PSCI Linked to Increased Risk for Recurrent Stroke and All-Cause Mortality

Poststroke cognitive impairment (PSCI) that is detected 3 to 6 months after a stroke is associated with a significant increase in the risk for recurrent stroke and mortality, according to a study in the Journal of the American Heart Association.

The systematic review and meta-analysis assessed the risk for recurrent stroke and all-cause mortality in patients with PSCI.

The PubMed, MEDLINE, Scopus, Cochrane Library, and Google Scholar databases were searched for retrospective or prospective studies reporting original data on PSCI and recurrent stroke or mortality published from 1994 to 2022.

The primary endpoints were recurrent stroke and mortality.

A total of 27 studies with 39,412 patients were included. The association between PSCI and risk for stroke recurrence was evaluated in 9 studies (n=8050 patients), and 18 studies (n=31,362 patients) assessed the effect of PSCI on mortality risk.

Pooled data revealed a statistically significant 59% increase for the hazard of recurrent stroke in patients with PSCI vs those without (hazard ratio [HR], 1.59; 95% CI, 1.29-1.94; I² =52.2%). In addition, pooled data demonstrated a statistically significant 2-fold increase in the hazard of mortality in patients with PSCI vs those without (HR, 2.07; 95% CI, 1.65-2.59; I² =89.3%).

In subgroup analyses, no evidence was found that the average effect of PSCI on recurrent stroke risk differed based on cognitive impairment severity (P =.16).

In subgroup analyses that compared study years (1994 to 2003 vs 2004 to 2022), no evidence indicated that the average effect of PSCI on recurrent stroke differed for the 2 study periods (P =.393). The average effect of PSCI on mortality risk was different in the 2 periods, as studies conducted earlier, on average, reported larger effects compared with studies conducted after 2003. The difference in the 2 estimates was z = -2.9638 (P =.003).

The researchers noted that some early events before cognitive testing could be missed, and large heterogeneity was observed for both outcomes. In addition, adjustment for confounders in the studies was not identical, and wide and heterogeneous definitions were used for PSCI.

“These findings have significant clinical implications as PSCI may represent a promising biomarker for secondary stroke prevention risk stratification, which can be tested in prospective studies and randomized controlled trials,” the study authors wrote.

This article originally appeared on The Cardiology Advisor