TY - JOUR
T1 - C-reactive protein levels are associated with early cardiac complications or death in patients with acute ischemic stroke
T2 - a propensity-matched analysis of a global federated health from the TriNetX network
AU - Bucci, Tommaso
AU - Sagris, Dimitrios
AU - Harrison, Stephanie L.
AU - Underhill, Paula
AU - Pastori, Daniele
AU - Ntaios, George
AU - McDowell, Garry
AU - Buckley, Benjamin J.R.
AU - Lip, Gregory Y.H.
N1 - Funding Information:
Dr. Bucci reports no disclosures; Dr. Sagris reports receiving research support by the ESC council on Stroke; Dr Harrison has received a grant from Bristol-Myers Squibb (BMS) outside of the submitted work; Dr Underhill is an employee of TriNetX LLC; Prof. Pastori reports no disclosures; Prof. Ntaios: none related; Dr. McDowell: has received funding and research support from Roche Diagnostics and Abbott; Dr. Buckley: Research funding from BMS/Pfizer; Prof. Lip: Consultant and speaker for BMS/Pfizer, Boehringer Ingelheim and Daiichi-Sankyo. No fees are received personally. GYHL is co-principal investigator of the AFFIRMO project on multimorbidity in AF, which has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No 899871.
Funding Information:
European Society of Cardiology Council on Stroke supported Dr Sagris’ research fellowship at the Liverpool Centre of Cardiovascular Science.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/8
Y1 - 2023/8
N2 - 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.
AB - 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.
KW - Cardiovascular complications
KW - Stroke
KW - Stroke–heart syndrome
UR - http://www.scopus.com/inward/record.url?scp=85153779360&partnerID=8YFLogxK
U2 - 10.1007/s11739-023-03280-1
DO - 10.1007/s11739-023-03280-1
M3 - Article
AN - SCOPUS:85153779360
SN - 1828-0447
VL - 18
SP - 1329
EP - 1336
JO - Internal and Emergency Medicine
JF - Internal and Emergency Medicine
IS - 5
ER -