Rates and risk factors for major adverse cardiovascular and cerebrovascular events after stroke due to intracerebral hemorrhage: Systematic review and study-level meta-analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Background: Intracerebral hemorrhage (ICH) survivors are at increased risk of major adverse cardiovascular and cerebrovascular events (MACE) compared with population controls; however, little is known about the annual rates and risk factors for MACE. Methods: We searched Medline, Embase, and trial registries systematically in April 2024 for studies of adults with ICH, reporting either a MACE composite outcome or both ischemic and hemorrhagic outcomes, with at least one year of follow-up. We excluded studies limited to secondary ICH or isolated non-ICH intracranial hemorrhages. We used the QUIPS tool to assess studies’ risk of bias. The primary outcome was the rate of MACE. We used a random-effects meta-analysis to estimate the annual event rate (per 100 person-years, expressed as %) for each outcome. We conducted subgroup analyses and meta-regression to explore heterogeneity. Results: We included 26 studies, involving 198,289 ICH survivors. Individual studies’ reported annual rate of MACE ranged 4.2–14.6%. The pooled annual rate of recurrent ICH was 2.1% (95% confidence interval (CI) = 1.7–2.6; 26 studies; I 2 = 94%) and of ischemic stroke was 2.0% (95% CI = 1.5–2.7; 24 studies; I 2 = 95%). Meta-regression analyses identified one statistically significant association between a higher prevalence of atrial fibrillation and an increased risk of ischemic stroke. Discussion: The rates of recurrent ICH and ischemic stroke were comparable among ICH survivors, but evidence about other MACE outcomes remains limited. An individual participant data meta-analysis is needed to investigate the predictors of MACE outcomes, which may help inform risk stratification and prognosis among ICH survivors.
Source: International Journal of Stroke
Authors: Vega Pratiwi Putri, Neshika Samarasekera, Tom J Moullaali, Saketh Jampana, Joseph Aked, Signild Åsberg, Sam Schulman, Georgios Tsivgoulis, Maria Pikilidou, Hsin-Hsi Tsai, Li-Kai Tsai, Phyo Kyaw Myint, Tiberiu A Pana, Charlotte Cordonnier, Barbara Casolla, David Gaist, Alessandro Pezzini, Pol Camps-Renom, Catharina J.M. Klijn, Michele Romoli, Arnstein Tveiten, Ming Liu, Mangmang Xu, Bo Wu, David Werring, Philip S Nash, Gargi Banerjee, Linxin Li, Rustam Al-Shahi Salman
Institutions: Universitas Gadjah Mada, University of Edinburgh, Lund University, Blekingesjukhuset, Region Blekinge, Uppsala University, Thrombosis and Atherosclerosis Research Institute, McMaster University, National and Kapodistrian University of Athens, Aristotle University of Thessaloniki, AHEPA University Hospital, National Taiwan University Hospital, University of Aberdeen, Inserm, Université de Lille, Centre Hospitalier Universitaire de Lille, Lille Neurosciences & Cognition, Université Côte d'Azur, Hôpital Pasteur, University of Southern Denmark, Odense University Hospital, University of Parma, Ospedale di Parma, Hospital de Sant Pau, Radboud University Medical Center, University Medical Center Utrecht, Donders Institute for Brain, Cognition and Behaviour, Ospedale Infermi di Rimini, Hospital of Southern Norway, Sichuan University, West China Hospital of Sichuan University, National Hospital for Neurology and Neurosurgery, UCL Queen Square Institute of Neurology, University College London, MRC Prion Unit, University of Oxford
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,400
OpenAlex ID: W7126038304