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In-hospital cardiac complications after intracerebral hemorrhage

Authors


  • Conflict of interest:

    JP: Travel expenses and honoraria from Boehringer-Ingelheim, Genzyme, and Orion Pharma (all modest).

    ML: Travel expenses from Bayer, Pfizer, MSD, Sanofi-Aventis; consultant to Boehringer-Ingelheim, Bayer, Pfizer, MSD, Sanofi-Aventis; and research contracts with Boehringer-Ingelheim and Sanofi-Aventis.

    AM: Compensation for consultancy with Boehringer-Ingelheim.

    KS: None declared.

    JK: None declared.

    R-JK: None declared.

    MK: Honoraria and travel expenses for participating on the Steering Committee meetings of the PERFORM, CEPO, MCI-184-E04, and DIAS-4 trials, and for serving as a consultant for Boehringer-Ingelheim, Servier, Mitsubishi Pharma Europe Ltd, Siemens AG, Merck, and H. Lundbeck A/S (all modest).

    TT: Scientific advisory boards for Boehringer-Ingelheim and Mitsubishi Pharma; consultant to Boehringer Ingelheim, PhotoThera, BrainsGate, Schering Plough, H. Lundbeck A/S, Sanofi-Aventis, and Concentric Medical (all modest); and research contracts with Boehringer Ingelheim, PhotoThera, BrainsGate, Schering Plough, H. Lundbeck A/S, Sanofi-Aventis, Concentric Medical, Mitsubishi Pharma (all significant).

    DS: None declared.

  • Funding: This study was supported by the Helsinki University Central Hospital Research Funds (EVO). Additional support was received from the Sigrid Jusélius Foundation (AM, TT), and the Academy of Finland (TT).

Abstract

Background and purpose

Data on cardiac complications and their precipitants after intracerebral hemorrhage are scarce. We examined the frequency and risk factors for serious in-hospital cardiac events in a large cohort of consecutive intracerebral hemorrhage patients.

Methods

A retrospective chart review of 1013 consecutive patients with nontraumatic intracerebral hemorrhage treated at the Helsinki University Central Hospital (2005–2010). We excluded patients with intraparenchymal hematoma related to sub-arachnoid hemorrhage or intracerebral hemorrhage because of fibrinolytic therapies for acute ischemic stroke or myocardial infarction. Serious in-hospital cardiac event was defined as any of in-hospital poststroke acute myocardial infarction, ventricular fibrillation or tachycardia, moderate to serious acute heart failure, or cardiac death.

Results

Among the 948 patients included, ≥1 serious in-hospital cardiac event occurred in 39 (4·1%) patients after a median delay of two-days from stroke onset (acute myocardial infarction in three patients, ventricular fibrillation or tachycardia in three patients, acute heart failure in 36 patients, and cardiac death in three patients). Hospital stay was longer in patients with serious in-hospital cardiac event than in those without (median 12, interquartile range 7–19 vs. 8, 3–14; P = 0·001), with no difference in in-hospital mortality (23·1% vs. 24·3%; P = 0·86). In multivariable logistic regression analysis adjusted for age, gender, and diabetes, atrial fibrillation during hospitalization (odds ratio 6·68 for new-onset atrial fibrillation, 95% confidence interval 2·11–21·18; 4·46 for old atrial fibrillation, 2·08–9·56), and history of myocardial infarction (3·20, 1·18–8·66) were independently associated with serious in-hospital cardiac events.

Conclusions

After intracerebral hemorrhage, 4% of patients suffer an acute serious cardiac complication. Those with history of myocardial infarction or in-hospital atrial fibrillation are at greater risk for such events.

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