PD Dr. Jochen Sembill (Erlangen / DE), David Haupenthal (Erlangen / DE), Dr. Maximilian Sprügel (Erlangen / DE), Dr. Anne Mrochen (Erlangen / DE), PD Dr. Hannes Lücking (Erlangen / DE), Prof. Dr. Tobias Engelhorn (Erlangen / DE), Dr. Kosmas Macha (Erlangen / DE), PD Dr. Joji Kuramatsu (Erlangen / DE)
Abstract-Text (inkl. Referenzen und Bildunterschriften)
Objectives
Patients with lobar intracerebral hemorrhage (ICH) often have poor functional outcomes and higher risk of subsequent major adverse cardiovascular events (MACE), possibly due to underlying cerebral amyloid angiopathy (CAA). The simplified Edinburgh CT criteria are useful for identification of lobar ICH associated with CAA. We investigated whether the simplified Edinburgh CT criteria stratify patients" 5-year risk for MACE as well as the overall burden of disease associated with lobar ICH.
Methods
This analysis included 595 consecutive lobar ICH patients from a prospective cohort study conducted at the university hospital Erlangen, Germany (2006-2015, UKER-ICH, NCT03183167). We applied the simplified Edinburgh CT criteria to stratify patients according to their risk for underlying CAA, i.e. low risk (neither finger-like projections nor subarachnoid hemorrhage), medium risk (either finger-like projections or subarachnoid hemorrhage) or high risk (finger-like projections and subarachnoid hemorrhage). We investigated the association between CAA risk and MACE over a 5-year follow-up period using Kaplan-Meier estimates. Additionally, we calculated disability-adjusted life-years (DALY) based on their modified Rankin Scale at 12 months and explored their association with patients" respective CAA risk.
Results
Of 595 patients with lobar ICH, 288 (48.4%) patients had low risk for CAA-associated ICH, 201 (33.8%) patients had medium risk and 106 (18.8%) patients had high risk according to the simplified Edinburgh CT criteria. The 5-year Kaplan-Meier estimates of MACE showed higher rates in patients at high risk for CAA [n=66/106(62.3%)], compared to patients at medium risk [n=115/201(57.2%)] or low risk [n=124/288(43.1%)] (logrank p<0.001). Overall, lobar ICH was associated with a mean (SD) of 8.7 (±7.2) DALYs, which increased with increasing CAA risk (low risk: 6.4[3.4-11.4]; p=0.03; medium risk: 7.4[4.6-12.2]; high risk: 8.1[5.4-11.4]; p=0.03).
Conclusion
These findings suggest both increased cardiovascular risk and burden of disease after lobar ICH when associated with CAA.