Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Rates and risk factors for major adverse cardiovascular and cerebrovascular events after stroke due to intracerebral hemorrhage : Systematic review and study-level meta-analysis

Putri, Vega Pratiwi ; Samarasekera, Neshika ; Moullaali, Tom J. ; Jampana, Saketh ; Aked, Joseph LU orcid ; Åsberg, Signild ; Schulman, Sam ; Tsivgoulis, Georgios ; Pikilidou, Maria and Tsai, Hsin Hsi , et al. (2026) In International Journal of Stroke
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... (More)

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; I2 = 94%) and of ischemic stroke was 2.0% (95% CI = 1.5–2.7; 24 studies; I2 = 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.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and , et al. (More)
; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; ; and (Less)
organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
Intracerebral hemorrhage, MACE, prognosis, stroke, stroke recurrence, systematic review
in
International Journal of Stroke
publisher
Wiley-Blackwell
external identifiers
  • pmid:41605872
  • scopus:105030953414
ISSN
1747-4930
DOI
10.1177/17474930261416692
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2026 World Stroke Organization. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
id
bf0ccd41-62e5-4ad9-84c5-cf79d54afcbc
date added to LUP
2026-04-13 13:04:45
date last changed
2026-07-08 02:38:20
@article{bf0ccd41-62e5-4ad9-84c5-cf79d54afcbc,
  abstract     = {{<p>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<sup>2</sup> = 94%) and of ischemic stroke was 2.0% (95% CI = 1.5–2.7; 24 studies; I<sup>2</sup> = 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.</p>}},
  author       = {{Putri, Vega Pratiwi and Samarasekera, Neshika and Moullaali, Tom J. and Jampana, Saketh and Aked, Joseph and Åsberg, Signild and Schulman, Sam and Tsivgoulis, Georgios and Pikilidou, Maria and Tsai, Hsin Hsi and Tsai, Li Kai and Myint, Phyo Kyaw and Pana, Tiberiu A. and Cordonnier, Charlotte and Casolla, Barbara and Gaist, David and Pezzini, Alessandro and Camps-Renom, Pol and Klijn, Catharina J.M. and Romoli, Michele and Tveiten, Arnstein and Liu, Ming and Xu, Mangmang and Wu, Bo and Werring, David and Nash, Philip S. and Banerjee, Gargi and Li, Linxin and Al-Shahi Salman, Rustam}},
  issn         = {{1747-4930}},
  keywords     = {{Intracerebral hemorrhage; MACE; prognosis; stroke; stroke recurrence; systematic review}},
  language     = {{eng}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{International Journal of Stroke}},
  title        = {{Rates and risk factors for major adverse cardiovascular and cerebrovascular events after stroke due to intracerebral hemorrhage : Systematic review and study-level meta-analysis}},
  url          = {{http://dx.doi.org/10.1177/17474930261416692}},
  doi          = {{10.1177/17474930261416692}},
  year         = {{2026}},
}