Abstract 50: Impact of Acute Cocaine use on Aneurysmal Subarachnoid Hemorrhage

Objective: To analyze the impact of acute cocaine use on presentation and outcomes following aneurysmal subarachnoid hemorrhage (aSAH). Background: Acute cocaine use has been temporally associated with aSAH but there are varying reports describing how it affects patient presentation, complications and outcomes. Design/Methods: Data of aSAH patients admitted to our institution between 1991-2009 were reviewed to determine which patients had used cocaine within 72 hours of aSAH based on positive urine toxicology or a history of cocaine use within 72 hours (C). These patients were then compared with aSAH patients without recent cocaine exposure (NC) in relation to their clinical and radiological presentations, complications such as DIND (delayed ischemic neurological deficit defined by vasospasm mediated cerebral infarcts) and outcomes defined by hospital mortality. Results: Data of 1134 patients were reviewed; aSAH in142 patients (12.5%) was associated with cocaine use. Cocaine users were more likely to be younger (mean age: C:49, NC:53, p0.05), admission GCS 0.05), associated IVH (C:56%, NC:51%, p>0.05) or hydrocephalus on admission CT (C:49%; NC:52%, p> 0.05). Cocaine users were more likely to have vasospasm related infarcts when compared to non-cocaine users (C:22%; NC:16%, p<0.05) but after correcting for other factors impacting vasospasm, cocaine use was not independently associated with DIND. Cocaine users had higher rates of aneurysm re-rupture (C:7.7%, NC:2.7%, p0.004). Cocaine users were less likely to survive hospitalization compared to non-users following univariate analysis (Mortality: C:26%, NC:17%, p< 0.05); the adjusted odds of hospital mortality were 2.9 times higher among cocaine users following multivariate analysis (p<0.001). Conclusions: Acute cocaine use was associated with a higher risk of aneurysm re-rupture and hospital mortality following aSAH. The various mechanisms for the nearly threefold increased odds of death associated with cocaine use warrants further investigation.

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Cocaine use as an independent predictor of seizures after aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/2015.2.jns142856 ◽

2016 ◽

Vol 124 (3) ◽

pp. 730-735 ◽

Cited By ~ 11

Author(s):

Tiffany R. Chang ◽

Robert G. Kowalski ◽

J. Ricardo Carhuapoma ◽

Rafael J. Tamargo ◽

Neeraj S. Naval

Keyword(s):

Subarachnoid Hemorrhage ◽

Risk Stratification ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Clinical Grade ◽

Surgical Clipping ◽

Cocaine Use ◽

Seizure Prophylaxis ◽

Cocaine Users ◽

Mca Aneurysm ◽

The Impact

OBJECT Seizures are relatively common after aneurysmal subarachnoid hemorrhage (aSAH). Seizure prophylaxis is controversial and is often based on risk stratification; middle cerebral artery (MCA) aneurysms, associated intracerebral hemorrhage (ICH), poor neurological grade, increased clot thickness, and cerebral infarction are considered highest risk for seizures. The purpose of this study was to evaluate the impact of recent cocaine use on seizure incidence following aSAH. METHODS Prospectively collected data from aSAH patients admitted to 2 institutional neuroscience critical care units between 1991 and 2009 were reviewed. The authors analyzed factors that potentially affected the incidence of seizures, including patient demographic characteristics, poor clinical grade (Hunt and Hess Grade IV or V), medical comorbidities, associated ICH, intraventricular hemorrhage (IVH), hydrocephalus, aneurysm location, surgical clipping and cocaine use. They further studied the impact of these factors on “early” and “late” seizures (defined, respectively, as occurring before and after clipping/coiling). RESULTS Of 1134 aSAH patients studied, 182 (16%) had seizures; 81 patients (7.1%) had early and 127 (11.2%) late seizures, with 26 having both. The seizure rate was significantly higher in cocaine users (37 [26%] of 142 patients) than in non-cocaine users (151 [15.2%] of 992 patients, p = 0.001). Eighteen cocaine-positive patients (12.7%) had early seizures compared with 6.6% of cocaine-negative patients (p = 0.003); 27 cocaine users (19%) had late seizures compared with 10.5% non-cocaine users (p = 0.001). Factors that showed a significant association with increased risk for seizure (early or late) on univariate analysis included younger age (< 40 years) (p = 0.009), poor clinical grade (p = 0.029), associated ICH (p = 0.007), and MCA aneurysm location (p < 0.001); surgical clipping was associated with late seizures (p = 0.004). Following multivariate analysis, age < 40 years (OR 2.04, 95% CI 1.355–3.058, p = 0.001), poor clinical grade (OR 1.62, 95% CI 1.124–2.336, p = 0.01), ICH (OR 1.95, 95% CI 1.164–3.273, p = 0.011), MCA aneurysm location (OR 3.3, 95% CI 2.237–4.854, p < 0.001), and cocaine use (OR 2.06, 95% CI 1.330–3.175, p = 0.001) independently predicted seizures. CONCLUSIONS Cocaine use confers a higher seizure risk following aSAH and should be considered during risk stratification for seizure prophylaxis and close neuromonitoring.

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EXPRESS: Prehemorrhage antiplatelet use in aneurysmal subarachnoid hemorrhage and impact on clinical outcome

International Journal of Stroke ◽

10.1177/17474930211035647 ◽

2021 ◽

pp. 174749302110356

Author(s):

Martina SebÃ¶k ◽

Isabel C. Hostettler ◽

Emanuella Keller ◽

Ilari Rautalin ◽

Bert A. Coert ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Clinical Outcome ◽

Hospital Mortality ◽

Primary Outcome ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Data Access ◽

Antiplatelet Agents ◽

Poor Clinical Outcome ◽

The Impact ◽

Thrombocyte Transfusion

Background: Literature is inconclusive regarding the association between antiplatelet agents use and outcome after aneurysmal subarachnoid hemorrhage (aSAH). Aims: To investigate the association between clinical outcome and prehemorrhage use in aSAH patients as well as the impact of thrombocyte transfusion on rebleed and clinical outcome. Methods: Data were collected from prospective databases of two European tertiary reference centers for aSAH patients. Patients were divided into âantiplatelet-userâ and ânon-userâ according to the use of acetylsalicylic acid (ASA) prior to the hemorrhage. Primary outcome was poor clinical outcome at six months (Glasgow Outcome Scale score 1-3). Secondary outcomes were in-hospital mortality, and impact of thrombocyte transfusion. Results: One hundred and sixty-one of 1,033 patients (15.6%) were antiplatelet users. The antiplatelet users were older with higher incidence of cardiovascular risk factors. Antiplatelet use was associated with poor outcome and in-hospital mortality. After correction for age, sex, WFNS score, infarction and heart disorder, pre-hemorrhage ASA use was only associated with poor clinical outcome at six months (adjusted OR 1.80, 95% CI 1.08 to 3.02). Thrombocyte transfusion was not associated with a reduction in rebleed or poor clinical outcome. Conclusion: In this multicenter study, the prehemorrhage ASA use in aSAH patients was independently associated with poor clinical outcome at six months. Thrombocyte transfusion was not associated with the rebleed rate or poor clinical outcome at six months. Data access statement: The data that support this study are available upon reasonable request.

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Abstract TP36: Predictors and Associated Outcomes of Subarachnoid Hemorrhage Following Endovascular Treatment for Acute Ischemic Stroke

Stroke ◽

10.1161/str.47.suppl_1.tp36 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Alexandros L Geordiadis ◽

Muhammad A Saleem ◽

Adnan I Qureshi

Keyword(s):

Heart Disease ◽

Subarachnoid Hemorrhage ◽

Ischemic Heart Disease ◽

Endovascular Treatment ◽

Univariate Analysis ◽

Prospective Trial ◽

Endovascular Intervention ◽

Ischemic Heart ◽

History Of ◽

Stroke Trial

Introduction: The rates of occurrence, predictors, and associated outcomes of subarachnoid hemorrhage (SAH) following endovascular treatment are not well studied. Methods: We retrospectively analyzed data from the Interventional Management of Stroke Trial (IMS III). This prospective trial randomized patients to intravenous (IV) rt-PA alone versus IV rt-PA followed by endovascular intervention. All patients underwent computed tomography (CT) at 24 hours post randomization. The scans were assessed by independent reviewers at a core laboratory for the presence, location, and type of intracranial hemorrhage.The primary outcome assessment was by modified Rankin Scale (mRS) score at 3 months. Results: Thirty four out of 434 (7.8%) patients who received endovascular treatment suffered SAH at 24 hours. There were 19 men (55.9%), and 19 patients were older than 70 years.In univariate analysis only pre-existing ischemic heart disease was identified as a predictor of SAH (p=0.03) while patient age was borderline significant (p=0.055). Three-monthmRS score was available for 24/34 patients with SAH and for 318/400 among the other patients. There was no difference in mortality (12.5% vs. 4.1%, p=0.167) or favorable outcome defined as mRS =<2 (41.7% vs. 53.5%, p=0.366). Conclusions: SAH following endovascular intervention for acute stroke is more common among patients with history of ischemic heart disease. It does not impact on functional outcome or mortality at 3 months.

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The influence of aneurysm morphology on the volume of hemorrhage after rupture

Journal of Neurosurgery ◽

10.3171/2021.3.jns21293 ◽

2021 ◽

pp. 1-9

Author(s):

Pablo M. Munarriz ◽

Blanca Navarro-Main ◽

Jose F. Alén ◽

Luis Jiménez-Roldán ◽

Ana M. Castaño-Leon ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Univariate Analysis ◽

Size Ratio ◽

Computer Assisted ◽

Data Set ◽

Aneurysm Size ◽

Risk Of Rupture ◽

Morphological Variables ◽

Hemorrhage Volume ◽

The Impact

OBJECTIVE Factors determining the risk of rupture of intracranial aneurysms have been extensively studied; however, little attention is paid to variables influencing the volume of bleeding after rupture. In this study the authors aimed to evaluate the impact of aneurysm morphological variables on the amount of hemorrhage. METHODS This was a retrospective cohort analysis of a prospectively collected data set of 116 patients presenting at a single center with subarachnoid hemorrhage due to aneurysmal rupture. A volumetric assessment of the total hemorrhage volume was performed from the initial noncontrast CT. Aneurysms were segmented and reproduced from the initial CT angiography study, and morphology indexes were calculated with a computer-assisted approach. Clinical and demographic characteristics of the patients were included in the study. Factors influencing the volume of hemorrhage were explored with univariate correlations, multiple linear regression analysis, and graphical probabilistic modeling. RESULTS The univariate analysis demonstrated that several of the morphological variables but only the patient’s age from the clinical-demographic variables correlated (p < 0.05) with the volume of bleeding. Nine morphological variables correlated positively (absolute height, perpendicular height, maximum width, sac surface area, sac volume, size ratio, bottleneck factor, neck-to-vessel ratio, and width-to-vessel ratio) and two correlated negatively (parent vessel average diameter and the aneurysm angle). After multivariate analysis, only the aneurysm size ratio (p < 0.001) and the patient’s age (p = 0.023) remained statistically significant. The graphical probabilistic model confirmed the size ratio and the patient’s age as the variables most related to the total hemorrhage volume. CONCLUSIONS A greater aneurysm size ratio and an older patient age are likely to entail a greater volume of bleeding after subarachnoid hemorrhage.

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Clot volume and clearance rate as independent predictors of vasospasm after aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/jns.2004.101.2.0255 ◽

2004 ◽

Vol 101 (2) ◽

pp. 255-261 ◽

Cited By ~ 118

Author(s):

Christopher Reilly ◽

Chris Amidei ◽

Jocelyn Tolentino ◽

Babak S. Jahromi ◽

R. Loch Macdonald

Keyword(s):

Subarachnoid Hemorrhage ◽

Clearance Rate ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Quantitative Imaging ◽

Univariate Analysis ◽

Ct Scans ◽

Focal Neurological Deficit ◽

Content Type ◽

Fisher Grade ◽

Fine Print

Object. This study was conducted for two purposes. The first was to determine whether a combination of measurements of subarachnoid clot volume, clearance rate, and density could improve prediction of which patients experience vasospasm. The second was to determine if each of these three measures could be used independently to predict vasospasm. Methods. Digital files of the cranial computerized tomography (CT) scans obtained in 75 consecutive patients admitted within 24 hours of subarachnoid hemorrhage (SAH) were analyzed in a blinded fashion by an observer who used quantitative imaging software to measure the volume of SAH and its density. Clot clearance rates were measured by quantifying SAH volume on subsequent CT scans. Vasospasm was defined as new onset of a focal neurological deficit or altered consciousness 5 to 12 days after SAH in the absence of other causes of deterioration, diagnosed with the aid of or exclusively by confirmatory transcranial Doppler ultrasonography and/or cerebral angiography. Univariate analysis showed that vasospasm was significantly associated with the SAH grade as classified on the Fisher scale, the initial clot volume, initial clot density, and percentage of clot cleared per day (p < 0.05). In multivariate analysis, initial clot volume and percentage of clot cleared per day were significant predictors of vasospasm (p < 0.05), whereas Fisher grade and initial clot density were not. Conclusions. Quantitative analysis of subarachnoid clot shows that vasospasm is best predicted by initial subarachnoid clot volume and the percentage of clot cleared per day.

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Clinical Outcome Prediction in Aneurysmal Subarachnoid Hemorrhage Using Bayesian Neural Networks with Fuzzy Logic Inferences

Computational and Mathematical Methods in Medicine ◽

10.1155/2013/904860 ◽

2013 ◽

Vol 2013 ◽

pp. 1-10 ◽

Cited By ~ 12

Author(s):

Benjamin W. Y. Lo ◽

R. Loch Macdonald ◽

Andrew Baker ◽

Mitchell A. H. Levine

Keyword(s):

Neural Networks ◽

Fuzzy Logic ◽

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Hidden Variables ◽

Decision Rules ◽

Bayesian Neural Networks ◽

Prognostic System ◽

History Of ◽

Prediction Approach

Objective. The novel clinical prediction approach of Bayesian neural networks with fuzzy logic inferences is created and applied to derive prognostic decision rules in cerebral aneurysmal subarachnoid hemorrhage (aSAH).Methods. The approach of Bayesian neural networks with fuzzy logic inferences was applied to data from five trials of Tirilazad for aneurysmal subarachnoid hemorrhage (3551 patients).Results. Bayesian meta-analyses of observational studies on aSAH prognostic factors gave generalizable posterior distributions of population mean log odd ratios (ORs). Similar trends were noted in Bayesian and linear regression ORs. Significant outcome predictors include normal motor response, cerebral infarction, history of myocardial infarction, cerebral edema, history of diabetes mellitus, fever on day 8, prior subarachnoid hemorrhage, admission angiographic vasospasm, neurological grade, intraventricular hemorrhage, ruptured aneurysm size, history of hypertension, vasospasm day, age and mean arterial pressure. Heteroscedasticity was present in the nontransformed dataset. Artificial neural networks found nonlinear relationships with 11 hidden variables in 1 layer, using the multilayer perceptron model. Fuzzy logic decision rules (centroid defuzzification technique) denoted cut-off points for poor prognosis at greater than 2.5 clusters.Discussion. This aSAH prognostic system makes use of existing knowledge, recognizes unknown areas, incorporates one's clinical reasoning, and compensates for uncertainty in prognostication.

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Development of a questionnaire to identify persons with a family history of aneurysmal subarachnoid hemorrhage

International Journal of Stroke ◽

10.1177/17474930211069004 ◽

2022 ◽

pp. 174749302110690

Author(s):

Charlotte CM Zuurbier ◽

Jacoba P Greving ◽

Gabriel JE Rinkel ◽

Ynte M Ruigrok

Keyword(s):

Subarachnoid Hemorrhage ◽

Family History ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Positive Family History ◽

Stroke Patients ◽

Degree Relative ◽

First Degree Relatives ◽

Family History Questionnaire ◽

Affected Relative ◽

History Of

Background: Preventive screening for intracranial aneurysms is effective in persons with a positive family history of aneurysmal subarachnoid hemorrhage (aSAH), but for many relatives of aSAH patients, it can be difficult to assess whether their relative had an aSAH or another type of stroke. Aim: We aimed to develop a family history questionnaire for people in the population who believe they have a first-degree relative who had a stroke and to assess its accuracy to identify relatives of aSAH patients. Methods: A questionnaire to distinguish between aSAH and other stroke types (ischemic stroke and intracerebral hemorrhage) was developed by a team of clinicians and consumers. The level of agreement between the questionnaire outcome and medical diagnosis was pilot tested in 30 previously admitted aSAH patients. Next, the sensitivity and specificity of the questionnaire were assessed in 91 first-degree relatives (siblings/children) of previously admitted stroke patients. Results: All 30 aSAH patients were identified by the questionnaire in the pilot study; 29 of 30 first-degree relatives of aSAH patients were correctly identified. The questionnaire had a sensitivity of 97% (95% confidence interval (CI) = 83–100%) and a specificity of 93% (95% CI = 84–98%) when tested in the first-degree relatives of stroke patients. Conclusion: Our questionnaire can help persons to discriminate an aSAH from other types of stroke in their affected relative. This family history questionnaire is developed in the Netherlands but could also be used in other countries after validation.

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Abstract 37: Refining of the Association of Fever with Functional Outcome in SAH

Stroke ◽

10.1161/str.46.suppl_1.37 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Marianna Pegoli ◽

Christopher L Kramer ◽

Jay Mandrekar ◽

Giuseppe Lanzino ◽

Alejandro Rabinstein

Keyword(s):

Functional Outcome ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Core Body Temperature ◽

Univariate Analysis ◽

Great Majority ◽

Icu Stay ◽

Poor Outcome ◽

Fever Onset ◽

Fisher Grade ◽

The Impact

Background: Fever has been associated with worse clinical outcomes in aneurysmal subarachnoid hemorrhage (aSAH). However, the impact of the cause, severity, and duration of fever is not clear. We conducted this study to evaluate the impact of fever and subfebrile load and fever characteristics on functional outcome. Methods: We collected detailed information on fever onset, cause, severity, and duration during the ICU stay in a cohort of 586 consecutive patients with aSAH. Fever was defined as core body temperature ≥ 38.3°C. Subfebrile measurements were those between 37 and 38.2°C. Febrile and subfrebile loads were defined as number of hours with fever or subfebrile measurements. Poor outcome was defined as modified Rankin score (mRS) > 2. Univariate and multivariate logistic regression models were developed to define predictors of outcome using various categorizations of fever cause, severity, and duration. Results: 532/586 patients (90.9%) had fever for a mean of 2.1±3.0 days. Fever started within 24 hours in 69 (11.8%) and within 72 hours in 110 (18.8%). Poor outcome occurred in 175 patients (29.9%). On univariate analysis, days of fever, febrile load, fever onset within 24 hours, and fever onset within 72 hours were associated with poor outcome (all p<0.001), but subfebrile load was not (p=0.58). On multivariate model constructed with all variables associated with outcome on univariate analyses (including age, WFNS grade, modified Fisher grade) days of fever remained independently associated with poor outcome (OR 1.14 of poor outcome per day of fever, 95% CI 1.06-1.22; p=0.0006) displacing all other fever measures from the final model. Conclusions: The great majority of patients with aSAH are febrile during their ICU stay. Early onset of fever, number of hours with fever, and especially days of fever are associated with poor functional outcome. Conversely, the number of hours with elevated but subfebrile temperature does not influence clinical outcome. These data suggest that prolonged fever should be avoided, but subfebrile temperatures do not justify intervention.

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Abstract TP425: The Impact of Social Determinants of Health on 1-Month Outcomes Post Aneurysmal Subarachnoid Hemorrhage

Stroke ◽

10.1161/str.51.suppl_1.tp425 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Drew Prescott ◽

Xueyuan Cao ◽

Brandon Baughman ◽

Ansley Stanfill

Keyword(s):

Subarachnoid Hemorrhage ◽

Drug Abuse ◽

Marital Status ◽

Social Determinants ◽

Household Income ◽

Physical Disability ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Stroke Severity ◽

Depression And Anxiety ◽

The Impact

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) carries high disability rates. Depression and anxiety are also common for survivors, but little work has been done to investigate the role of social determinants of health (SDOH) on such outcomes. The purpose of this abstract is to examine the impact of SDOH on physical disability, depression, and anxiety at 1-month post-aSAH, in order to better identify factors that are amenable to intervention to improve quality of life for these patients. Methods: A retrospective chart review was conducted of aSAH patients (selected by ICD-9/10 code) seen at a high-volume neurology and neurosurgery clinic from 2002-2018. Standard patient demographic and clinical characteristics were collected. The outcomes of physical disability, depression, and anxiety were also collected at 1-month post-aSAH. The studied SDOH characteristics were: race, gender, marital status, employment, smoking, drug/alcohol use, and household income level category (defined as low or middle income per US Census Bureau standards). Results: These patients (N=970) were 52.9 (±14.5) years old, 59.5% Caucasian, and 67.4% female. In addition to stroke severity measures (i.e., Hunt/Hess Grade, Fisher, GCS at time of admission), physical disability at 1-month was also associated with female gender, drug abuse, and low household income ( p ≤0.05). Depression at 1-month was not associated with stroke severity measures but was associated with these same SDOH factors and also with unemployment prior to aSAH ( p <0.0001). Anxiety was not associated with drug abuse or income in this group. Race, marital status, and smoking history were not found to be associated with these 1-month outcomes. Conclusions: This work demonstrates that measures of SDOH should be included in addition to clinical variables in a comprehensive predictive model of outcomes post-aSAH.

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P1515Female sex is an independent predictor of mortality in patients with STEMI in Spain: a study in 325,017 episodes over 11 years (2005–2015)

European Heart Journal ◽

10.1093/eurheartj/ehz748.0277 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Anguita ◽

A Sambola Ayala ◽

J Elola ◽

J L Bernal ◽

C Fernandez ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Hospital Mortality ◽

Independent Predictor ◽

National Health System ◽

Anterior Myocardial Infarction ◽

Female Sex ◽

Spanish National Health System ◽

History Of ◽

The Impact

Abstract Background Recent studies reported a decrease in the mortality of ST-elevation myocardial infarction (STEMI) patients. This favorable evolution could not extend to women. The interaction between gender and mortality in STEMI remains controversial. Purpose To assess the impact of female sex on mortality of patients with STEMI through of period of 11 years. Methods We conducted a retrospective longitudinal study using information provided by the minimal database system of the Spanish National Health System to identify all hospitalizations in patients aged 35–94 years with the principal diagnosis of STEMI from 2005–2015. Results A total of 325,017 STEMI were identified. Of them, 273,182 were included, and 106,277 (38.8%) were women. Women were older than men and had more comorbidities. Through the study period 53% men vs 37.2% underwent PTCA; women presented more frequently heart failure, shock and stroke than men (p<0.001, respectively). The mean crude in-hospital mortality rate for the whole study period was higher in women (OR: 2.18; 95% CI: 2.12.-2.23, p<0.0001). Female sex was independently associated with higher in-hospital mortality (adjusted OR: 1.18; 95% CI: 1.14–1.22, p<0.001) (Table 1). The risk was maintained through the whole study period (lower OR: 1.14 in 2014; higher OR: 1.28 in 2006). Table 1. Variables independently associated with in-hospital mortality adjusted by risk in a multilevel logistic regression model, 2005–2015 STEMI In-hospital mortality Odds Ratio P 95% CI Woman 1.18 <0.001 1.14 1.22 Age 1.06 <0.001 1.06 1.06 History of PTCA 1.58 <0.001 1.40 1.77 Congestive heart failure 1.26 <0.001 1.22 1.30 Acute Myocardial Infarction 1.84 <0.001 1.54 2.20 Anterior myocardial infarction 1.47 <0.001 1.23 1.76 Cardio-respiratory failure or shock 15.25 <0.001 14.78 15.75 Hypertension 0.81 <0.001 0.79 0.84 Stroke 5.76 <0.001 5.18 6.42 Cerebrovascular disease 0.86 <0.001 0.79 0.93 Renal failure 1.95 <0.001 1.88 2.02 Vascular disease and complications 7.03 <0.001 5.72 8.63 CI, Confidence Interval. Conclusions Female sex is an independent predictor of mortality in patients with STEMI in Spain, maintaining through a period of the 11 years.

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