炎症在预测卒中患者早期心脏并发症中的作用尚不清楚。TriNetX的电子病历,全球联合健康研究网络,用于回顾性分析。在卒中后24小时内测量的缺血性卒中和C反应蛋白(CRP)水平的患者分为三组:(i)<1mg/L,(ii)1-3mg/L和(iii)>3mg/L主要结局是心脏并发症的复合结局(心力衰竭(HF),缺血性心脏病,心房颤动(AF),室性心律失常和Takotsubo心肌病)或从指示事件起30天死亡。Cox回归分析用于产生1:1倾向评分匹配(PSM)后的风险比(HR)和95%置信区间(CI)。在纳入的104,741名患者中,51%为女性,平均年龄为66±16岁。PSM之后,5624例(33.1%)CRP>3mg/L的患者在30天内出现新的心脏并发症或死亡,4243例(25.6%)患者CRP为1-3mg/L,3891例(23.5%)患者CRP<1mg/L。CRP水平为1-3mg/L和>3mg/L的患者复合结局的风险更高(HR1.10,95CI1.05-1.52;HR1.51,95CI1.45-1.58),死亡(HR1.43,95CI1.24-1.64;HR3.50,95CI3.01-3.96),HF(HR1.08,95CI1.01-1.16;HR1.51,95CI1.41-1.61),AF(HR1.10,95%CI:1.02-1.18;HR1.42,95CI1.33-1.52)和室性心律失常(HR1.25,95CI1.02-1.52;HR1.67,95%CI1.38-2.01)。与CRP<1mg/L的患者相比,缺血性心脏病在CRP水平>3mg/L的患者中更为常见(HR:1.33,95%CI:1.26-1.40),而在所有分析中均未发现与Takotsubo心肌病相关。缺血性卒中最初24小时内的CRP水平可预测30天的心脏并发症或死亡。
The role of inflammation in predicting early cardiac complications among stroke patients is unclear. Electronic medical records from TriNetX, a global federated health research network, were used for this retrospective analysis. Patients with ischemic stroke and C-Reactive Protein (CRP) levels measured within 24 h post-stroke were categorized into three groups: (i) < 1 mg/L, (ii)1-3 mg/L and (iii) > 3 mg/L. The primary outcome was a composite outcome of cardiac complications (heart failure (HF), ischemic heart disease, atrial fibrillation (AF), ventricular arrhythmias and Takotsubo cardiomyopathy) or death at 30 days from the index event. Cox-regression analyses were used to produce hazard ratios (HRs) and 95% confidence intervals (CI) following 1:1 propensity score matching (PSM). Of the 104,741 patients enrolled, 51% were female and the mean age was 66 ± 16 years. After PSM, a new cardiac complication or death within 30 days occurred in 5624 (33.1%) patients with CRP > 3 mg/L, in 4243 (25.6%) patients with CRP 1-3 mg/L and in 3891 (23.5%) patients with CRP < 1 mg/L. Patients with CRP levels of 1-3 mg/L and > 3 mg/L had higher risk of the composite outcome (HR 1.10, 95%CI 1.05-1.52; HR 1.51, 95%CI 1.45-1.58), death (HR 1.43, 95%CI 1.24-1.64; HR 3.50, 95%CI 3.01-3.96), HF (HR 1.08, 95%CI 1.01-1.16; HR 1.51, 95%CI 1.41-1.61), AF (HR 1.10, 95% CI:1.02-1.18; HR 1.42, 95%CI 1.33-1.52) and ventricular arrhythmias (HR 1.25, 95%CI 1.02-1.52; HR 1.67, 95% CI 1.38-2.01) compared to those with CRP < 1 mg/L. Ischemic heart disease were more common among patients with CRP levels > 3 mg/L compared to those with CRP < 1 mg/L (HR:1.33, 95% CI:1.26-1.40), while no association with Takotsubo cardiomyopathy was found in all the analyses. CRP levels within the first 24 h of an ischemic stroke predict 30-day cardiac complications or death.