C-reactive protein in Stroke-Heart-Syndrome: a propensity-matched analysis of a global federated health network

Abstract

Abstract Introduction The role of inflammation in the Stroke-Heart-Syndrome is unclear. Purpose To assess the predictive role of C-Reactive Protein (CRP) for early cardiovascular complications in patients with stroke. Methods Electronic medical records from TriNetX, a global federated health research network, were used for this retrospective analysis. Patients with ischemic stroke and CRP levels measured within 24 hours post-stroke, were categorized into three groups: i)<1mg/L, ii)1-3 mg/L and iii)>3mg/L. The primary outcome was a composite outcome of cardiac complications (heart failure (HF), atrial fibrillation (AF), ischemic heart disease, 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. Results Of the 104,741 patients enrolled, 51% were female and the mean age was 67±2 years. Cardiac complications or death within 30 days occurred in 40.4% patients with CRP>3 mg/L, in 27.6% patients with CRP 1-3 mg/L and in 23.2% patients with CRP<1 mg/L. After propensity score matching, patients with CRP levels of 1-3mg/L and >3mg/L had higher risk of the composite outcome (HR: 1.10, 95%CI: 1.05-1.50;HR: 1.51, 95%CI: 1.45-1.58), death (HR:1.43, 95%CI:1.24-1.64; HR:3.50, 95%CI:3.10-3.96), 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:1.24, 95% CI:1.02-1.52, HR:1.67, 95% CI:1.39-2.01) compared to those with CRP<1 mg/L. Ischemic heart disease was more common only in patients with CRP levels >3mg/L (HR:1.33, 95% CI:1.26-1.40) compared to those with CRP<1mg/L. No association with Takotsubo cardiomyopathy was found. At the sensitivity analysis, these results were also confirmed considering only older patients or excluding those with possible confounding factors. Conclusion CRP levels at the admission for an ischemic stroke predict the 30-day risk of cardiac complications or death.