Traumatic Brain Injury Increases the Risk of Major Adverse Cardiovascular and Cerebrovascular Events: A 13-Year, Population-Based Study

Tee-Tau Eric Nyam; Chung-Han Ho; Chung-Ching Chio; Sher-Wei Lim; Jhi-Joung Wang; Ching-Hung Chang; Jinn-Rung Kuo; Che-Chuan Wang

doi:10.1016/j.wneu.2018.10.130

Traumatic Brain Injury Increases the Risk of Major Adverse Cardiovascular and Cerebrovascular Events: A 13-Year, Population-Based Study

World Neurosurg. 2019 Feb:122:e740-e753. doi: 10.1016/j.wneu.2018.10.130. Epub 2018 Nov 1.

Authors

Tee-Tau Eric Nyam¹, Chung-Han Ho², Chung-Ching Chio¹, Sher-Wei Lim³, Jhi-Joung Wang⁴, Ching-Hung Chang¹, Jinn-Rung Kuo⁵, Che-Chuan Wang⁶

Affiliations

¹ Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan.
² Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
³ Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan.
⁴ Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
⁵ Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan. Electronic address: kuojinnrung@gmail.com.
⁶ Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Center for General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan.

PMID: 30391613
DOI: 10.1016/j.wneu.2018.10.130

Abstract

Background: Previous studies have indicated traumatic brain injury (TBI) as a risk factor for stroke and myocardial injury. Whether TBI increases new onset of major adverse cardiovascular and cerebrovascular events (MACCE) is not well established.

Methods: Patients with a diagnosis of TBI from 2000 to 2012 were 1:2 age-, sex-, and age-adjusted comorbidities matched with normal population cohorts. The MACCE, which included coronary artery disease, heart failure and arrhythmia, ischemic and hemorrhagic stroke, and death, was defined as one inpatient admission with MACCE diagnosis. The maximum follow-up duration to MACCE after the initial TBI diagnosis was 5 years. The baseline comorbidities before TBI, including hypertension, diabetes mellitus, renal disease, and liver disease, also were considered to estimate the risk of MACCE.

Results: In total, 16,211 patients with TBI and 32,422 people from the control group were enrolled in the current study. Our results showed that patients with TBI had a 2.77-fold risk of MACCE, 1.72-fold risk of cardiovascular disease, 2.10-fold risk of ischemic stroke, 6.02-fold risk of hemorrhagic stroke, and 3.13-fold risk of mortality compared with the control group (all P < 0.0001) after adjusting the confounding factors. In addition, the trend of cumulated incidence risk among MACCE, cardiovascular disease, ischemic and hemorrhagic stroke, and mortality presented the greatest incidence within the first year after diagnosis and persisted during the 5 years of follow-up.

Conclusions: Our results showed that patients with TBI have a significantly greater risk of MACCE than the control group. We hope this information will remind critical-care physicians and neurosurgeons to keep in mind the long-term effects of TBI on MACCE.

Keywords: ACCI; Cardiovascular; MACCE; Mortality; Stroke; Traumatic brain injury.

MeSH terms

Adult
Brain Injuries, Traumatic / diagnosis
Brain Injuries, Traumatic / mortality*
Cardiovascular Diseases / diagnosis
Cardiovascular Diseases / mortality*
Cerebrovascular Disorders / diagnosis
Cerebrovascular Disorders / mortality*
Female
Humans
Longitudinal Studies
Male
Middle Aged
Mortality / trends
Population Surveillance* / methods
Risk Factors
Time Factors