1
|
Kwok CS, Qureshi AI, Borovac JA, Will M, Schwarz K, Hall M, Mann P, Holroyd E, Lip GYH. Readmissions for Cardiac Disease Within 30 Days of Hospitalization for Cerebral Infarction: An Evaluation of the Stroke-Heart Syndrome Using the Nationwide Readmission Database. J Cardiovasc Dev Dis 2025; 12:116. [PMID: 40278175 PMCID: PMC12027694 DOI: 10.3390/jcdd12040116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Revised: 03/14/2025] [Accepted: 03/18/2025] [Indexed: 04/26/2025] Open
Abstract
BACKGROUND The stroke-heart syndrome refers to incident cardiac complications post stroke. This study aims to evaluate the stroke-heart syndrome by determining the rate and predictors of readmission for cardiac disease within 30 days of hospitalization for cerebral infarction. METHODS Data from the United States Nationwide Readmissions Database (2018 to 2020) were analyzed to identify rates and factors associated with 30-day readmissions for heart disease following cerebral infarction, excluding patients with atrial fibrillation, heart failure and myocardial infarction during admission with cerebral infarction. RESULTS There were 3,115,850 hospital admissions for cerebral infarction, and 75,440 admissions (2.4%) were readmitted with new onset cardiac events within 30 days of discharge. This included 36,310 (1.4%) readmissions for heart failure, 35,900 (1.1%) readmissions for atrial fibrillation, 17,465 (0.5%) readmissions for acute myocardial infarction, 810 (0.03%) readmissions for ventricular arrhythmias and 700 (0.02%) readmissions for Takotsubo syndrome. Readmitted patients were older (median age of 73 years vs. 68 years, p < 0.001) and had a longer length of stay for initial admission (median of 4 days vs. 3 days, p < 0.001). The most significant predictors of readmission were elective admission (OR 2.00, 95%CI 1.89-2.13, p < 0.001), cancer (OR 1.91, 95%CI 1.81-2.01, p < 0.001), chronic kidney disease (OR 1.80, 95%CI 1.73-1.87, p < 0.001), previous myocardial infarction (OR 1.59, 95%CI 1.50-1.69, p < 0.001) and liver failure (OR 1.34, 95%CI 1.06-1.68, p = 0.013). Palliative care was linked to a reduced odds of readmission (OR 0.36, 95%CI 0.31-0.41, p < 0.001). CONCLUSIONS New cardiac-related hospital readmissions within 30 days after ischemic stroke occur in 2.4% of patients, with elective admission and cancer being a strong predictor of readmissions.
Collapse
Affiliation(s)
- Chun Shing Kwok
- Department of Cardiology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe CW1 4QJ, UK; (M.H.); (P.M.); (E.H.)
| | - Adnan I. Qureshi
- Zeenat Qureshi Stroke Institute, St. Cloud, MN 56303, USA;
- Department of Neurology, University of Missouri, Columbia, MI 65201, USA
| | - Josip Andelo Borovac
- Division of Interventional Cardiology, Cardiovascular Diseases Department, University Hospital of Split (KBC Split), 21000 Split, Croatia;
| | - Maximilian Will
- Division of Internal Medicine 3, University Hospital St. Pölten, 3100 St. Pölten, Austria; (M.W.); (K.S.)
- Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
- Karl Landsteiner Institute for Cardiometabolics, Karl Landsteiner Society, 3100 St. Poelten, Austria
| | - Konstantin Schwarz
- Division of Internal Medicine 3, University Hospital St. Pölten, 3100 St. Pölten, Austria; (M.W.); (K.S.)
| | - Mark Hall
- Department of Cardiology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe CW1 4QJ, UK; (M.H.); (P.M.); (E.H.)
| | - Paul Mann
- Department of Cardiology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe CW1 4QJ, UK; (M.H.); (P.M.); (E.H.)
| | - Eric Holroyd
- Department of Cardiology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe CW1 4QJ, UK; (M.H.); (P.M.); (E.H.)
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University & Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK;
- Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
| |
Collapse
|
2
|
Kubsad S, Collins AP, Dasari SP, Chansky HA, Fernando ND, Hernandez NM. Impact of Extended Prophylactic Antibiotics on Risk of Prosthetic Joint Infection in Primary Total Hip Arthroplasty: A Matched Cohort Analysis. J Am Acad Orthop Surg 2025; 33:307-312. [PMID: 39254971 DOI: 10.5435/jaaos-d-24-00290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/29/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Extended oral prophylactic antibiotics have been increasingly used in arthroplasty with the goal of reducing the risk of prosthetic joint infection (PJI). While a reduction in the rate of PJI has been noted with extended oral antibiotic regimens in high-risk patients, no large database study has assessed infection risk after primary total hip arthroplasty among well-balanced cohorts receiving and not receiving postoperative extended oral antibiotics. METHODS A retrospective cohort study was conducted using a national database, TriNetX, to identify patients who underwent primary total hip arthroplasty. This cohort was stratified by oral antibiotic prescription within one day of procedure. A one-to-one propensity score matching based on age, sex, class of obesity, and medical comorbidities was conducted. Outcomes explored in this study were 90-day risk of PJI, superficial skin infection, deep skin infection, and all-cause revision. RESULTS 90-day postoperative infection complications of PJI were higher in the group receiving antibiotics (hazard ratio: 1.83, P -value = 0.012). Other complications such as superficial skin infection, deep skin infection, and all-cause revision showed no statistically significant differences. CONCLUSION This database analysis of 5,476 patients demonstrated no decrease in complications of PJI, superficial or deep skin infection, or revision at 90 days. Future randomized controlled trials are needed to evaluate the efficacy of extended oral antibiotics. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Sanjay Kubsad
- From the Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA
| | | | | | | | | | | |
Collapse
|
3
|
Ntaios G, Dalakoti M. Treat the patient, not the disease: The embolic stroke of undetermined source as an opportunity to optimize cardiovascular prevention in a holistic approach. Eur J Intern Med 2025; 132:9-17. [PMID: 39443247 DOI: 10.1016/j.ejim.2024.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 10/09/2024] [Accepted: 10/16/2024] [Indexed: 10/25/2024]
Abstract
For any physician treating a patient with a medical condition of unclear etiology, the differential diagnosis aims to identify the actual most probable cause among various potential etiologies, in order to tailor treatment options. In patients with embolic stroke of undetermined source (ESUS), this can be challenging due to the frequent presence of multiple potential embolic sources, raising difficulties to identify the most likely cause. Additionally, despite targeted preventive measures for the presumed embolic source, patients may remain at risk for stroke and cardiovascular events due to other unrecognized or underestimated pathologies. The multi-level complexity and multimorbidity typically associated with ESUS, represents a challenge that requires broad knowledge of the cardiovascular pathophysiology, deep expertise of the available diagnostic and therapeutic options, and interdisciplinary approach. At the same time, it is an ideal opportunity to assess thoroughly the overall cardiovascular status of the patient, which in turn can allow us to optimize therapeutic and preventive strategies in a holistic approach, and prevent future strokes, cardiovascular events and disability through different parallel pathways. In this context, rather than narrowing our perspective on identifying the specific embolic source presumed to be the most likely cause of ESUS, it is crucial to shift our focus from the disease to the patient, and evaluate the overall cardiovascular profile by assessing the risk of all cardiovascular comorbidities present, no matter if causally associated with ESUS or not. In order to bring across these points and more, this article is centred around a clinical case that serves as a starting point to illustrate the holistic approach to the management of patients with ESUS. After all, this is the beauty, the magic and the art of Internal Medicine: to treat the patient, not the disease, the system or the organ.
Collapse
Affiliation(s)
- George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41110, Greece.
| | - Mayank Dalakoti
- Cardiovascular Metabolic Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| |
Collapse
|
4
|
Bucci T, Choi SE, Tsang CTW, Yiu KH, Buckley BJR, Pignatelli P, Scheitz JF, Lip GYH, Abdul-Rahim AH. Incident dementia in ischaemic stroke patients with early cardiac complications: A propensity-score matched cohort study. Eur Stroke J 2024:23969873241293573. [PMID: 39487764 PMCID: PMC11558657 DOI: 10.1177/23969873241293573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Accepted: 10/07/2024] [Indexed: 11/04/2024] Open
Abstract
INTRODUCTION The risk of dementia in patients with stroke-heart syndrome (SHS) remains unexplored. PATIENTS AND METHODS Retrospective analysis using the TriNetX network, including patients with ischaemic stroke from 2010 to 2020. These patients were categorised into two groups: those with SHS (heart failure, myocardial infarction, ventricular fibrillation, or Takotsubo cardiomyopathy within 30 days post-stroke) and those without SHS. The primary outcome was the 1-year risk of dementia (vascular dementia, dementia in other disease, unspecified dementia, or Alzheimer's disease). The secondary outcome was the 1-year risk of all-cause death. Cox regression analysis after 1:1 propensity score matching (PSM) was performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the outcomes. RESULTS We included 52,971 patients with SHS (66.6 ± 14.6 years, 42.2% females) and 854,232 patients without SHS (64.7 ± 15.4 years, 48.2% females). Following PSM, 52,970 well-balanced patients were considered in each group. Patients with SHS had a higher risk of incident dementia compared to those without SHS (HR 1.28, 95%CI 1.20-1.36). The risk was the highest during the first 31 days of follow-up (HR 1.51, 95%CI 1.31-1.74) and was mainly driven by vascular and mixed forms. The increased risk of dementia in patients with SHS, was independent of oral anticoagulant use, sex and age but it was the highest in those aged <75 years compared to ⩾75 years. DISCUSSION AND CONCLUSION SHS is associated with increased risk of dementia. Future studies are needed to develop innovative strategies for preventing complications associated with stroke-heart syndrome and improving the long-term prognosis of these patients.
Collapse
Affiliation(s)
- Tommaso Bucci
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Sylvia E Choi
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Christopher TW Tsang
- Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, The University of Hong Kong, Hong Kong, China
| | - Benjamin JR Buckley
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Cardiovascular Health Sciences, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Pasquale Pignatelli
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Jan F Scheitz
- Department of Neurology and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gregory YH Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Azmil H Abdul-Rahim
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Stroke Division, Department Medicine for Older People, Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, UK
| |
Collapse
|
5
|
Ishiguchi H, Huang B, El-Bouri WK, Dawson J, Lip GY, Abdul-Rahim AH. Incidence and Outcomes of Patients With Early Cardiac Complications After Intracerebral Hemorrhage: A Report From VISTA. Stroke 2024; 55:2669-2676. [PMID: 39355933 PMCID: PMC11518970 DOI: 10.1161/strokeaha.124.048189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/14/2024] [Accepted: 09/05/2024] [Indexed: 10/03/2024]
Abstract
BACKGROUND The incidence and outcomes of early cardiac complications in patients with intracerebral hemorrhage (ICH) are poorly understood. These cardiac complications may be part of the so-called stroke-heart syndrome in patients with ICH. We investigated this issue in an individual patient data pooled analysis from an international repository of clinical trial data. METHODS We used the Virtual International Stroke Trials Archive to investigate the incidence of cardiac complications within 30 days post-ICH or acute ischemic stroke (AIS). These complications included acute coronary syndrome encompassing myocardial injury, heart failure/left ventricular dysfunction, atrial fibrillation/atrial flutter, other arrhythmia/ECG abnormalities, and cardiorespiratory arrest. We used propensity score matching to compare the incidence of patients with stroke-heart syndrome in patients with ICH with those following AIS. Factors associated with 90-day mortality were evaluated using multivariate logistic regression analysis in the ICH cohort. RESULTS We pooled data from 8698 participants recruited in acute stroke trials (mean age, 68±12 years; 56% male), of whom 914 (11%) were patients with ICH. Among the patients with ICH, 123 (13%) had stroke-heart syndrome in patients with ICH. Following propensity score matching, a total of 1828 patients (914 for each of the cohorts) were analyzed. While the overall incidence of cardiac events tended to be lower in the ICH group compared with the AIS group (the cumulative incidence freedom from the event, 86.3% [95% CI, 84.1-88.6] versus 83.6% [95% CI, 81.2-86.0]; P=0.100), the incidences cardiac events other than atrial fibrillation/atrial flutter were comparable between the 2 matched groups. The incidence of atrial fibrillation/atrial flutter was significantly lower in the ICH group than in the AIS group (P<0.001). The multivariate-adjusted analysis found that stroke-heart syndrome in patients with ICH was associated with 90-day mortality (adjusted odds ratio, 1.12 [95% CI, 1.06-1.19]; P<0.001). CONCLUSIONS Cardiac events are common and negatively affect prognosis in patients with ICH, just as seen in AIS.
Collapse
Affiliation(s)
- Hironori Ishiguchi
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, United Kingdom (H.I., B.H., W.K.E.-B., G.Y.H.L., A.H.A.-R.)
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan (H.I.)
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom (H.I., B.H., W.K.E.-B., A.H.A.-R.)
| | - Bi Huang
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, United Kingdom (H.I., B.H., W.K.E.-B., G.Y.H.L., A.H.A.-R.)
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom (H.I., B.H., W.K.E.-B., A.H.A.-R.)
| | - Wahbi K. El-Bouri
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, United Kingdom (H.I., B.H., W.K.E.-B., G.Y.H.L., A.H.A.-R.)
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom (H.I., B.H., W.K.E.-B., A.H.A.-R.)
| | - Jesse Dawson
- School of Cardiovascular and Metabolic Health, College of Medical, Veterinary and Life Sciences, University of Glasgow, United Kingdom (J.D.)
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, United Kingdom (H.I., B.H., W.K.E.-B., G.Y.H.L., A.H.A.-R.)
- Department of Clinical Medicine, Danish Centre for Health Services Research, Aalborg University, Denmark (G.Y.H.L.)
| | - Azmil H. Abdul-Rahim
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, United Kingdom (H.I., B.H., W.K.E.-B., G.Y.H.L., A.H.A.-R.)
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom (H.I., B.H., W.K.E.-B., A.H.A.-R.)
- Stroke Division, Department Medicine for Older People, Mersey and West Lancashire Teaching Hospitals NHS Trust, Prescot, United Kingdom (A.H.A.-R.)
| |
Collapse
|
6
|
Tang H, Xing X, Han Y, Gao D, Chan P, Zhang S, Xue H. A Retrospective Study of Brain-Heart Syndrome in Patients with Acute Cerebrovascular Diseases. Risk Manag Healthc Policy 2024; 17:2161-2168. [PMID: 39263551 PMCID: PMC11389706 DOI: 10.2147/rmhp.s467205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/01/2024] [Indexed: 09/13/2024] Open
Abstract
Objective To investigate the clinical characteristics, risk factors and outcomes of brain-heart syndrome (BHS) in patients with acute cerebrovascular diseases (ACVDs). Methods A retrospective analysis was conducted of 100 patients who were admitted to our hospital with ACVDs between January 2023 and December 2023. The demographic, clinical, laboratory and imaging data of the patients were collected, and the presence and severity of BHS were evaluated. The neurological and cardiac outcomes of the patients at discharge and at 12-month follow-up were also assessed. Results Out of the 100 patients, 38% had BHS, classified as mild (18%), moderate (12%) and severe (8%). The most prevalent ACVDs were cerebral infarction (58%), cerebral haemorrhage (32%) and subarachnoid haemorrhage (10%). Cardiac complications included arrhythmia (26%), myocardial ischaemia (18%) and heart failure (10%). Patients with BHS had higher results for blood pressure, heart rate, white blood cell count, C-reactive protein, IL-6, D-dimer and troponin, more severe neurological deficits, higher mortality and poorer functional outcomes. Multivariable analysis identified age, hypertension, diabetes, coronary artery disease, prior cardiovascular events, cerebral haemorrhage, brainstem infarction and hypothalamic or insular lesions as independent risk factors for BHS. Conclusion Brain-heart syndrome is a frequent, severe complication in patients with ACVD, linked with multiple risk factors and poor prognosis. Prompt diagnosis and treatment are crucial for improving patient outcomes.
Collapse
Affiliation(s)
- Hui Tang
- Department of Emergency Internal Medicine, Xuanwu Hospital of China Capital Medical University, Beijing, People's Republic of China
| | - Xiurong Xing
- Department of Emergency Internal Medicine, Xuanwu Hospital of China Capital Medical University, Beijing, People's Republic of China
| | - Yingna Han
- Department of Emergency Internal Medicine, Xuanwu Hospital of China Capital Medical University, Beijing, People's Republic of China
| | - Daiquan Gao
- Department of Neurology, Xuanwu Hospital of China Capital Medical University, Beijing, People's Republic of China
| | - Piu Chan
- Department of Neurobiology, Xuanwu Hospital of China Capital Medical University, Beijing, People's Republic of China
| | - Shengfang Zhang
- School of Medicine, Capital Medical University, Beijing, People's Republic of China
| | - Huixin Xue
- School of Medicine, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
7
|
Bucci T, Pastori D, Pignatelli P, Ntaios G, Abdul-Rahim AH, Violi F, Lip GY. Albumin Levels and Risk of Early Cardiovascular Complications After Ischemic Stroke: A Propensity-Matched Analysis of a Global Federated Health Network. Stroke 2024; 55:604-612. [PMID: 38323429 PMCID: PMC10896196 DOI: 10.1161/strokeaha.123.044248] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/18/2023] [Accepted: 01/12/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND No studies have investigated the association between albumin levels and the risk of early cardiovascular complications in patients with ischemic stroke. METHODS Retrospective analysis with a federated research network (TriNetX) based on electronic medical records (International Classification of Diseases-Tenth Revision-Clinical Modification and logical observation identifiers names and codes) mainly reported between 2000 and 2023, from 80 health care organizations in the United States. Based on albumin levels measured at admission to the hospital, patients with ischemic stroke were categorized into 2 groups: (1) reduced (≤3.4 g/dL) and (2) normal (≥3.5 g/dL) albumin levels. The primary outcome was a composite of all-cause death, heart failure, atrial fibrillation, ventricular arrhythmias, myocardial infarction, and Takotsubo cardiomyopathy 30 days from the stroke. Secondary outcomes were the risk for each component of the primary outcome. Cox regression analyses were used to calculate hazard ratios (HRs) and 95% CIs following propensity score matching. RESULTS Overall, 320 111 patients with stroke had normal albumin levels (70.9±14.7 years; 48.9% females) and 183 729 (57.4%) had reduced albumin levels (72.9±14.3 years; 50.3% females). After propensity score matching, the primary outcomes occurred in 36.0% of patients with reduced and 26.1% with normal albumin levels (HR, 1.48 [95% CI, 1.46-1.50]). The higher risk in patients with reduced albumin levels was consistent also for all-cause death (HR, 2.77 [95% CI, 2.70-2.84]), heart failure (HR, 1.31 [95% CI, 1.29-1.34]), atrial fibrillation (HR, 1.11 [95% CI, 1.09-1.13]), ventricular arrhythmias (HR, 1.38 [95% CI, 1.30-1.46]), myocardial infarction (HR, 1.60 [95% CI, 1.54-1.65]), and Takotsubo cardiomyopathy (HR, 1.51 [95% CI, 1.26-1.82]). The association between albumin levels and the risk of cardiovascular events was independent of advanced age, sex, multimorbidity, and other causes of hypoalbuminemia. A progressively increased risk of adverse events was found in patients with mild and severe reduced compared to normal albumin levels. CONCLUSIONS Albumin levels are associated with the risk of early cardiovascular events and death in patients with ischemic stroke. The potential pathophysiological or therapeutic roles of albumin in patients with stroke warrant further investigation.
Collapse
Affiliation(s)
- Tommaso Bucci
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, United Kingdom (T.B., D.P., A.H.A.-R., G.Y.H.L.)
- Department of General and Specialized Surgery, Sapienza University of Rome, Italy (T.B.)
| | - Daniele Pastori
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, United Kingdom (T.B., D.P., A.H.A.-R., G.Y.H.L.)
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.P., P.P., F.V.)
| | - Pasquale Pignatelli
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.P., P.P., F.V.)
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N.)
| | - Azmil H. Abdul-Rahim
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, United Kingdom (T.B., D.P., A.H.A.-R., G.Y.H.L.)
- Stroke Division, Department of Medicine for Older People, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, United Kingdom (A.H.A.-R.)
| | - Francesco Violi
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.P., P.P., F.V.)
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, United Kingdom (T.B., D.P., A.H.A.-R., G.Y.H.L.)
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
| |
Collapse
|