Cardiovascular And Cerebrovascular Events In Patients With Intracerebral Haemorrhage: Clinical Characteristics And Risk Factors

Objectives: Spontaneous intracerebral haemorrhage accounts for approximately 10%-15% of all strokes and at high risk of mortality,disability and recurrence.Recent studies have found that the risk of intracranial and extracranial ischemic vascular events after intracerebral haemorrhage was at least as high as that of recurrent intracerebral haemorrhage,which seriously affects the prognosis of intracerebral haemorrhage patients.There are few studies on cardiovascular and cerebrovascular events following intracranial haemorrhage in the Chinese population so far.This study assessed the risks and clinical characteristics of cardiovascular and cerebrovascular events occurring within 5 years after intracerebral haemorrhage,providing evidence for clinician to make secondary prevention strategy for improving long-term prognosis.Subjects and Methods: We included consecutive patients diagnosed with first-ever intracerebral haemorrhage who were still alive after 30 days between June 2013 and December 2014.Demographics and baseline clinical data were collected at their first presentation.Patients were followed up for cardiovascular and cerebrovascular events(including recurrent intracerebral haemorrhage,ischemic stroke and acute coronary syndrome)and death until the end of the study(December 31,2019).We used univariate analysis and binary logistic regression to examine the risk factors and clinical characteristics of cardiovascular and cerebrovascular events after intracerebral haemorrhage.Results: 307 intracerebral haemorrhage patients were included in our single-center retrospective observational study.Within 5 years after intracerebral haemorrhage,62 patients developed 70 cardiovascular and cerebrovascular events(20.20%,95% CI 15.71-24.69).There were 31 cases of recurrent intracerebral haemorrhage(25 cases of intracerebral haemorrhage occurred within 3 years after first intracerebral haemorrhage),35 cases of ischemic stroke and 4 cases of acute coronary syndrome.We observed high incidence of recurrent intracerebral haemorrhage(10.10%)and ischemic stroke(11.40%),but low incidence of acute coronary syndrome(1.30%).The 5-year all-cause mortality rate of intracerebral haemorrhage was 28.01%(86/307),and 14 patients died of recurrent intracerebral haemorrhage,accounting for 16.28% of all-cause deaths.Of the 31 patients with recurrent intracerebral haemorrhage,14 patients died,and of the 35 patients with recurrent ischemic stroke,5 patients died.Intracerebral haemorrhage patients had a higher mortality rate of recurrent intracerebral haemorrhage than that of recurrent ischemic stroke(45.16% vs14.29%).Age(≥ 56 years)was identified as a risk factor of cardiovascular and cerebrovascular events after intracerebral haemorrhage.History of ischemic stroke or TIA was an independent risk factor of cardiovascular and cerebrovascular events after intracerebral haemorrhage.Conclusions: Intracerebral haemorrhage patients are at high risk of both cardiovascular and cerebrovascular events.In the long term,the incidence of cardiovascular and cerebrovascular ischemic events was as high as that of recurrent intracerebral haemorrhage.Recurrent intracerebral haemorrhage was more likely to occur within the first three years after first intracerebral haemorrhage than at later time,and the mortality rate of recurrent intracerebral haemorrhage was higher than that of ischemic stroke.Age(≥ 56 years)was identified as a risk factor of cardiovascular and cerebrovascular events after intracerebral haemorrhage.History of ischemic stroke or TIA was an independent risk factor of cardiovascular and cerebrovascular events after intracerebral haemorrhage.