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Kim BJ, Cho YJ, Hong KS, Lee J, Kim JT, Choi KH, Park TH, Park SS, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Nah HW, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi JC, Kim WJ, Shin DI, Yeo MJ, Sohn SI, Hong JH, Lee JS, Lee J, Han MK, Gorelick PB, Bae HJ. Trajectory Groups of 24-Hour Systolic Blood Pressure After Acute Ischemic Stroke and Recurrent Vascular Events. Stroke 2019; 49:1836-1842. [PMID: 30012819 DOI: 10.1161/strokeaha.118.021117] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background and Purpose- Blood pressure dynamics in patients with acute ischemic stroke may serve as an important modifiable and prognostic factor. Methods- A total of 8376 patients with acute ischemic stroke were studied from a prospective multicenter registry. Patients were eligible if they had been admitted within 24 hours of symptom onset and had ≥5 systolic blood pressure (SBP) measurements during the first 24 hours of hospitalization. SBP trajectory groups in the first 24 hours were identified using the TRAJ procedure in SAS software with delta-Bayesian Information Criterion and prespecified modeling parameters. Vascular events, including recurrent stroke, myocardial infarction, and death, were prospectively collected. The risk of having vascular events was calculated using the frailty model to adjust for clustering by hospital. Results- The group-based trajectory model classified patients with acute ischemic stroke into 5 SBP trajectory groups: low (22.3%), moderate (40.8%), rapidly stabilized (11.9%), acutely elevated (18.5%), and persistently high (6.4%) SBP. The risk of having vascular events was increased in the acutely elevated (hazard ratio, 1.28 [95% confidence interval, 1.12-1.47]) and the persistently high SBP groups (hazard ratio, 1.67 [95% confidence interval, 1.37-2.04]) but not in the rapidly stabilized group (hazard ratio, 1.13 [95% confidence interval, 0.95-1.34]), when compared with the moderate SBP group. Conclusions- SBP during the first 24 hours after acute ischemic stroke may be categorized into distinct trajectory groups, which differ in relation to stroke characteristics and frequency of subsequent recurrent vascular event risks. The findings may help to recognize potential candidates for future blood pressure control trials.
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Kim TJ, Lee JS, Oh MS, Lim JS, Nam KW, Lee CH, Mo H, Jeong HY, Jung KH, Ko SB, Yu KH, Lee BC, Yoon BW. Abstract WP552: Post-stroke Dementia Incidence and Risk Factors in Korea: Linked Big Data Between the Clinical Research Center for Stroke Data and the Health Insurance Review & Assessment Service Data Analysis. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Post-stroke dementia is an important factor of poor functional outcome following stroke. However, few longitudinal studies on the incidence and risk factors of dementia after stroke have been performed.
Hypothesis:
We aimed to investigate the incidence and clinical factors related to dementia after ischemic stroke.
Methods:
A total of 47,779 patients with acute ischemic stroke (within 7 days after stroke onset) were enrolled, who were registered in the Clinical Research Center for Stroke (CRCS) registry from 2006 to 2014 and successfully linked the Health Insurance Review and Assessment Service (HIRA) big database. All included patients did not have dementia before index stroke. The incidence of post-stroke dementia was identified using International Classification of Diseases, Tenth Revision, dementia diagnosis codes (F00, F01, F02, F03, and G30) with prescription of an anti-dementia medications after index stroke based on linked big data.
Results:
Of the 47,779 patients, 10,357 patients (21.7%) had post-stroke dementia. The cumulative incidence of dementia after stroke was 10.4% after 1 year, 15.6 % after 3 years, 19.5% after 5 years, 22.9% after 7 years, and 27.1% after 10 years. The crude incidence rate of post-stroke dementia was 40.03 cases per 1000 person-years in this stroke registry based linkage big data. Post-stroke dementia groups were older, more frequently female, and were more likely to have severe stroke, history of stroke, lower education level, dependency before stroke.
Conclusions:
Our study demonstrated that about 22% of ischemic stroke patients were demented after stroke, particularly were associated with history of stroke, and stroke severity. These patients with high risk of dementia should be controlled risk factors for preventing cognitive impairment following stroke.
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Kim TJ, Lee JS, Oh MS, Kim JW, Lim JS, Lee CH, Mo H, Jeong HY, Kim Y, Lee SH, Jung KH, Ko SB, Yu KH, Lee BC, Yoon BW. Abstract TP386: The Risk Score to Predict Functional Outcome Following Acute Ischemic Stroke Based on the Linked Big Data between theClinical Research Center for Stroke Data and the Health Insurance Review and Assessment Service Data. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tp386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Prediction of outcome after stroke may help clinicians provide effective stroke management and plan long-term care for patients.
Hypothesis:
We aimed to develop and validate a risk score for predicting functional outcome available at hospital after ischemic stroke using linked big data.
Methods:
A total of 24,907 cases with acute ischemic stroke (within 7 days after onset) were enrolled, who were registered in the Clinical Research Center for Stroke (CRCS) registry from 2006 to 2014 and successfully linked the Health Insurance Review and Assessment Service (HIRA) database. Among them, 22,005 cases were derivation and internal validation group, and 2,902 cases were external validation group. We assessed the functional outcome using a modified Rankin Scale (mRS) at 3-month after onset ischemic stroke. We evaluated the predictive value of variables associated with the favorable 3-month outcome (mRS ≤ 2) and developed the score using the logistic regression coefficients. The prediction model performance was assessed by the area under the receiver-operating characteristic curve (AUC).
Results:
Proportion of cases with favorable outcome were 67.0% (n=14,748) in the derivation and internal validation group, and 68.4% (n=1,986) in the external validation group. Multivariable predictors of functional outcome at 3-month included age, gender, stroke severity, body mass index, stroke subtype, previous functional status, recanalization treatment, pre-stroke antiplatelet or anticoagulation therapy, fasting glucose level, history of stroke, hyperlipidemia, diabetes mellitus, hypertension, congestive heart failure, kidney disease on dialysis, cancer before the stroke. The AUC of the prediction model was 0.855 (0.850 - 0.860) in the derivation group and 0.854 (0.849 - 0.860) in the internal validation group for 3-month functional outcome. In addition, the AUC of the model was 0.860 (0.846 - 0.874) in the external validation group for outcome at 3-month.
Conclusions:
This prediction of functional outcome model is a valid clinical tool to predict functional outcome following ischemic stroke and reliable externally. This prediction model may assist to estimate functional outcome after stroke and to decide the care plan after stroke.
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Kim DE, Ryu WS, Schellingerhout D, Jeong HG, Kim P, Jeong SW, Park MS, Choi KH, Kim JT, Kim BJ, Han MK, Lee J, Cha JK, Kim DH, Nah HW, Lee SJ, Kim JG, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Park JM, Kang K, Lee KB, Park TH, Park SS, Lee YS, Bae HJ. Estimation of Acute Infarct Volume with Reference Maps: A Simple Visual Tool for Decision Making in Thrombectomy Cases. J Stroke 2019; 21:69-77. [PMID: 30732442 PMCID: PMC6372899 DOI: 10.5853/jos.2018.03202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/08/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Thrombectomy within 24 hours can improve outcomes in selected patients with a clinical-infarct mismatch. We devised an easy-to-use visual estimation tool that allows infarct volume estimation in centers with limited resources. METHODS We identified 1,031 patients with cardioembolic or large-artery atherosclerosis infarction on diffusion-weighted images (DWIs) obtained before recanalization therapy and within 24 hours of onset, and occlusion of the internal carotid or middle cerebral artery. Acute DWIs were mapped onto a standard template and used to create visual reference maps with known lesion volumes, which were then used in a validation study (with 130 cases) against software estimates of infarct volume. RESULTS The DWI reference map chart comprises 144 maps corresponding to 12 different infarct volumes (0.5, 1, 2, 3, 5, 7, 9, 11, 13, 15, 17, and 19 mL) in each of 12 template slices (Montreal Neurological Institute z-axis -15 to 51 mm). Infarct volume in a patient is estimated by selecting a slice with a similar infarct size at the corresponding z-axis level on the reference maps and then adding up over all slices. The method yielded good correlations to software volumetrics and was easily learned by both experienced and junior physicians, with approximately 1 to 2 minutes spent per case. The sensitivity, specificity, and accuracy for detecting threshold infarct volumes (<21, <31, and <51 mL) were very high (all about >90%). CONCLUSION s We developed easy-to-use reference maps that allow prompt and reliable visual estimation of infarct volumes for triaging patients to thrombectomy in acute stroke.
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Kim JY, Kang K, Kang J, Koo J, Kim DH, Kim BJ, Kim WJ, Kim EG, Kim JG, Kim JM, Kim JT, Kim C, Nah HW, Park KY, Park MS, Park JM, Park JH, Park TH, Park HK, Seo WK, Seo JH, Song TJ, Ahn SH, Oh MS, Oh HG, Yu S, Lee KJ, Lee KB, Lee K, Lee SH, Lee SJ, Jang MU, Chung JW, Cho YJ, Choi KH, Choi JC, Hong KS, Hwang YH, Kim SE, Lee JS, Choi J, Kim MS, Kim YJ, Seok J, Jang S, Han S, Han HW, Hong JH, Yun H, Lee J, Bae HJ. Executive Summary of Stroke Statistics in Korea 2018: A Report from the Epidemiology Research Council of the Korean Stroke Society. J Stroke 2018; 21:42-59. [PMID: 30558400 PMCID: PMC6372894 DOI: 10.5853/jos.2018.03125] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 11/29/2018] [Indexed: 12/14/2022] Open
Abstract
Despite the great socioeconomic burden of stroke, there have been few reports of stroke statistics in Korea. In this scenario, the Epidemiologic Research Council of the Korean Stroke Society launched the “Stroke Statistics in Korea” project, aimed at writing a contemporary, comprehensive, and representative report on stroke epidemiology in Korea. This report contains general statistics of stroke, prevalence of behavioral and vascular risk factors, stroke characteristics, pre-hospital system of care, hospital management, quality of stroke care, and outcomes. In this report, we analyzed the most up-to-date and nationally representative databases, rather than performing a systematic review of existing evidence. In summary, one in 40 adults are patients with stroke and 232 subjects per 100,000 experience a stroke event every year. Among the 100 patients with stroke in 2014, 76 had ischemic stroke, 15 had intracerebral hemorrhage, and nine had subarachnoid hemorrhage. Stroke mortality is gradually declining, but it remains as high as 30 deaths per 100,000 individuals, with regional disparities. As for stroke risk factors, the prevalence of smoking is decreasing in men but not in women, and the prevalence of alcohol drinking is increasing in women but not in men. Population-attributable risk factors vary with age. Smoking plays a role in young-aged individuals, hypertension and diabetes in middle-aged individuals, and atrial fibrillation in the elderly. About four out of 10 hospitalized patients with stroke are visiting an emergency room within 3 hours of symptom onset, and only half use an ambulance. Regarding acute management, the proportion of patients with ischemic stroke receiving intravenous thrombolysis and endovascular treatment was 10.7% and 3.6%, respectively. Decompressive surgery was performed in 1.4% of patients with ischemic stroke and in 28.1% of those with intracerebral hemorrhage. The cumulative incidence of bleeding and fracture at 1 year after stroke was 8.9% and 4.7%, respectively. The direct costs of stroke were about ₩1.68 trillion (KRW), of which ₩1.11 trillion were for ischemic stroke and ₩540 billion for hemorrhagic stroke. The great burden of stroke in Korea can be reduced through more concentrated efforts to control major attributable risk factors for age and sex, reorganize emergency medical service systems to give patients with stroke more opportunities for reperfusion therapy, disseminate stroke unit care, and reduce regional disparities. We hope that this report can contribute to achieving these tasks.
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Jang SH, Oh MS, Baek HI, Ha KC, Lee JY, Jang YS. Oral Administration of Silk Peptide Enhances the Maturation and Cytolytic Activity of Natural Killer Cells. Immune Netw 2018; 18:e37. [PMID: 30402332 PMCID: PMC6215900 DOI: 10.4110/in.2018.18.e37] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/21/2018] [Accepted: 10/23/2018] [Indexed: 02/07/2023] Open
Abstract
Silk peptide, the hydrolysate of silk protein derived from cocoons, has been employed as a biomedical material and is believed to be safe for human use. Silk peptide display various bioactivities, including anti-inflammatory, immune-regulatory, anti-tumor, anti-viral, and anti-bacterial. Although earlier investigations demonstrated that silk peptide stimulates macrophages and the production of pro-inflammatory cytokines, its effect on natural killer (NK) cell function has not yet been explored. In this study, we initially confirmed that silk peptide enhances NK cell activity in vitro and ex vivo. To assess the modulatory activity of silk peptide on NK cells, mice were fed various amounts of a silk peptide-supplemented diet for 2 months and the effects on immune stimulation, including NK cell activation, were evaluated. Oral administration of silk peptide significantly enhanced the proliferation of mitogen- or IL-2-stimulated splenocytes. In addition, oral silk peptide treatment enhanced the frequency and degree of maturation of NK cells in splenocytes. The same treatment also significantly enhanced the target cell cytolytic activity of NK cells, which was determined by cell surface CD107a expression and intracellular interferon-γ expression. Finally, oral administration of silk peptide stimulated T helper 1-type cytokine expression from splenic lymphocytes. Collectively, our results suggest that silk peptide potentiates NK cell activity in vivo and could be used as a compound for immune-modulating anti-tumor treatment.
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Bae HJ, Lim JS, Kim BJ, Park JM, Lee KB, Kim DE, Heo JH, Park TH, Cha JK, Oh MS, Yu KH, Lee BC, Park H, Kang Y, Lee J. P3‐029: EFFICACY AND SAFETY OF OXIRACETAM IN PATIENTS WITH VASCULAR COGNITIVE IMPAIRMENT (OVERCOME): DESIGN AND RATIONALE FOR A MULTICENTER, RANDOMIZED, DOUBLE‐BLINDED, PLACEBO‐CONTROLLED, PARALLEL‐DESIGN, PHASE IV CLINICAL TRIAL. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lee KJ, Kim BJ, Kim DE, Ryu WS, Han MK, Kim JT, Choi KH, Cho KH, Cha JK, Kim DH, Nah HW, Park JM, Kang K, Lee SJ, Kim JG, Oh MS, Yu KH, Lee BC, Hong KS, Cho YJ, Park TH, Lee KB, Lee J, Lee JS, Lee J, Bae HJ. Nationwide Estimation of Eligibility for Endovascular Thrombectomy Based on the DAWN Trial. J Stroke 2018; 20:277-279. [PMID: 29886718 PMCID: PMC6007293 DOI: 10.5853/jos.2018.00836] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/25/2018] [Accepted: 05/03/2018] [Indexed: 11/23/2022] Open
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Lee EJ, Oh MS, Kim JS, Chang DI, Park JH, Cha JK, Heo JH, Sohn SI, Kim DE, Kim HY, Kim J, Seo WK, Lee J, Park SW, Kim YJ, Lee BC. Serotonin transporter gene polymorphisms may be associated with poststroke neurological recovery after escitalopram use. J Neurol Neurosurg Psychiatry 2018; 89:271-276. [PMID: 29030421 DOI: 10.1136/jnnp-2017-316882] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/13/2017] [Accepted: 09/28/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Selective serotonin reuptake inhibitors (SSRIs) putatively improve neurological recovery after stroke. We aimed to investigate whether serotonin transporter (SERT) gene polymorphisms are related to the responsiveness to SSRIs in the poststroke neurological recovery. METHODS This was a post hoc analysis of the EMOTION study (ClinicalTrials.gov NCT01278498), a randomised, placebo-controlled, double-blind trial examining the efficacy of escitalopram on emotional and neurological disturbances after acute stroke. Patients with no/minimal disability initially (modified Rankin Scale (mRS) 0-1) were excluded. Of the participants, 301 underwent genetic studies of the STin2 (a variable number tandem repeat (VNTR) in intron 2) (STin2 12/10 and STin2 12/12 genotypes) and 5-HTTLPR (a variable-length repeat in the promoter region) polymorphisms of SERT. We explored whether neurological function (National Institutes of Health Stroke Scale (NIHSS) score and mRS) at 3 months would differ according to SERT polymorphisms within each treatment arm (escitalopram and placebo). RESULTS Among the escitalopram users (n=159), neurological function in subjects with STin2 12/10 (n=29) improved significantly more than that in STin2 12/12 carriers (n=130) at 3 months. After adjusting for age, initial NIHSS and depression, STin2 12/10 independently predicted a good clinical outcome (mRS 0-1) (OR 2.99, 95% CI 1.04 to 8.58) at 3 months. However, differences between STin2 polymorphisms were not shown in the placebo group (n=142). 5-HTTLPR polymorphisms were not associated with neurological recovery in any treatment group. CONCLUSION STin2 VNTR polymorphisms may be associated with poststroke neurological recovery after SSRI therapy. Further studies are needed to identify the role of serotonin in neurological recovery after stroke.
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Kim YS, Kim MN, Lee KE, Hong JY, Oh MS, Kim SY, Kim KW, Sohn MH. Activated leucocyte cell adhesion molecule (ALCAM/CD166) regulates T cell responses in a murine model of food allergy. Clin Exp Immunol 2018; 192:151-164. [PMID: 29363753 DOI: 10.1111/cei.13104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 12/14/2022] Open
Abstract
Food allergy is a major public health problem. Studies have shown that long-term interactions between activated leucocyte cell adhesion molecule (ALCAM/CD166) on the surface of antigen-presenting cells, and CD6, a co-stimulatory molecule, influence immune responses. However, there are currently no studies on the functions of ALCAM in food allergy. Therefore, we aimed to identify the functions of ALCAM in ovalbumin (OVA)-induced food allergy using ALCAM-deficient mice. Wild-type (WT) and ALCAM-deficient (ALCAM-/- ) mice were sensitized intraperitoneally and with orally fed OVA. The mice were killed, and parameters related to food allergy and T helper type 2 (Th2) immune responses were analysed. ALCAM serum levels increased and mRNA expression decreased in OVA-challenged WT mice. Serum immunoglobulin (Ig)E levels, Th2 cytokine mRNA and histological injuries were higher in OVA-challenged WT mice than in control mice, and these were attenuated in ALCAM-/- mice. T cell proliferation of total cells, CD3+ CD4+ T cells and activated T cells in immune tissues were diminished in OVA-challenged ALCAM-/- mice. Proliferation of co-cultured T cells and dendritic cells (DCs) was decreased by the anti-CD6 antibody. In addition, WT mice sensitized by adoptive transfer of OVA-pulsed ALCAM-/- BM-derived DCs showed reduced immune responses. Lastly, serum ALCAM levels were higher in children with food allergy than in control subjects. In this study, serum levels of ALCAM were elevated in food allergy-induced WT mice and children with food allergy. Moreover, immune responses and T cell activation were attenuated in OVA-challenged ALCAM-/- mice. These results indicate that ALCAM regulates food allergy by affecting T cell activation.
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Lee KJ, Kim BJ, Han MK, Kim JT, Cho KH, Shin DI, Yeo MJ, Cha JK, Kim DH, Nah HW, Kim DE, Ryu WS, Park JM, Kang K, Lee SJ, Oh MS, Yu KH, Lee BC, Hong KS, Cho YJ, Choi JC, Park TH, Park SS, Kwon JH, Kim WJ, Lee J, Lee JS, Lee J, Bae HJ. Abstract TMP89: Early Heart Rate as an Outcome Predictor in Atrial Fibrillation Related Acute Ischemic Stroke. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tmp89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Backgrounds:
Previous studies demonstrated the association of resting heart rate with cardiovascular outcomes while there were only few evidence for patients who experienced ischemic stroke. As atrial fibrillation (AF) is characterized by rapidity and irregularity of heart rate, heart rate characteristics might be a predictor for future vascular event in patients with AF acute ischemic stroke.
Methods:
From a multicenter prospective registry of stroke patients, acute ischemic stroke patients with AF who admitted within 48 hours after stroke onset were included. Heart rate data during the first 24 hours after admission were collected and level and variability of heart rate were assessed by mean and coefficient of variation (CV). Primary outcome was a composite of stroke recurrence, myocardial infarction and all-cause death, which was prospectively captured until 1 year after stroke onset.
Results:
A total of 2,046 patients were included for the final analysis. There were 102 (5.0%) stroke recurrence, 9 (0.4%) myocardial infarction and 440 (21.5%) death events within 1 year after stroke onset. Proportional hazards regression models were constructed and the non-linearity of effects of heart rate parameters were examined for outcome events. Among all the associations, effects of mean heart rate on primary outcome and all-cause mortality were non-linear (
p’s
for quadratic effect = 0.017 and 0.032, respectively). The overall effects were significant only for effects of mean heart rate on primary outcome and all-cause mortality (P =0.013 and P=0.006, respectively). Effects of CV on outcome variables were not significant.
Conclusion:
This study suggests that mean heart rate during the first day of hospitalization was a predictor of future vascular events in AF patients presenting with acute ischemic stroke and the association seems to be non-linear ‘J shaped’. However, heart rate variability did not affect.
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Lee KJ, Kim BJ, Han MK, Kim JT, Cho KH, Shin DI, Yeo MJ, Cha JK, Kim DH, Nah HW, Kim DE, Ryu WS, Park JM, Kang K, Lee SJ, Oh MS, Yu KH, Lee BC, Hong KS, Cho YJ, Choi JC, Sohn SI, Hong JH, Park TH, Park SS, Kwon JH, Kim WJ, Lee J, Lee JS, Lee J, Gorelick PB, Bae HJ. Predictive Value of Pulse Pressure in Acute Ischemic Stroke for Future Major Vascular Events. Stroke 2018; 49:46-53. [DOI: 10.1161/strokeaha.117.019582] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 09/29/2017] [Accepted: 10/18/2017] [Indexed: 01/21/2023]
Abstract
Background and Purpose—
This study aimed to investigate whether pulse pressure (PP) obtained during the acute stage of ischemic stroke can be used as a predictor for future major vascular events.
Methods—
Using a multicenter prospective stroke registry database, patients who were hospitalized for ischemic stroke within 48 hours of onset were enrolled in this study. We analyzed blood pressure (BP) data measured during the first 3 days from onset. Primary and secondary outcomes were time to a composite of stroke recurrence, myocardial infarction, all-cause death, and time to stroke recurrence, respectively.
Results—
Of 9840 patients, 4.3% experienced stroke recurrence, 0.2% myocardial infarction, and 7.3% death during a 1-year follow-up period. In Cox proportional hazards models including both linear and quadratic terms of PP, PP had a nonlinear J-shaped relationship with primary (for a quadratic term of PP,
P
=0.004) and secondary (
P
<0.001) outcomes. The overall effects of PP and other BP parameters on primary and secondary outcomes were also significant (
P
<0.05). When predictive power of BP parameters was compared using a statistic of −2 log-likelihood differences, PP was a stronger predictor than systolic BP (8.49 versus 5.91; 6.32 versus 4.56), diastolic BP (11.42 versus 11.05; 10.07 versus 4.56), and mean atrial pressure (8.75 versus 5.91; 7.03 versus 4.56) for the primary and secondary outcomes, respectively.
Conclusions—
Our study shows that PP when measured in the acute period of ischemic stroke has nonlinear J-shaped relationships with major vascular events and stroke recurrence, and may have a stronger predictive power than other commonly used BP parameters.
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Sol IS, Kim YH, Park YA, Lee KE, Hong JY, Kim MN, Kim YS, Oh MS, Yoon SH, Kim MJ, Kim KW, Sohn MH, Kim KE. Relationship between sputum clusterin levels and childhood asthma. Clin Exp Allergy 2017; 46:688-95. [PMID: 26661728 DOI: 10.1111/cea.12686] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 11/27/2015] [Accepted: 12/05/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Clusterin is a sensitive cellular biosensor of oxidative stress and has been studied as a biomarker for inflammation-associated diseases. Clusterin levels in childhood asthma have not been evaluated. OBJECTIVES (1) To evaluate sputum clusterin levels in children with asthma compared to a control group. (2) To assess the relationships between sputum clusterin levels and airway inflammation, pulmonary function, and bronchial hyperresponsiveness. METHODS This study included 170 children aged 5-18 years with stable asthma (n = 91), asthma exacerbation (n = 29), or no asthma (healthy controls; n = 50). Induced sputum, pulmonary function, and methacholine challenge tests were performed. Stable asthma was classified into two groups according to the severity. Clusterin levels in sputum were measured using an enzyme-linked immunosorbent assay. RESULTS Children with stable asthma had a higher clusterin level than healthy controls [4540 (3872-5651) pg/mL vs. 3857 (1054-4369) pg/mL, P < 0.001]. The clusterin level was also more elevated in eosinophil-dominant sputum than in non-eosinophilic sputum in stable asthma [5094 (4243-6257) pg/mL vs. 4110 (1871-4839) pg/mL, P = 0.0017]. Clusterin levels were associated with asthma severity. Paradoxically, clusterin levels were lower during asthma exacerbation than in stable asthma [1838 (350-4790] pg/mL vs. 4540 (3872-5651) pg/mL, P < 0.001]. Clusterin levels were strongly correlated with the methacholine concentration that caused a 20% decrease in the forced expiratory volume in 1 s (r = -0.617, P < 0.001); there was no significant correlation between clusterin levels and other pulmonary function parameters. CONCLUSIONS AND CLINICAL RELEVANCE Clusterin levels were altered in children with stable asthma and asthma exacerbation because of its antioxidant and anti-inflammatory effects. Clusterin may be a marker that reflects airway inflammation and severity of symptoms, and it can be used in the assessment and management of childhood asthma.
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Park HK, Kim BJ, Han MK, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Nah HW, Park TH, Park SS, Lee KB, Lee J, Hong KS, Cho YJ, Lee BC, Yu KH, Oh MS, Kim JT, Choi KH, Kim DE, Ryu WS, Choi JC, Johansson S, Lee SJ, Lee WH, Lee JS, Lee J, Bae HJ. One-Year Outcomes After Minor Stroke or High-Risk Transient Ischemic Attack. Stroke 2017; 48:2991-2998. [DOI: 10.1161/strokeaha.117.018045] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/16/2017] [Accepted: 09/01/2017] [Indexed: 11/16/2022]
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Park HK, Chung JW, Hong JH, Jang MU, Noh HD, Park JM, Kang K, Lee SJ, Ko Y, Kim JG, Cha JK, Kim DH, Nah HW, Han MK, Kim BJ, Park TH, Park SS, Lee KB, Lee J, Hong KS, Cho YJ, Lee BC, Yu KH, Oh MS, Cho KH, Kim JT, Kim DE, Ryu WS, Choi JC, Kim WJ, Shin DI, Yeo MJ, Sohn SI, Lee JS, Lee J, Yoon BW, Bae HJ. Preceding Intravenous Thrombolysis in Patients Receiving Endovascular Therapy. Cerebrovasc Dis 2017; 44:51-58. [DOI: 10.1159/000471492] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/06/2016] [Indexed: 11/19/2022] Open
Abstract
Background: The beneficial effects of endovascular therapy (EVT) in acute ischemic stroke have been demonstrated in recent clinical trials using new-generation thrombectomy devices. However, the comparative effectiveness and safety of preceding intravenous thrombolysis (IVT) in this population has rarely been evaluated. Methods: From a prospective multicenter stroke registry database in Korea, we identified patients with acute ischemic stroke who were treated with EVT within 8 h of onset and admitted to 14 participating centers during 2008-2013. The primary outcome was a modified Rankin Scale (mRS) score at 3 months. Major secondary outcomes were successful recanalization defined as a modified Treatment in Cerebral Ischemia score of 2b-3, functional independence (mRS score 0-2), mortality at 3 months, and symptomatic hemorrhagic transformation (SHT) during hospitalization. Multivariable logistic regression analyses using generalized linear mixed models were performed to estimate the adjusted odds ratios (ORs) of preceding IVT. Results: Of the 639 patients (male, 61%; age 69 ± 12; National Institutes of Health Stroke Scale score of 15 [11-19]) who met the eligibility criteria, 458 received preceding IVT. These patients showed lower mRS scores (adjusted common OR, 1.38 [95% CI 0.98-1.96]). Preceding IVT was associated with successful recanalization (1.96 [1.23-3.11]) and reduced 3-month mortality (0.58 [0.35-0.97]) but not with SHT (0.96 [0.48-1.93]). Conclusion: In patients treated with EVT within 8 of acute ischemic stroke onset, preceding IVT may enhance survival and successful recanalization without additional risk of SHT, and mitigate disability at 3 months.
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Park HK, Kim BJ, Han MK, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Nah HW, Park TH, Lee KB, Lee J, Hong KS, Cho YJ, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Kim JT, Choi KH, Choi JC, Kim WJ, Shin DI, Yeo MJ, Sohn SI, Hong JH, Lee JS, Lee J, Bae HJ. Abstract 183: Effect of Statin in Acute Cardioembolic Stroke Patients Who Are not Indicated According to Current Guidelines. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
There is no specific recommendation on statin therapy for cardioembolic stroke (CES) patients in current stroke guidelines. We evaluated the effect of statin on major vascular events following acute ischemic stroke in patients with CES and no other indications for statin.
Methods:
Using a prospective multicenter stroke registry database, we identified acute ischemic stroke patients who were hospitalized between 2008 and 2015 and were categorized into CES according to the Trial of Org 10172 in Acute Stroke Treatment classification. Patients who had established indications for statin in accordance with the recent stroke guidelines were excluded. Primary outcome measure was a major vascular event, a composite of stroke recurrence, myocardial infarction and vascular death; and secondary outcome measures were stroke recurrence and all-cause death. We performed frailty model analysis to estimate hazard ratios (HRs) of statin therapy on outcomes accounting for variation in quality of care among centers. Stabilized inverse probability of treatment weighting method with propensity scores was used to remove baseline imbalances between statin users and non-users.
Results:
Of the 6124 CES patients, 2987 patients (male, 52%; mean age, 73±12 years) met the eligibility criteria; and 2125 (71%) of 2987 patients were on statin at discharge. Compared to the non-users, the statin users were more likely to arrive at hospitals later, have milder neurologic deficits at presentation, be on stain prior to index stroke and have hyperlipidemia and were less likely to have atrial fibrillation and occlusion of relevant cerebral arteries. During the median follow-up of 364 days, major vascular events were observed in 118 patients (5.6%) among the statin users and 177 patients (20.5%) among the non-users, respectively (p<0.001 on log rank test); the adjusted HR of statin therapy was 0.35 (95% confidence interval, 0.27-0.46). The adjusted HRs of statin therapy were 0.71 (0.49-1.04) for stroke recurrence and 0.55 (0.46-0.66) for all-cause death, respectively.
Conclusion:
This study suggests that statin therapy may reduce major vascular events and all-cause death in cardioembolic stroke patients without definite indications for statin.
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Kim JY, Han MK, Lee KB, Hong KS, Cho YJ, Park TH, Park SS, Park JM, Kang K, Lee SJ, Ko YC, Lee J, Cha JK, Kim DH, Lee BC, Yu KH, Oh MS, Lee JS, Lee J, Bae HJ. Abstract TP184: Impact on Ischemic Stroke Subtypes of Fasting and Non-fasting Triglycerides. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.tp184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Remnant cholesterol, comprising triglycerides(TG)-rich lipoproteins, accumulates in intimal foam cells and causes atherosclerosis. Fasting TG is reported to be associated with atherosclerotic stroke, but relationships between non-fasting TG (NFTG) and ischemic stroke subtypes are unknown. Recently NFTG was found to produce endothelial dysfunction. This study aimed to elucidate the association of fasting and NFTG with ischemic stroke subtypes, especially large-artery atherosclerosis (LAA) and small vessel occlusion (SVO).
Methods:
Using a prospective multicenter stroke registry (Clinical Research Center for Stroke - 5th division), we identified acute ischemic stroke patients, hospitalized within 48 hours of onset, and whose fasting and non-fasting TG values were available. We measured lipid profiles in each individual twice; at presentation and after overnight fasting. Initial TG were regarded as NFTG when measured within 8 hours from last mealtime.
Results:
Total 3,170 patients were analyzed. Stroke subtypes were categorized as LAA (37.9%), SVO (18.7%) and non-LAA and non-SVO (43.4%). Lipid levels according stroke subtypes are presented in Table. Lipid levels were divided by quartiles and the highest quartile was compared to others. In multinomial analyses compared to non-LAA and non-SVO group, fasting TG was associated with LAA (adjusted ORs 1.33 [95% CIs 1.09 - 1.62]) and SVO (1.61 [1.27 - 2.04]). NFTG was associated not with LAA (1.05 [0.87 - 1.28]), but with SVO (1.36 [1.08 - 1.71]). With respect to other lipid levels, fasting and non-fasting LDL were associated with both LAA (1.57 [1.29 - 1.90], fasting; 1.89 [1.56 - 2.29], non-fasting) and SVO (1.40 [1.11 - 1.77], fasting; 1.74 [1.38 - 2.19], non-fasting).
Conclusions:
This study may be the first one to demonstrate an association between non-fasting TG and SVO. It should be explored further on mechanisms of differential effect of fasting and non-fasting TG on ischemic stroke subtypes.
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Chung JW, Bang OY, Ahn K, Park SS, Park TH, Kim JG, Ko Y, Lee S, Lee KB, Lee J, Kang K, Park JM, Cho YJ, Hong KS, Nah HW, Kim DH, Cha JK, Ryu WS, Kim DE, Kim JT, Choi JC, Oh MS, Yu KH, Lee BC, Lee JS, Lee J, Park HK, Kim BJ, Han MK, Bae HJ. Air Pollution Is Associated With Ischemic Stroke via Cardiogenic Embolism. Stroke 2016; 48:17-23. [PMID: 27899751 DOI: 10.1161/strokeaha.116.015428] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/26/2016] [Accepted: 11/08/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE The aim of the study was to assessed the impact of short-term exposure to air pollution on ischemic stroke subtype, while focusing on stroke caused via cardioembolism. METHODS From a nationwide, multicenter, prospective, stroke registry database, 13 535 patients with acute ischemic stroke hospitalized to 12 participating centers were enrolled in this study. Data on the hourly concentrations of particulate matter <10 μm, nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO) were collected from 181 nationwide air pollution surveillance stations. The average values of these air pollutants over the 7 days before stroke onset from nearest air quality monitoring station in each patient were used to determine association with stroke subtype. The primary outcome was stroke subtype, including large artery atherosclerosis, small-vessel occlusion, cardioembolism, and stroke of other or undetermined cause. RESULTS Particulate matter <10 μm and SO2 concentrations were independently associated with an increased risk of cardioembolic stroke, as compared with large artery atherosclerosis and noncardioembolic stroke. In stratified analyses, the proportion of cases of cardioembolic stroke was positively correlated with the particulate matter <10 μm, NO2, and SO2 quintiles. Moreover, seasonal and geographic factors were related to an increased proportion of cardioembolic stroke, which may be attributed to the high levels of air pollution. CONCLUSIONS Our findings suggest that the short-term exposure to air pollutants is associated with cardioembolic stroke, and greater care should be taken for those susceptible to cerebral embolism during peak pollution periods. Public and environmental health policies to reduce air pollution could help slow down global increasing trends of cardioembolic stroke.
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Choi JC, Lee JS, Park TH, Cho YJ, Park JM, Kang K, Lee KB, Lee SJ, Kim JG, Lee J, Park MS, Choi KH, Kim JT, Yu KH, Lee BC, Oh MS, Cha JK, Kim DH, Nah HW, Kim DE, Ryu WS, Kim BJ, Bae HJ, Kim WJ, Shin DI, Yeo MJ, Sohn SI, Hong JH, Lee J, Hong KS. Prestroke Antiplatelet Effect on Symptomatic Intracranial Hemorrhage and Functional Outcome in Intravenous Thrombolysis. J Stroke 2016; 18:344-351. [PMID: 27733024 PMCID: PMC5066428 DOI: 10.5853/jos.2016.00185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose About 30%-40% of stroke patients are taking antiplatelet at the time of their strokes, which might increase the risk of symptomatic intracranial hemorrhage (SICH) with intravenous tissue plasminogen activator (IV-TPA) therapy. We aimed to assess the effect of prestroke antiplatelet on the SICH risk and functional outcome in Koreans treated with IV-TPA. Methods From a prospective stroke registry, we identified patients treated with IV-TPA between October 2009 and November 2014. Prestroke antiplatelet use was defined as taking antiplatelet within 7 days before the stroke onset. The primary outcome was SICH. Secondary outcomes were discharge modified Rankin Scale (mRS) score and in-hospital mortality. Results Of 1,715 patients treated with IV-TPA, 441 (25.7%) were on prestroke antiplatelet. Prestroke antiplatelet users versus non-users were more likely to be older, to have multiple vascular risk factors. Prestroke antiplatelet use was associated with an increased risk of SICH (5.9% vs. 3.0%; adjusted odds ratio [OR] 1.79 [1.05-3.04]). However, at discharge, the two groups did not differ in mRS distribution (adjusted OR 0.90 [0.72-1.14]), mRS 0-1 outcome (34.2% vs. 33.7%; adjusted OR 1.27 [0.94-1.72), mRS 0-2 outcome (52.4% vs. 52.9%; adjusted OR 1.21 [0.90-1.63]), and in-hospital mortality (6.1% vs. 4.2%; adjusted OR 1.19 [0.71-2.01]). Conclusions Despite an increased risk of SICH, prestroke antiplatelet users compared to non-users had comparable functional outcomes and in-hospital mortality with IV-TPA therapy. Our results support the use of IV-TPA in eligible patients taking antiplatelet therapy before their stroke onset.
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Chung JW, Kim BJ, Han MK, Kang K, Park JM, Park SS, Park TH, Cho YJ, Hong KS, Lee KB, Kim JG, Ko Y, Lee S, Nah HW, Kim DH, Cha JK, Oh MS, Yu KH, Lee BC, Jang MS, Lee JS, Lee J, Bae HJ. Family History and Risk of Recurrent Stroke. Stroke 2016; 47:1990-6. [DOI: 10.1161/strokeaha.116.013148] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 06/13/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The association between family history of stroke and stroke recurrence remains unclear.
Methods—
Using a web-based multicenter stroke registry database, information on history of stroke in first-degree relatives was collected prospectively for acute ischemic stroke patients who were hospitalized within 7 days of onset. The collected information was categorized as follows: type of the affected relative(s) with stroke (paternal, maternal, sibling, or 2 or more) and age of the relative’s stroke onset (<50, 50–59, 60–69, and ≥70 years). Stroke recurrence was captured prospectively using a predetermined protocol. Subgroup analyses were performed according to the patient’s age at the index stroke.
Results—
Among 7642 patients, 937 (12.3%) had a history of stroke in their first-degree relatives and 475 (6.2%: 201 within and 274 after 3 weeks from index stroke) experienced stroke recurrence (median follow-up, 365 days). In multivariable Cox proportional hazard models, overall family history was not associated with stroke recurrence (hazard ratio, 1.08; 95% confidence interval, 0.81–1.43). However, the details of their family histories, including relative’s age at stroke onset (<50 years: hazard ratio, 2.14; 95% confidence interval, 1.004–4.54) and stroke history in a sibling (hazard ratio, 1.67; 95% confidence interval, 1.09–2.58), were independently associated with stroke recurrence after adjusting for potential confounders. The associations appeared to be stronger in young adults with stroke (age, <55 years) than in older stroke patients.
Conclusions—
This study suggests that elevated risks of recurrent stroke are associated with having relatives with early-onset stroke and siblings with stroke histories, implying that additional precautions may be needed in such populations.
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Chung JW, Kim BJ, Han MK, Ko Y, Lee S, Kang K, Park JM, Park SS, Park TH, Cho YJ, Hong KS, Lee KB, Lee J, Ryu WS, Kim DE, Nah HW, Kim DH, Cha JK, Kim JT, Cho KH, Choi JC, Oh MS, Yu KH, Lee BC, Jang MS, Lee JS, Lee J, Gorelick PB, Yoon BW, Bae HJ. Impact of Guidelines on Clinical Practice: Intravenous Heparin Use for Acute Ischemic Stroke. Stroke 2016; 47:1577-83. [PMID: 27118793 DOI: 10.1161/strokeaha.116.012639] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 03/24/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Since its introduction, controversy has existed about the administration of intravenous heparin for the treatment of acute ischemic stroke. We studied trends in the intravenous heparin use during a 6-year time period and the potential influence of clinical guidelines in national language on intravenous heparin administration in Korea. METHODS On the basis of a prospective nationwide multicenter stroke registry, we collected data on patients with acute ischemic stroke who arrived within 7 days of symptom onset during the time period 2008 to 2013. We studied patient demographics, prestroke medical history, stroke characteristics, and stroke treatment. Data from a total of 23 425 patients from 12 university hospitals or regional stroke centers were analyzed. RESULTS The administration of intravenous heparin steadily decreased throughout the study period: 9.7% in 2008, 10.9% in 2009, 9.4% in 2010, 6.0% in 2011, 4.7% in 2012, and 4.3% in 2013 (P for trend <0.001). The reduced intravenous heparin use was associated with moderate stroke severity, atrial fibrillation, and stroke of cardioembolic, other-, and undetermined etiology. In a multivariable logistic model, increase of 1 calendar year (odds ratio, 0.89; 95% confidence interval, 0.84-0.95; P<0.001) and release of clinical practice guidelines in Korean (odd ratio, 0.74; 95% confidence interval, 0.59-0.91; P<0.01) were independent factors associated with reduction in the frequency of intravenous heparin use. CONCLUSIONS Use of intravenous heparin for acute ischemic stroke treatment has decreased in Korea, and this change may be attributable to the spread and successful implementation of regional clinical practice guidelines.
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Choi JC, Park MS, Lee JS, Park TH, Cho YJ, Hong KS, Park JM, Kang K, Lee KB, Lee SJ, Ko Y, Lee J, Choi KH, Oh MS, Yu KH, Lee BC, Cha JK, Kim DH, Lee J, Kim DE, Kim BJ, Bae HJ. Abstract TP304: Use, Time Delay and Outcomes of the Drip-and-Ship Thrombolysis Paradigm for Patients With Acute Ischemic Stroke. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tp304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
The utilization of drip-and-ship thrombolysis paradigm, clinical characteristics and outcomes of patients treated with the paradigm could vary with regional stroke care system.
Hypothesis:
We hypothesized that clinical characteristics and functional outcomes of patients treated with drip-and-ship paradigm would be different from those of patients treated via direct visit.
Methods:
From a multicenter stroke registry, we identified acute ischemic stroke patients treated with tPA who arrived hospital within 6 hours from the symptom onset. Functional outcomes at three months after the stroke were classified as favorable (modified Rankin Scale score [mRS] 0 to 1) or unfavorable (mRS 2-6). Using multivariable analysis, we compared the modified Rankin scale (mRS) score at 3 months and symptomatic intracranial hemorrhages (SICH) between patients treated with drip-and-ship paradigm and those treated via direct visit.
Results:
Among 1,843 patients who met the eligible criteria, 244 patients (13.2%; 95% CI, 11.7-14.9) were treated using drip-and-ship paradigm. Patients treated with drip-and-ship paradigm had shorter onset to needle time compared with patients treated via direct visit (median[IQR], 110 minutes[79-150] vs 126 minutes[90-173], p<0.001). After multivariable analysis, patients treated with drip-and-ship paradigm had significantly greater risk of unfavorable functional outcome (mRS 2-6) at 3 months after the stroke compared with patients treated via direct visit (OR 2.15; 95% CI, 1.50-3.08; p < 0.001). SICH also occurred more frequently in patients treated with drip-and-ship paradigm (OR 1.78; 95% CI, 1.02-3.12; p =0.04). Of 1,843 patients, 509 patients (27.6%, 71 patients with drip-and-ship paradigm and 438 patients via direct visit) received subsequent endovascular recanalization therapy. The use of drip-and-ship paradigm caused approximately 105 minute delay in onset to groin puncture time compared with those treated via direct visit (305 minutes[260-345] vs 200 minutes[155-245], p<0.001).
Conclusions:
Drip-and-ship thrombolysis paradigm was used in less than 15% of patients treated with tPA, and use of the paradigm caused a significant delay in onset to groin puncture time for endovascular therapy.
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Kim JY, Chung JW, Kim BJ, Han MK, Kang K, Park JM, Park SS, Park TH, Cho YJ, Hong KS, Lee KB, Ko Y, Lee S, Kim DH, Nah HW, Cha JK, Oh MS, Yu KH, Lee BC, Jang MS, Lee JS, Lee J, Bae HJ. Abstract TP200: Family History and Risk of Recurrent Stroke. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tp200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Association between family history of stroke and stroke recurrence remains unclear.
Methods:
Using a web-based multicenter stroke registry database, information on history of stroke in first-degree relatives was collected prospectively in ischemic stroke patients hospitalized within 7 day of onset. Collected information was categorized as follows: type of affected relatives with stroke (paternal, maternal, sibling, or two or more) and age of relative’s stroke onset in relative (< 50, 50∼59, 60∼69, and ≥ 70). Stroke recurrence was captured prospectively using predetermined protocol. Subgroup analysis was performed using categories based on patient’s age at the index stroke.
Results:
Among 7,642 patients, 937 (12.3%) had history of stroke in their first-degree relatives, and 475(6.2%) experienced stroke recurrence (median follow-up, 365 days). In multivariate Cox proportional hazard models, overall family history was not associated with stroke recurrence (hazard ratio [HR], 1.06; 95% confidence interval [CI], 0.80-1.41). However, the details of family history, including relative’s age at stroke onset < 50 (HR, 2.15; 95% CI, 1.01-4.57) and stroke history in sibling (HR, 1.67; 95% CI, 1.09-2.57) were independently associated with stroke recurrence after adjusting for possible confounders. The associations seemed to be stronger in stroke of young adults (age, <55) compared to older stroke patients.
Conclusion:
This study suggests that having relative with early onset stroke and sibling with history of stroke increase the risk of recurrent stroke and imply that additional precautions may be needed in such population.
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Choi JC, Lee JS, Park TH, Cho YJ, Hong KS, Park JM, Kang K, Lee KB, Lee SJ, Ko Y, Lee J, Kim JT, Choi KH, Oh MS, Yu KH, Lee BC, Cha JK, Kim DH, Lee J, Kim DE, Ryu WS, Kim BJ, Han MK, Bae HJ. Abstract WP76: Utility of Individual NIH Stroke Scale Items as a Predictor of Functional Outcomes in Acute Ischemic Stroke Patients Presenting With Mild Neurologic Deficits. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.wp76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Predicting outcomes of acute stroke patients initially presenting with mild neurologic deficits is important in making decision for thrombolytic therapy. Previous researches with a small sample size have failed to find specific items of NIH Stroke Scale or clinical syndromes to be predictive of functional outcome.
Hypothesis:
We hypothesized that certain items of the NIH Stroke Scale or their combinations would be independently associated with unfavorable functional outcome after mild stroke
Methods:
Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had initial NIH Stroke Scale scores ≤ 5. Functional outcomes at three months after the stroke were classified as favorable (modified Rankin Scale score [mRS] 0 to 1) or unfavorable (mRS 2-6). The individual NIH Stroke Scale items were dichotomized as absent (0) or present (≥1) for the analysis. The NIH Stroke Scale items and the total score were tested for predicting the outcomes in multivariable models adjusting for demographics and clinical characteristics. Area under the ROC curve (AUC) was used to assess the performance of multivariable models.
Results:
Among 2,209 patients who met the eligible criteria, 588 patients (26.6%) exhibited unfavorable functional outcome (mRS 2-6) at three months. The most frequently present items were item 10 (dysarthria, 37.5%), item 4 (facial palsy, 21.1%), item 8 (sensory, 15.0%), and items indicating limb paralysis. Among 15 items of NIH Stroke Scale, all items except for item 8 (sensory) and item 11 (extinction) were significantly associated with unfavorable functional outcomes in bivariate analysis (P <0.05), and many of them remained significant in multivariable analyses. In multivariable analyses, the model including the total NIH Stroke Scale scores exhibited similar AUC (0.759; 95% CI, 0.740 -0.776; P=0.75 for pairwise comparison) compared to the model with all NIH Stroke Scale items (0.758; 0.739 - 0.775) in predicting functional outcomes after the stroke.
Conclusions:
Simply using the total score was as effective as using all NIH Stroke Scale items in predicting outcomes of patients presented with mild stroke symptom.
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Kim BJ, Park JM, Kang K, Lee SJ, Ko Y, Kim JG, Cha JK, Kim DH, Nah HW, Han MK, Park TH, Park SS, Lee KB, Lee J, Hong KS, Cho YJ, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Cho KH, Kim JT, Choi JC, Kim WJ, Shin DI, Yeo MJ, Sohn SI, Hong JH, Lee J, Lee JS, Yoon BW, Bae HJ. ERRATUM: Table Correction: Case Characteristics, Hyperacute Treatment, and Outcome Information from the Clinical Research Center for Stroke-Fifth Division Registry in South Korea. J Stroke 2015; 17:377-8. [PMID: 26438006 PMCID: PMC4635710 DOI: 10.5853/jos.2015.17.3.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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