All-cause mortality and early cardiovascular complications in relation to lesion location and stroke subtype in haemorrhagic and ischaemic stroke: the Perugia stroke registry

Background Acute stroke is frequently complicated by new-onset cardiac or thromboembolic events, referred to as Stroke-Heart Syndrome (SHS). The role of stroke subtype and lesion location in determining SHS risk remains underexplored. Methods We conducted a retrospective analysis of data from the hospital-based Perugia Stroke Registry (March 2005–September 2019). Patients with acute neurological symptoms were classified as ischaemic stroke (IS) or haemorrhagic stroke (HS) based on neuroimaging. Logistic regression identified predictors of stroke subtype and in-hospital complications. Subgroup analyses compared first-ever versus recurrent strokes, and lesion location (lacunar, non-lacunar anterior, or non-lacunar posterior for IS; typical versus atypical for HS). The primary outcome was a composite of all-cause death, cardiac events and venous thromboembolic events during Stroke Unit stay. Secondary outcomes were each component. Results Among 2080 patients (mean age 72.8 ± 12.5 years; 57% male), 1788 (86%) had IS and 292 (14%) HS. During Stroke Unit stay (median 8 days, IQR 5–14), HS patients had higher rates of the composite outcome (26% vs 14%) and all-cause death (21.2% vs 8.8%) than IS. In IS, non-lacunar posterior and anterior strokes were associated with increased risk of composite outcome (OR 1.97, 95%CI 1.10–3.63; OR 1.61, 95%CI 0.96–2.81) and all-cause death (OR 3.35, 95%CI 1.35–9.51; OR 2.90, 95%CI 1.28–7.79) versus lacunar strokes. Among HS, atypical lesions increased risk of composite outcome (OR 2.51, 95%CI 1.24–5.22) and all-cause death (OR 2.80, 95%CI 1.31–6.17). Conclusions Lesion location is a key determinant of SHS. Non-lacunar posterior stroke and atypical HS predict higher mortality and cardiovascular complications.