Neurocritical Care

, Volume 17, Issue 3, pp 374–381 | Cite as

Cardiovascular Predictors of Long-Term Outcomes After Non-Traumatic Subarachnoid Hemorrhage

  • Jonathan G. Zaroff
  • Jonathan Leong
  • Helen Kim
  • William L. Young
  • Sean P. Cullen
  • Vivek A. Rao
  • Michael Sorel
  • Charles P. QuesenberryJr.
  • Steve Sidney
Original Article

Abstract

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.

Methods

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).

Results

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).

Conclusions

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.

Keywords

Subarachnoid hemorrhage Mortality Cardiac Myonecrosis 

Supplementary material

12028_2011_9592_MOESM1_ESM.docx (14 kb)
Online Data Supplement: ICD-9 codes used for case ascertainment and outcome determinations (DOCX 14 kb)

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Jonathan G. Zaroff
    • 1
  • Jonathan Leong
    • 2
  • Helen Kim
    • 3
  • William L. Young
    • 3
  • Sean P. Cullen
    • 4
  • Vivek A. Rao
    • 4
  • Michael Sorel
    • 1
  • Charles P. QuesenberryJr.
    • 1
  • Steve Sidney
    • 1
  1. 1.Kaiser Northern California Division of ResearchSan FranciscoUSA
  2. 2.Kaiser San Francisco Medical CenterSan FranciscoUSA
  3. 3.University of California San Francisco Center for Cerebrovascular ResearchSan FranciscoUSA
  4. 4.Kaiser Redwood City Medical CenterRedwood CityUSA

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