All-cause mortality and early cardiovascular complications in relation to lesion location and stroke subtype in haemorrhagic and ischaemic stroke: the Perugia stroke registry

Background: Acute stroke is frequently complicated by new-onset cardiac or thromboembolic events, referred to as Stroke-Heart Syndrome (SHS).The role of stroke subtype and lesion location in determining SHS risk remains underexplored.Methods: We conducted a retrospective analysis of data from the hospital-based Perugia Stroke Registry (March 2005-September 2019).Patients with acute neurological symptoms were classified as ischaemic stroke (IS) or haemorrhagic stroke (HS) based on neuroimaging.Logistic regression identified predictors of stroke subtype and in-hospital complications.Subgroup analyses compared first-ever versus recurrent strokes, and lesion location (lacunar, non-lacunar anterior, or non-lacunar posterior for IS; typical versus atypical for HS).The primary outcome was a composite of all-cause death, cardiac events and venous thromboembolic events during Stroke Unit stay.Secondary outcomes were each component.Results: Among 2080 patients (mean age 72.8 12.5 years; 57% male), 1788 (86%) had IS and 292 (14%) HS.During Stroke Unit stay (median 8 days, IQR 5-14), HS patients had higher rates of the composite outcome (26% vs 14%) and all-cause death (21.2% vs 8.8%) than IS.In IS, non-lacunar posterior and anterior strokes were associated with increased risk of composite outcome (OR 1.97, OR 1.61,) and all-cause death (OR 3.35, OR 2.90,) versus lacunar strokes.Among HS, atypical lesions increased risk of composite outcome (OR 2.51,) and all-cause death (OR 2.80, 95%CI 1.31-6.17).Conclusions: Lesion location is a key determinant of SHS.Non-lacunar posterior stroke and atypical HS predict higher mortality and cardiovascular complications.