Rates and Risk Factors for Major Adverse Cardiovascular and Cerebrovascular Events after stroke due to intracerebral haemorrhage: systematic review and study-level meta-analysis.

BACKGROUND: Intracerebral haemorrhage (ICH) survivors are at increased risk of major adverse cardiovascular and cerebrovascular events (MACE) compared to population controls; however, little is known about the annual rates and risk factors for MACE. METHODS: We systematically searched Medline, Embase, and trial registries in April 2024 for studies of adults with ICH reporting either a MACE outcome or both ischaemic and haemorrhagic outcomes with at least one year of follow-up. We excluded studies limited to secondary ICH or other isolated non-ICH intracranial haemorrhages. We used QUIPS tool to assess studies' risk of bias. The primary outcome was the rate of MACE. We used a random-effects meta-analysis ('metarate' in R) to estimate the annual event rate (per 100 person-years, expressed as %) for each outcome. We conducted subgroup analyses and meta-regression to explore heterogeneityResults:We included 26 studies, involving 198,289 ICH survivors. Individual studies' reported annual rate of MACE ranged from 4.2-14.6%. The pooled annual rate of recurrent ICH was 2.1% (95% CI 1.7-2.6; 26 studies; I2=94%) and of ischaemic stroke was 2.0% (95% CI 1.5-2.7; 24 studies; I2=95%). In the meta-regression analysis, only a higher prevalence of atrial fibrillation was associated with an increased risk of ischaemic stroke. DISCUSSION: The rates of recurrent ICH and ischaemic stroke were comparable among ICH survivors, but evidence on the 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.