Acute stroke may be accompanied by cardiac or thromboembolic complications collectively referred to as Stroke-Heart Syndrome (SHS). A retrospective analysis of the Perugia Stroke Registry (March 2005–September 2019), published in the European Journal of Medicine, examined whether stroke subtype and lesion location were associated with SHS risk. 

Patients presenting with acute neurological symptoms were classified as ischemic stroke (IS) or hemorrhagic stroke (HS) using neuroimaging. Logistic regression analysis identified factors associated with stroke subtype and in-hospital complications. Subgroup analyses evaluated first-ever versus recurrent stroke and lesion location categories (lacunar, non-lacunar anterior, or non-lacunar posterior in IS; typical versus atypical in HS).

Among 2080 patients (mean age 72.8 ± 12.5 years; 57% male), 1788 (86%) had IS and 292 (14%) HS. During a median Stroke Unit stay of 8 days (IQR 5–14), HS showed higher composite outcome rates (26% vs 14%) and all-cause death (21.2% vs 8.8%) than IS. Posterior and anterior non-lacunar ischemic strokes, as well as atypical hemorrhagic lesions, showed higher rates of in-hospital mortality and composite cardiovascular events. 

Compared with lacunar stroke, posterior non-lacunar ischemic lesions were associated with higher odds of the composite outcome (OR 1.97; 95% CI 1.10-3.63) and mortality (OR 3.35; 95% CI 1.35-9.51). Anterior non-lacunar lesions also showed higher odds of the composite outcome (OR 1.61; 95% CI 0.96-2.81) and mortality (OR 2.90; 95% CI 1.28-7.79).

The findings indicate that SHS risk varied according to the anatomical location of the stroke lesion. These findings highlight variation in in-hospital outcomes according to stroke subtype and anatomical distribution.