Importance of Cardiovascular Risk Profile for In-Hospital Mortality Due to Cerebral Infarction

Introduction and objectivesTo investigate cardiovascular risk profiles and their prognostic implications in patients with different subtypes of cerebral infarction.MethodsThe study involved the retrospective analysis of data from a hospital stroke registry on 2704 consecutive CI patients who were admitted between 1986 and 2004. Of the 2704 strokes recorded, 770 were classified as thrombotic, 763 as cardioembolic, 733 as lacunar, 324 as undetermined, and 114 as atypical. Multivariate analysis was used to compare cardiovascular risk profiles in each subtype and their influence on inhospital mortality.ResultsArterial hypertension (AH) was present in55.5%, atrial fibrillation (AF) in 29.8%, and diabetes mellitus in 23.4%. The in-hospital mortality rate was12.9%, and in-hospital mortality was independently associated with AF (odds ratio [OR]=2.33; 95% confidence interval [CI], 1.84-2.96), and heart failure (HF) (OR=1.96; 95% CI, 1.33-2.89). In patients with thrombotic stroke, the cardiovascular risk factors associated with in-hospital mortality were HF (OR=2.87; 95% CI, 1.45-5.71), AF (OR=1.80; 95% CI, 1.09-2.96) and age (OR=1.06; 95% CI, 1.04-1.08). In patients with cardioembolic stroke, they were peripheral vascular disease (OR=2.18; 95% CI, 1.17-4.05), previous cerebral infarction (OR=1.75; 95% CI, 1.16-2.63), HF (OR=1.71; 95% CI, 1.01-2.90), and age (OR=1.06; 95% CI, 1.04-1.08). In those with undetermined stroke, they were AH (OR=3.68; 95% CI, 1.78-7.62) and age (OR=1.05; 95% CI, 1.01-1.09).ConclusionsEach cerebral infarction etiologic subtype was associated with its own cardiovascular risk profile. Consequently, the cardiovascular risk factors associated with mortality were also different for each ischemic stroke subtype.

Introducción y objetivosAnalizar el perfil cardiovascular y su pronóstico en los infartos cerebrales y sus subtipos etiológicos.MétodosSe efectúa un análisis retrospectivo de una serie clínica de 2.704 pacientes con infartos cerebrales procedentes de un registro hospitalario de ictus ingresados entre 1986 y 2004 (770 trombóticos, 763 cardioembólicos, 733 lacunares, 324 indeterminados y 114 inhabituales). Se compara el perfil cardiovascular de cada subtipo etiológico y su influencia con la mortalidad hospitalaria mediante un análisis multivariable.ResultadosLa hipertensión arterial (HTA) se presentó en el 55,5%, seguida por la fibrilación auricular (FA) (29,8%) y la diabetes mellitus (23,4%). La mortalidad hospitalaria fue del 12,9% y estaba relacionada con la FA (odds ratio [OR] = 2,33; intervalo de confianza [IC] del 95%, 1,84-2,96) y la insuficiencia cardiaca (OR = 1,96; IC del 95%, 1,33-2,89). El perfil cardiovascular asociado a la mortalidad estaba formado en los trombóticos, por la insuficiencia cardiaca (OR = 2,87; IC del 95%, 1,45-5,71), la FA (OR = 1,80; IC del 95%, 1,09-2,96) y la edad (OR = 1,06; IC del 95%, 1,04-1,08); en los cardioembólicos, por la enfermedad vascular periférica (OR = 2,18; IC del 95%, 1,17-4,05), el infarto cerebral previo (OR = 1,75; IC del 95%, 1,16-2,63), la insuficiencia cardiaca (OR = 1,71; IC del 95%, 1,01-2,90) y la edad (OR = 1,06; IC del 95%, 1,04-1,08), y en los infartos indeterminados, por la HTA (OR = 3,68; IC del 95%, 1,78-7,62) y la edad (OR = 1,05; IC del 95%, 1,01-1,09).ConclusionesCada subtipo etiológico de infarto cerebral presenta un perfil cardiovascular propio. El perfil cardiovascular asociado a la mortalidad también es diferente en cada subtipo de infarto cerebral.