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Risk Factors, Incidence, and Effect of Cardiac Failure and Myocardial Infarction in Aneurysmal Subarachnoid Hemorrhage Patients

Kim, Young Woo MD*; Neal, Dan MS‡; Hoh, Brian L. MD‡

Neurosurgery 73:3:450-457, 2013. doi: 10.1227/NEU.0000000000000001

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BACKGROUND: Cardiac dysfunction is a well-known complication of aneurysmal subarachnoid hemorrhage (aSAH). However, the clinical significance of cardiac complications is largely unknown.

OBJECTIVE: To determine whether cardiac complications are independently related to outcomes and to identify potential predictors associated with these complications.

METHODS: We extracted all hospitalizations for aSAH from the National Inpatient Sample database for years 2002 to 2009. We used generalized estimating equations to determine whether cardiac complications were associated with the patient outcomes and to evaluate potential predictors of cardiac complications.

RESULTS: Among 53 713 cases of aSAH, there were 3609 (6.72%) and 151 (0.28%) incidences of cardiac failure (CF) and myocardial infarction (MI), respectively. The overall in-hospital mortality rate was 24.8%, whereas the mortality rate for patients with CF was 34.4% and the mortality rate for patients with MI was 29.8%. Patients who experienced CF were significantly more likely than other patients to die in the hospital (odds ratio: 1.6, 95% confidence interval: 1.47-1.68; P < .001). The difference in mortality rates between MI patients and other patients, however, was not statistically significant. The generalized estimating equation model identified 7 factors that were predictive of CF: age, sex, race, primary payer, diabetes, smoker, and cardiac disease. For MI, the model identified age, race, and primary payer as significant predictors of MI.

CONCLUSION: Our results suggest that an important association exists between cardiac complications and mortality/morbidity in aSAH patients. aSAH patients with CF appear to have a higher mortality rate, longer hospital length of stay, and higher hospitalization costs compared with those without CF.


ABBREVIATIONS: aSAH, aneurysmal subarachnoid hemorrhageAUC, area under the receiver-operating characteristic curveCF, cardiac failureCI, confidence intervalECG, electrocardiogramGEE, generalized estimating equationLOS, length of stayMI, myocardial infarctionNIS, Nationwide Inpatient SampleSAH, subarachnoid hemorrhage

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written by gcaruso.nch, September 30, 2013
Cardiac complications are common after SAH. In this review cardiac failure is linked to a significant worse outcome, whereas myocardial infarction does not increase mortality. Finally we can consider that older age represents the most important prognostic factor, especially if patients already have cardiac risk factors. Intensive cardiac monitoring may be proposed for elderly patients even in absence of clear clinical signs of cardiac failure, in order to prevent late complications.

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