THE IMPACT OF ACUTE CARDIAC EVENTS ON LONG-TERM MORTALITY AFTER SUBARACHNOID HEMORRHAGE

Abstract

NTRODUCTION. Acute cardiac events are common after subarachnoid hemorrhage (SAH) and are associated with an increased risk of poor outcome. However, the impact of cardiac events on long term mortality after SAH is barely studied. OBJECTIVES. The aim was to evaluate the impact of acute cardiac events on long-term mortality after SAH. The hypothesis of this study was that these events are associated with an increased long-term mortality. METHODS. This is a retrospective study. Medical records from all patients admitted to our NICU and general ICU from 2010 to 2015 with the diagnosis SAH were analyzed. Variables obtained were age, medical history, WFNS score, modified fisher grade, cerebral infarction during hospital admission, treatment, troponin release and NTproBNP levels, ECG, echocardiograpic evaluation. Kaplan-Meier curves and Cox-regression were used in the statistical analyses. RESULTS. A total of 708 patients were admitted with suspected/verified SAH during the study period. 118 patients did not fulfill SAH-diagnosis, 33 patients were not included due to long time to admission (>4 days) and in 28 patients no ECG/echo/cardiac biomarkers were obtained. Of the 529 patients analysed, 109 patients had died at the time mortalily data was obtained (april 2016). In a univariate cox-regression model; WFNS grade 4-5, Fisher grade, age, history of hypertension, cardiovascular disease (CVD) or renal disease, levels of troponin and NTproBNP was significantly associated with a higher risk (hazard ratio) for death. A normal ECG was significantly associated with reduced mortality. Stress-Induced Cardiomyopathy was not significantly associated with an inreased risk of death. In a multivariable cox-regression model, both troponin levels and NTproBNP levels were significantly associated with an increased risk of death when adjusting for WNFS grade 4-5, age, history of CVD or renal disease and Fisher grade. However, these differences were only significant the first year after the hemorrhage. CONCLUSIONS. Acute release of the cardiac biomarkers troponin and NTproBNP after SAH is an omnious clinical sign which is associated with an increased risk of death, especially the first year after the hemorrhage. Further research is needed to address whether measures to optimize cardiac treatment after SAH might improve outcome.