Cardiovascular Predictors of Long-Term Outcomes After Non-Traumatic Subarachnoid Hemorrhage
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- Zaroff, J.G., Leong, J., Kim, H. et al. Neurocrit Care (2012) 17: 374. doi:10.1007/s12028-011-9592-x
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Background and Purpose
Cardiac injury is common after subarachnoid hemorrhage (SAH) and is associated with adverse early outcomes, but long-term effects are unknown. The first aim of this study was to compare the long-term rates of death, stroke, and cardiac events in SAH survivors versus a matched population without SAH. The second aim was to quantify the effects of cardiac injury on the outcome rates.
This was a retrospective cohort study of patients with and without non-traumatic SAH. For aim #1, the predictor variable was SAH and the outcome variables were all-cause and cerebrovascular mortality, stroke, cardiac mortality, acute coronary syndrome (ACS), and heart failure (HF) admission. A multivariable Cox proportional hazards analysis was performed. For aim #2, the predictor variables were cardiac injury (elevated serum cardiac enzymes or a diagnosis code for ACS) and dysfunction (pulmonary edema on X-Ray or a diagnosis code for HF).
Compared with 4,695 members without SAH, the 910 SAH patients had higher rates of all-cause mortality (hazard ratio [HR 2.6], 95% confidence intervals [CI] 2.0–3.4), cerebrovascular mortality (HR 30.6, CI 13.5–69.4), and stroke (HR 10.2, CI 7.5–13.8). Compared with the non-SAH group, the SAH patients with cardiac injury had increased rates of all-cause mortality (HR 5.3, CI 3.0–9.3), cardiac mortality (HR 7.3, CI 1.7–31.6), and heart failure (HR 4.3, CI 1.53–11.88).
SAH survivors have increased long-term mortality and stroke rates compared with a matched non-SAH population. SAH-induced cardiac injury is associated with an increased risk of death and heart failure hospitalization.