Mortality Risk in Patients With Cardiac Complications Following Ischemic Stroke: A Report From the Virtual International Stroke Trials Archive

BACKGROUND: Cardiac complications may occur in patients following ischemic stroke (stroke-heart syndrome [SHS]). We investigated the mortality risk in patients with SHS and across the SHS manifestations. METHODS AND RESULTS: Data were sought from the VISTA (Virtual International Stroke Trials Archive), an international repository of clinical trials data. We reviewed relevant adverse events and classified patients into 2 cohorts based on the incidence of SHS. The SHS was defined as developing any cardiac complications within 30 days following stroke. Using Cox proportional hazards models, we evaluated the temporal risk dynamics of 90-day death associated with the day of SHS onset. We also compared the risk of 90-day death across SHS manifestations, using multivariate analysis. Among 15 054 patients with ischemic stroke (mean age, 69±12 years; 55% men), 1787 (11.8% [95% CI, 11.3-12.3]) developed SHS. The median onset time for SHS was 2 (interquartile range, 1-4) days. The most prevalent manifestation was other arrhythmia/ECG abnormalities, with the incidence rate of 6.5% (95% CI, 6.1-6.9). Patients who developed SHS between 10 and 30 days following stroke had significantly higher risks of death compared with those with SHS within the first 0 to 3 days (adjusted hazard ratio, 1.84 [95% CI, 1.36-2.49]). In the multivariate-adjusted analysis, SHS manifested as acute myocardial injury/myocardial injury, heart failure/left ventricular dysfunction, and atrial fibrillation/flutter were associated with the highest risk of death within 90 days after stroke across SHS manifestations excluding cardiorespiratory arrest. CONCLUSIONS: SHS is associated with a high risk of death, with a greater risk observed with delayed SHS onset.