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(Stroke. 2007;38:2295.)
© 2007 American Heart Association, Inc.

Original Contributions

Predictors of Early Cardiac Morbidity and Mortality After Ischemic Stroke

Jane Prosser, MBBS, FRACP; Lachlan MacGregor, MBBS, MMedSc; Kennedy R. Lees, MD, FRCP; Hans-Christoph Diener, MD; Werner Hacke, MD, PhD; Stephen Davis, MD, FRCP (Edin) FRACP on behalf of the VISTA Investigators

From the Departments of Neurology (J.P., S.D.), Clinical Epidemiology (L.M.), Royal Melbourne Hospital, University of Melbourne, Australia; the Western Infirmary (K.R.L.), University Department of Medicine & Therapeutics, Glasgow, United Kingdom; the Department of Neurology (H.-C.D.), University of Duisburg-Essen, Essen, Germany; and the Department of Neurology (W.H.), University of Heidelberg, Germany.

Correspondence to Prof Stephen Davis, Department of Neurology, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050 Australia. E-mail stephen.davis{at}mh.org.au

Background and Purpose— In the first 3 months after acute ischemic stroke, 2% to 6% of patients die from cardiac causes. This may reflect preexisting cardiac disease, cardiac dysfunction related to the acute neurohumoral and autonomic stress response to stroke, or both. Delineation of a high-risk group could facilitate prevention strategies. We aimed to describe the temporal profile of cardiac risk after stroke and develop a predictive model of serious cardiac adverse events (SCAEs) using baseline variables.

Methods— We used data from the one trial in the Virtual International Stroke Trials Archive that matched prespecified criteria. Survival analysis was used to describe the temporal profile of cardiac events after stroke. Prognostic determinants were assessed with multivariable logistic regression, and a risk score was derived from the key predictor variables.

Results— Of 846 ischemic stroke patients, 35 (4.1%) died from cardiac causes and 161 (19.0%) suffered at least one SCAE. The hazard of cardiac death was highest (0.001/d) in the second week. Hazard of a first SCAE peaked at 0.02/d between day 2 and 3. The 5 factors most predictive of SCAEs were a history of heart failure (OR 3.33 [2.28, 4.89], P<0.001), diabetes (OR 2.11 [1.39, 3.21], P<0.001), baseline creatinine >115µmol/L (OR 1.77 [1.16, 2.70], P=0.008), severe stroke (OR 1.98 [1.34,2.91], P=0.001), and a long QTc or ventricular extrasystoles on ECG (OR 1.93 [1.31, 2.85], P=0.001). Risk of SCAEs ranged from 6.3% (no predictors) to 62.2% (4 predictors).

Conclusion— Serious cardiac events are common in the acute period after stroke. Patients at highest risk are identifiable and may benefit from more aggressive strategies to improve survival.

Key Words: cardiovascular disease • electrocardiography • ischemic • prognosis • risk factors • stroke

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