Incidence of stroke among survivors of sudden cardiac arrest: a population-based cohort study

Objective: Out-of-hospital cardiac arrests (OHCA) impose a significant health burden worldwide, with low survival rates.Despite improvements in short-term outcomes, data on long-term outcomes of OHCA remain sparse.We investigated stroke incidence in OHCA survivors and aimed to identify characteristics associated with the risk of developing subsequent stroke.Methods: This was a retrospective cohort study of OHCA survivors in Singapore between 2010 to 2019.A combined dataset consisting of three population-based registries-Pan-Asian Resuscitation Outcomes Study (Singapore participants), Singapore Stroke Registry, and the Singapore Registry of Births and Deaths-was used to estimate the incidence of subsequent stroke and determine predictors using Cox regression hazard ratios for time-to-event analyses.Results: In total, 882 OHCA survivors were analyzed.Of these, 15 (1.7%) subsequently developed a stroke (73.3% ischemic and 26.7% hemorrhagic).OHCA survivors who developed subsequent stroke were more likely to have had a previous stroke (hazard ratio [HR], 2.2; 95% confidence interval [CI], 0.61-7.96)or acute myocardial infarction (HR, 2.96; 95% CI, 0.82-10.70).OHCA survivors with stroke who underwent targeted temperature management showed a trend toward a reduced risk of developing stroke (HR, 0.47; 95% CI, 0.10-2.12).Conclusion: In this population-based cohort study in a multi-ethnic Southeast Asian country, 1.7% of OHCA survivors developed stroke.OHCA survivors with a prior history of acute myocardial infarction or stroke showed a trend toward an increased incidence of stroke, while temperature management use exhibited a trend toward lower stroke incidence.Further randomized studies on the long-term outcomes of stroke and OHCA could potentially improve clinical outcomes.