsubo syndrome was associated with significantly higher odds of 5-year composite major adverse cardiovascular events (1.89 [1.29-2.77]). Atrial fibrillation/flutter was the only new-onset cardiac complication associated with significantly higher odds of recurrent ischemic stroke at 5 years (1.10 [1.07-1.14]). Conclusions: New-onset cardiovascular complications diagnosed following an ischemic stroke are very common and associate with significantly worse 5-year prognosis in terms of major adverse cardiovascular events. People with stroke and newly diagnosed cardiovascular complications had >50% prevalence of recurrent stroke at 5 years.