Abstract
Aim: Ischemic heart disease and stroke are the leading cause of morbidity and mortality worldwide. Ischemic stroke and ischemic heart disease have similar pathophysiological mechanisms and risk factors. Ischemic heart disease patients are associated with increased morbidity and mortality, but the studies describing outcomes of ischemic heart disease in ischemic stroke patients are a lack. This is the first study to correlate ischemic heart disease in ischemic stroke with length of stay and functional outcome by using modified Rankin Scale (mRS). This study aims to compare the clinical outcome of ischemic stroke patients with ischemic heart disease and without ischemic heart disease. Methods: This retrospective cohort study of 200 patients were first incident acute ischemic stroke recorded in the Bethesda Hospital Yogyakarta Stroke Registry (2012-2017). These patients were divided into ischemic stroke patients with ischemic heart disease and ischemic stroke patients without ischemic heart disease. The primary outcomes of the study was in-hospital mortality, disability measured by modified Rankin Scale (mRS), and length of stay. The data were analyzed bivariate followed by the Chi-square test and Mann-Whitney. Results: Data of 200 patients with 100 stroke patients with ischemic heart disease consist of fifty-eight male (58.0%) and eighty-six (86.0%) were more than 50 years old. Compare to 100 stroke patients without ischemic heart disease consist of fifty-eight male (58.0%) and eighty-nine (89.0%) were more than 50 years old. The mortality of stroke patients with ischemic heart disease group is eighteen patients (18.0%), sixty patients (60%) have poor functional outcome (mRS >2) and have length of stay 7.50 (0-40) days. Bivariate analysis showed stroke patients with ischemic heart disease group is significantly associated with higher in-hospital mortality (RR:2.9, 95%CI:1.1–7.3, p<0.019), worse disability (RR:2.6, 95%CI:1.3 –5.1, p<0.005) and prolonged hospital stay (7.50 (0-40) vs 4 (0-14), p<0.001) than in stroke patients without ischemic heart disease group. Conclusion: Ischemic stroke patients with ischemic heart disease is statistically significantly associated with higher in-hospital mortality, worse disability, prolonged hospitalization than in ischemic stroke patients without ischemic heart disease.
Highlights
Coronary artery disease (CAD) and stroke are the leading causes of death and disability in patients with cardiovascular disease (CVD)
This study aims to compare the clinical outcome of ischemic stroke patients with ischemic heart disease and without ischemic heart disease
The data obtained from 200 patients consisted of 100 ischemic stroke patients with history of ischemic heart disease and 100 ischemic stroke patients without history of ischemic heart disease
Summary
Coronary artery disease (CAD) and stroke are the leading causes of death and disability in patients with cardiovascular disease (CVD). The Sample Registration System (SRS) Ministry of Health in the Indonesia in 2014 showed that deaths of CAD were around 12.9%, the second highest position after stroke [2]. Previous studies have shown an increased risk of ischemic stroke after Ischemic heart disease is highest in the first few days after the event [4]. Stroke following an ischemic heart disease remains a challenge even today, and can lead to potentially poor clinical outcomes. Stroke remains a catastrophic complication of ischemic heart disease with a mortality rate of up to 60% at one year [3, 4]
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