Long-term cardiovascular outcomes of patients experiencing intra-cranial hemorrhage with or without acute cardiovascular events

Abstract Background Acute cardiovascular (CV) events would happen during the acute stage of ischemic stroke or intra-cranial hemorrhage (ICH), so called "Stroke-Heart Syndrome". However, long-term outcomes of patients who experienced acute CV events during the acute stage of ICH were unclear. In the present study, we aimed to report and compare long-term prognosis of patients with or without acute CV events after ICH. Methods A total of 104,955 patients who experienced ICH and survived longer than 90 days without past history of acute myocardial infarction (AMI), heart failure (HF), atrial fibrillation (AF) and ventricular arrhythmia (VA) were identified from the Taiwan National Health Insurance Research Database. Among them, 1,888 patients experienced CV events (AMI, HF, AF or VA) within 90 days after ICH, while 103,067 did not. Results Compared to patients without acute CV events, patients with acute CV events were older (73.53 vs 62.46 years, p<0.001), less males (57.89% vs 61.83%, p<0.001) and had more comorbidities , such as hypertension (77.17% vs 61.58%), diabetes mellitus (35.81% vs 26.54%), vascular diseases (3.5% vs 2.02%) and chronic obstructive pulmonary disease (15.57% vs 9.88%), all p<0.001. Compared to patients without acute CV events, those experiencing acute CV events had a higher adjusted risk of ischemic stroke (adjusted hazard ratio [aHR] 1.564), recurrent ICH (aHR 1.266), HF (aHR 4.693), AF (aHR 19.116), VA (aHR 3.485), AMI (aHR 2.463), sudden cardiac death (aHR 1.609) and mortality (aHR 1.855)(Figure). Conclusions Acute CV events occurring during acute stage of ICH were not a benign course simply related to acute stress and were associated with a poor long-term outcome. How to improve long-term clinical outcomes of these patients deserves more attentions, efforts and studies involving both cardiologists and neurologists.