Background and Purpose- The risk of arterial ischemic events after intracerebral hemorrhage (ICH) is poorly understood given the lack of a control group in prior studies. This study aimed to evaluate the risk of acute ischemic stroke and myocardial infarction (MI) among patients with and without ICH. Methods- We performed a retrospective cohort study using claims data from Medicare beneficiaries from 2008 to 2014. Our exposure was acute ICH, identified using validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Our primary outcome was a composite of acute ischemic stroke and MI, whereas secondary outcomes were ischemic stroke alone and MI alone. We used Cox regression analysis to compute hazard ratios during 1-month intervals after ICH. Sensitivity analyses entailed exclusion of patients with atrial fibrillation and valvular heart disease. Results- Among 1 760 439 Medicare beneficiaries, 5924 had ICH. The 1-year cumulative incidence of an arterial ischemic event was 5.7% (95% CI, 4.8-6.8) in patients with ICH and 1.8% (95% CI, 1.7-1.9) in patients without ICH. After adjusting for potential confounders, the risk of an arterial ischemic event remained significantly increased for the first 6 months after ICH and was especially high in the first month (hazard ratio, 6.7 [95% CI, 5.0-8.6]). In secondary analysis, the risk of ischemic stroke was increased in the first 6 months after ICH (hazard ratio, 6.1 [95% CI, 3.5-9.3]) but the risk of MI was not (hazard ratio, 1.6 [95% CI, 0.3-2.9]). In sensitivity analyses excluding patients with atrial fibrillation and valvular heart disease, the association between ICH and arterial ischemic events was similar to that of the primary analysis. Conclusions- In a large population-based cohort, we found that elderly patients with ICH had a substantially increased risk of ischemic stroke in the first 6 months after diagnosis. Further exploration of this risk is needed to determine optimal secondary prevention strategies for these patients.

中文翻译：

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脑出血后动脉缺血事件的风险。


背景和目的-由于先前的研究缺乏对照组，因此对脑出血（ICH）后动脉缺血事件的风险知之甚少。本研究旨在评估患有或不患有 ICH 的患者发生急性缺血性卒中和心肌梗死 (MI) 的风险。方法 - 我们使用 2008 年至 2014 年 Medicare 受益人的索赔数据进行了一项回顾性队列研究。我们的暴露是急性脑出血，使用经过验证的国际疾病分类第九版修订版临床修改诊断代码进行识别。我们的主要结局是急性缺血性卒中和心肌梗死的复合结局，而次要结局是单独的缺血性卒中和单独的心肌梗死。我们使用 Cox 回归分析来计算 ICH 后 1 个月间隔内的风险比。敏感性分析需要排除患有房颤和瓣膜性心脏病的患者。结果 - 在 1 760 439 名医疗保险受益人中，5924 人患有脑出血。 ICH 患者动脉缺血事件的 1 年累积发生率为 5.7%（95% CI，4.8-6.8），无 ICH 患者为 1.8%（95% CI，1.7-1.9）。调整潜在的混杂因素后，ICH后前6个月动脉缺血事件的风险仍然显着增加，并且在第一个月尤其高（风险比，6.7 [95% CI，5.0-8.6]）。二次分析显示，ICH 后前 6 个月内，缺血性卒中风险增加（风险比，6.1 [95% CI，3.5-9.3]），但 MI 风险并未增加（风险比，1.6 [95% CI， 0.3-2.9]）。在排除房颤和瓣膜性心脏病患者的敏感性分析中，ICH 和动脉缺血事件之间的关联与初步分析相似。 结论——在一个基于人群的大型队列中，我们发现患有 ICH 的老年患者在诊断后的前 6 个月内发生缺血性中风的风险显着增加。需要进一步探索这种风险，以确定这些患者的最佳二级预防策略。