Abstract 13133: Cardiovascular Abnormalities and Their Adverse Influence on Mortality in Patients With Intracranial Hemorrhage: A Meta-Analysis
Introduction: Intracranial hemorrhage (ICH) is associated with high mortality rate of 30-52% despite current advances in management. New cardiovascular abnormalities (CA), such as EKG or cardiac biomarker abnormalities ensue in ICH and are postulated to be due to hypothalamic injury and catecholamine surge. These CA are thought to portend a poor prognosis.
Methods: We evaluated clinical studies reporting CA in ICH and assessing their effect on mortality. Studies without a control group, pediatric, and non-English literature were excluded. We extracted data on demographics, comorbidities and mortality [in-hospital (IHM), 30 day (30M) and 90 day (90M)]. CA data included EKG changes (bradycardia, atrial fibrillation, bundle branch blocks, QTc prolongation, ST-segment depression, and ST-segment elevation), biomarker elevation (troponin-T (TnT), CK-MB and BNP), and wall motion abnormalities (WMA). Unadjusted and adjusted rates for CA and pooled risk ratio (RR) with 95% CI were calculated using Mantel-Haenszel random effects model for mortality.
Results: We reviewed 453 studies, of which 26 met our inclusion criteria. Heterogeneity varied from moderate to severe depending on the outcome chosen. Of a total 5580 patients, 2796 (50.1%) had sub-arachnoid hemorrhage (SAH), 1633 ICH (29.3%) and 1151 (20.6%) both. The incidence of CA is presented in Table 1. Of these 26 studies, 19 evaluated the influence of new CA on mortality. IHM was noted in 175/566 (30.9%) and 491/2496 (19.7%) patients with and without CA, respectively. In addition, 30M and 90M were noted in 18/38 (47.4%) vs. 14/136 (10.3%) and 90/175 (51.4%) vs. 247/1139 (21.7%) patients with and without CA, respectively. CA was associated with worse IHM (RR 2.03, 95% CI 1.58-2.62, p<0.001), 30M (RR 3.18, 95% CI 1.86-5.42, p<0.001) and 90M (RR 2.11, 95% CI 1.44-3.08, p<0.001) in patients with ICH compared to those who did not have CA.
Conclusion: CA are common in patients with ICH and are associated with worse IHM, 30M and 90M.
Author Disclosures: S. Vallabhajosyula: None. T. Mahfood Haddad: None. A. Kabach: None. A. Kanmanthareddy: None. L.E. Morrow: None. D.J. Esterbrooks: None.
- © 2015 by American Heart Association, Inc.