ABSTRACT NUMBER: ESOC2026A1296 LOBAR VERSUS NONLOBAR LOCATION IN LONGTERM MACE AFTER SPONTANEOUS INTRACEREBRAL HEMORRHAGE: A POPULATION-BASED HEALTH INSURANCE DATABASE STUDY IN CHINA

Abstract Background and aims Whether hematoma location predicts long-term major adverse cardiovascular and cerebrovascular events (MACE) after spontaneous intracerebral hemorrhage (sICH) in Asian populations remains debated. We described and compared the cumulative incidence of MACE between lobar and non-lobar sICH patients in a population-based health insurance database in China. Methods We identified patients with incident sICH that survived the first 30 days from the Shanghai medical insurance database (2020–2024). Patients were classified as lobar or non-lobar. Two-year cumulative incidence functions were estimated for MACE and its components (ischemic stroke, recurrent intracranial hemorrhage, myocardial infarction, vascular death), treating non-vascular death as a competing risk. A pre-specified descriptive subgroup analysis was performed among patients aged ≥75 years. Results Among 19,698 30-day survivors (median follow-up 2.00 years), 4,911 (24.93%) were lobar and 14,787 (75.07%) non-lobar. Compared with non-lobar survivors, lobar survivors were older (median 72 vs 66 years) and more often female (40.6% vs 29.4%). The overall 2-year cumulative MACE risk was 16.24% and was numerically similar between lobar and non-lobar survivors (15.13% vs 14.70%), with comparable risks for recurrent intracranial hemorrhage (10.40% vs 10.19%) and ischemic stroke (4.32% vs 4.45%). Among those aged≥75-years, although risks of ischemic stroke didn't differ by location (5.27% vs. 5.39%), lobar sICH had higher risks for MACE (18.37% vs 16.29%) and for recurrent intracranial hemorrhage (12.75% vs. 10.63%) compared with non-lobar sICH. Conclusions Lobar and non-lobar sICH survivors had similar long-term MACE risk overall. In older patients, lobar hemorrhage showed higher recurrent intracranial hemorrhage risk, potentially reflecting age-related small-vessel pathophysiology. Conflict of interest Jiahe Li, Ya Su, Linxin Li, Xin Cheng.nothing to disclose. Figure 1 - belongs to Results