Impact of ischemic heart disease and atrial fibrillation on survival after spontaneous intracerebral hemorrhage.

OBJECT: The well-known predictors for increased early deaths after spontaneous intracerebral hemorrhage (ICH) include the clinical and radiological severity of bleeding as well as being on a warfarin regimen at the onset of stroke. Ischemic heart disease and atrial fibrillation may also increase early deaths. In the present study the authors aimed to elucidate the role of the last 2 factors.

METHODS: The authors assessed the 3-month mortality rate in patients with spontaneous ICH (453 individuals) who were admitted to the stroke unit of Oulu University Hospital within a period of 11 years (1993-2004).

RESULTS: The 3-month mortality rate for the 453 patients was 28%. The corresponding mortality rates were 42% for the patients who had ischemic heart disease and 61% for those with atrial fibrillation on admission. The following independent predictors of death emerged after adjustment for sex and the use of warfarin or aspirin at the onset of ICH: 1) ischemic heart disease (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.12-2.48, p < 0.02); 2) atrial fibrillation on admission (HR 1.79, 95% CI 1.12-2.86, p < 0.02); 3) the Glasgow Coma Scale score on admission (HR 0.82 per unit, 95% CI 0.79-0.87, p < 0.01); 4) size of hematoma (HR 1.11 per 10 ml, 95% CI 1.07-1.16, p < 0.01); 5) intraventricular hemorrhage (HR 2.62, 95% CI 1.71-4.02, p < 0.01); 6) age (HR 1.04 per year, 95% CI 1.02-1.06, p < 0.01); and 7) infratentorial location of the hematoma (HR 1.93, 95% CI 1.26-2.97, p < 0.01).

CONCLUSIONS: Both ischemic heart disease and atrial fibrillation independently and significantly impaired the 3-month survival of patients with ICH.