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Liu CH, Wu YL, Hsu CC, Lee TH. Early Antiplatelet Resumption and the Risks of Major Bleeding After Intracerebral Hemorrhage. Stroke 2023; 54:537-545. [PMID: 36621820 DOI: 10.1161/strokeaha.122.040500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/28/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The appropriate timing of resuming antithrombotic therapy after intracerebral hemorrhage (ICH) remains unclear. The aim of this study was to compare the risks of major bleeding between early and late antiplatelet resumption in ICH survivors. METHODS Between 2008 and 2017, ICH patients were available in the National Health Insurance Research Database. Patients with a medication possession ratio of antiplatelet treatment ≥50% before ICH and after antiplatelet resumption were screened. We excluded patients with atrial fibrillation, heart failure, under anticoagulant or hemodialysis treatment, and developed cerebrovascular events or died before antiplatelet resumption. Finally, 1584 eligible patients were divided into EARLY (≤30 days) and LATE groups (31-365 days after the index ICH) based on the timing of antiplatelet resumption. Patients were followed until the occurrence of a clinical outcome, end of 1-year follow-up, death, or until December 31, 2018. The primary outcome was recurrent ICH. The secondary outcomes included all-cause mortality, major hemorrhagic events, major occlusive vascular events, and ischemic stroke. Cox proportional hazard model after matching was used for comparison between the 2 groups. RESULTS Both the EARLY and LATE groups had a similar risk of 1-year recurrent ICH (EARLY versus LATE: 3.12% versus 3.27%; adjusted hazard ratio [AHR], 0.967 [95% CI, 0.522-1.791]) after matching. Both groups also had a similar risk of each secondary outcome at 1-year follow-up. Subgroup analyses disclosed early antiplatelet resumption in the patients without prior cerebrovascular disease were associated with lower risks of all-cause mortality (AHR, 0.199 [95% CI, 0.054-0.739]) and major hemorrhagic events (AHR, 0.090 [95% CI, 0.010-0.797]), while early antiplatelet resumption in the patients with chronic kidney disease were associated with a lower risk of ischemic stroke (AHR, 0.065 [95% CI, 0.012-0.364]). CONCLUSIONS Early resumption of antiplatelet was as safe as delayed antiplatelet resumption in ICH patients. Besides, those without prior cerebrovascular disease or with chronic kidney disease may benefit more from early antiplatelet resumption.
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Affiliation(s)
- Chi-Hung Liu
- Department of Neurology, Linkou Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan (C.-H.L., T.-H.L.)
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei (C.-H.L.)
| | - Yi-Ling Wu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan (Y.-L.W., C.-C. H.)
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan (Y.-L.W., C.-C. H.)
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Department of Family Medicine, Min-Sheng General Hospital, Taoyuan, and Department of Health Services Administration, China Medical University, Taichung, Taiwan (C.-C. H.)
| | - Tsong-Hai Lee
- Department of Neurology, Linkou Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan (C.-H.L., T.-H.L.)
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Siokas V, Fleischmann R, Feil K, Liampas I, Kowarik MC, Bai Y, Stefanou MI, Poli S, Ziemann U, Dardiotis E, Mengel A. The Role of Vascular Risk Factors in Post-Stroke Delirium: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11195835. [PMID: 36233701 PMCID: PMC9571874 DOI: 10.3390/jcm11195835] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/12/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022] Open
Abstract
Vascular risk factors may predispose to post-stroke delirium (PSD). A systematic review and meta-analysis were performed by searching PubMed, Web of Science, and Scopus. The primary outcome was the prevalence of vascular risk factors in PSD vs. non-PSD patients. Odds ratios (ORs) with 95% confidence intervals (CIs) and mean differences (MDs) with 95% CIs were calculated for categorical and continuous variables, respectively. Fixed effects or random effects models were used in case of low- or high-statistical heterogeneity, respectively. We found an increased prevalence of atrial fibrillation (OR = 1.74, p = 0.0004), prior stroke (OR = 1.48, p < 0.00001), coronary artery disease (OR = 1.48, p < 0.00001), heart failure (OR = 2.01, p < 0.0001), and peripheral vascular disease (OR = 2.03, p < 0.00001) in patients with vs. without PSD. PSD patients were older (MD = 5.27 y, p < 0.00001) compared with their non-PSD counterparts. Advanced age, atrial fibrillation, prior stroke, coronary artery disease, heart failure, and peripheral vascular disease appeared to be significantly associated with PSD.
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Affiliation(s)
- Vasileios Siokas
- Department of Neurology & Stroke, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece
- Correspondence:
| | - Robert Fleischmann
- Department of Neurology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Katharina Feil
- Department of Neurology & Stroke, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany
| | - Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece
| | - Markus C. Kowarik
- Department of Neurology & Stroke, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany
| | - Yang Bai
- Department of Neurology & Stroke, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany
- School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou 310030, China
| | - Maria-Ioanna Stefanou
- Department of Neurology & Stroke, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany
| | - Sven Poli
- Department of Neurology & Stroke, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany
| | - Ulf Ziemann
- Department of Neurology & Stroke, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100 Larissa, Greece
| | - Annerose Mengel
- Department of Neurology & Stroke, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, 72076 Tübingen, Germany
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Xun K, Mo J, Ruan S, Dai J, Zhang W, Lv Y, Du N, Chen S, Shen Z, Wu Y. A Meta-Analysis of Prognostic Factors in Patients with Posterior Circulation Stroke after Mechanical Thrombectomy. Cerebrovasc Dis 2020; 50:185-199. [PMID: 33378751 DOI: 10.1159/000512609] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Posterior circulation stroke is characterized by poor prognosis because its optimal thrombolysis "time window" is always missed. After mechanical thrombectomy (MT), the recanalization rate of posterior circulation obstruction is significantly increased, but prognosis remains poor. To best manage patients, prognostic factors are needed to inform MT triaging after posterior circulation stroke. METHODS A systematic literature search was done for the period through April 2020. Studies included those with posterior circulation stroke cases that underwent MT. The primary outcome measure in this study was the modified Rankin Scale on day 90. RESULTS No outcome differences were found in gender, atrial fibrillation, smoking, and coronary artery disease (OR = 1.07, 95% CI: 0.90-1.28; OR = 1.02, 95% CI: 0.82-1.26; OR = 1.26, 95% CI: 0.94-1.68; and OR = 0.84, 95% CI: 0.58-1.22, respectively). Hypertension, diabetes mellitus, and previous stroke correlated with poorer prognosis (OR = 0.61, 95% CI: 0.48-0.77; OR = 0.60, 95% CI: 0.50-0.73; and OR = 0.74, 95% CI: 0.55-0.99, respectively). However, hyperlipidemia correlated with better prognosis (OR = 1.28, 95% CI: 1.04-1.58). CONCLUSION Our analysis indicates that hypertension, diabetes mellitus, or previous stroke correlate with poorer outcomes. Intriguingly, hyperlipidemia correlates with better prognosis. These factors may help inform triage decisions when considering MT for posterior circulation stroke patients. However, large, multicenter, randomized controlled trials are needed to validate these observations.
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Affiliation(s)
- Kai Xun
- Department of Emergency, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Jiahang Mo
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shunyi Ruan
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jinyao Dai
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenting Zhang
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuqi Lv
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Nannan Du
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shengyue Chen
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zefeng Shen
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Yuanxi Wu
- The Second Clinical Medicine School, Zhejiang Chinese Medical University, Hangzhou, China,
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Zhao Y, Yang C, Yan X, Ma X, Wang X, Zou C, Wang S. Prognosis and Associated Factors among Elderly Patients with Small Artery Occlusion. Sci Rep 2019; 9:15380. [PMID: 31653901 PMCID: PMC6814720 DOI: 10.1038/s41598-019-51671-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 09/30/2019] [Indexed: 01/22/2023] Open
Abstract
Small artery occlusion (SAO) is the one of the primary subtype of ischemic stroke in China. However, its outcomes among elderly patients are unclear. Consecutive patients with SAO were recruited at Jiamusi University First Hospital, China between January 2008 and December 2016. Stroke subtype, severity, and risk factors were collected; outcomes at 3, 12, and 36 months after stroke onset were assessed. A total of 1464 SAO patients were included in this study. Participants aged ≥75 years had higher dependency rates than Participants aged <75 years with SAO in all three follow-up periods, in addition to a higher recurrence rate at 12 months and a higher mortality rate 36 months after stroke. After adjusting for confounders, elevated triglyceride level was found to be a protective factor against mortality 36 months after stroke. Stroke severity, diabetes mellitus, artery stenosis, gender, obesity, and high-density lipoprotein cholesterol level were independently associated with the risk of dependency; elevated triglyceride level was an independent risk factor for recurrence at 3 months point after stroke onset. These findings suggest that it is vital to manage risk factors that may affect prognosis of stroke among elderly patients with SAO to improve patient prognosis and reduce the burden of stroke in China.
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Affiliation(s)
- Yuguang Zhao
- Department of Cell Biology, Harbin Medical University, Harbin, 150081, China
| | - Chunxiao Yang
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Xiaobo Yan
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Xu Ma
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Xiaokun Wang
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Chunying Zou
- Department of Neurology, The First Affliated Hospital of Jiamusi University, Jiamusi, 154000, China
| | - Shuang Wang
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
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5
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Wang IK, Liu CH, Yen TH, Jeng JS, Hsu SP, Chen CH, Lien LM, Lin RT, Chen AC, Lin HJ, Chi HY, Lai TC, Sun Y, Lee SP, Sung SF, Chen PL, Lee JT, Chiang TR, Lin SK, Muo CH, Ma H, Wen CP, Sung FC, Hsu CY. Cholesterol Levels Are Associated with 30-day Mortality from Ischemic Stroke in Dialysis Patients. J Stroke Cerebrovasc Dis 2017; 26:1349-1356. [PMID: 28341198 DOI: 10.1016/j.jstrokecerebrovasdis.2017.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/19/2017] [Accepted: 02/02/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We investigated the impact of serum cholesterol levels on 30-day mortality after ischemic stroke in dialysis patients. METHODS From the Taiwan Stroke Registry data, we identified 46,770 ischemic stroke cases, including 1101 dialysis patients and 45,669 nondialysis patients from 2006 to 2013. RESULTS Overall, the 30-day mortality was 1.46-fold greater in the dialysis group than in the nondialysis group (1.75 versus 1.20 per 1000 person-days). The mortality rates were 1.64, .62, 2.82, and 2.23 per 1000 person-days in dialysis patients with serum total cholesterol levels of <120 mg/dL, 120-159 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively. Compared to dialysis patients with serum total cholesterol levels of 120-159 mg/dL, the corresponding adjusted hazard ratios of mortality were 4.20 (95% confidence interval [CI] = 1.01-17.4), 8.06 (95% CI = 2.02-32.2), and 6.89 (95% CI = 1.59-29.8) for those with cholesterol levels of <120 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively. CONCLUSIONS Dialysis patients with serum total cholesterol levels of ≥160 mg/dL or <120 mg/dL on admission are at an elevated hazard of 30-day mortality after ischemic stroke.
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Affiliation(s)
- I-Kuan Wang
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan
| | - Chung-Hsiang Liu
- Departmemt of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Tzung-Hai Yen
- Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | | | - Shih-Pin Hsu
- Department of Neurology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Chih-Hung Chen
- Department of Neurology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Stroke Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Li-Ming Lien
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital and Taipei Medical University College of Medicine, Taipei, Taiwan
| | - Ruey-Tay Lin
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - An-Chih Chen
- Department Neurology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Huey-Juan Lin
- Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hsin-Yi Chi
- Show Chwan Memorial Hospital, Changhua. Taiwan
| | | | - Yu Sun
- En Chu Kong Hospital, New Taipei City, Taiwan
| | - Siu-Pak Lee
- Department of Neurology, Far Eastern Memorial Hospital, Taipei, Taiwan
| | - Sheng-Feng Sung
- Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Po-Lin Chen
- Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jiunn-Tay Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | | | | | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Henry Ma
- Monash University, Melbourne, Victoria, Australia
| | - Chi-Pang Wen
- Institute of Population Science, National Health Research Institute, Zhunan, Taiwan
| | - Fung-Chang Sung
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
| | - Chung Y Hsu
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Departmemt of Neurology, China Medical University Hospital, Taichung, Taiwan
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Paulus JK, Lai LYH, Lundquist C, Daneshmand A, Buettner H, Lutz JS, Raman G, Wessler BS, Kent DM. Field Synopsis of the Role of Sex in Stroke Prediction Models. J Am Heart Assoc 2016; 5:JAHA.115.002809. [PMID: 27151514 PMCID: PMC4889171 DOI: 10.1161/jaha.115.002809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Guidelines for stroke prevention recommend development of sex‐specific stroke risk scores. Incorporating sex in Clinical Prediction Models (CPMs) may support sex‐specific clinical decision making. To better understand their potential to guide sex‐specific care, we conducted a field synopsis of the role of sex in stroke‐related CPMs. Methods and Results We identified stroke‐related CPMs in the Tufts Predictive Analytics and Comparative Effectiveness CPM Database, a systematic summary of cardiovascular CPMs published from January 1990 to May 2012. We report the proportion of models including the effect of sex on stroke incidence or prognosis, summarize the directionality of the predictive effects of sex, and explore factors influencing the inclusion of sex. Of 92 stroke‐related CPMs, 30 (33%) contained a coefficient for sex or presented sex‐stratified models. Only 12/58 (21%) CPMs predicting outcomes in patients included sex, compared to 18/30 (60%) models predicting first stroke (P<0.0001). Sex was most commonly included in models predicting stroke among a general population (69%). Female sex was consistently associated with reduced mortality after ischemic stroke (n=4) and higher risk of stroke from arrhythmias or coronary revascularization (n=5). Models predicting first stroke versus outcomes among patients with stroke (odds ratio=5.75, 95% CI 2.18–15.14, P<0.001) and those developed from larger versus smaller sample sizes (odds ratio=4.58, 95% CI 1.73–12.13, P=0.002) were significantly more likely to include sex. Conclusions Sex is included in a minority of published CPMs, but more frequently in models predicting incidence of first stroke. The importance of sex‐specific care may be especially well established for primary prevention.
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Affiliation(s)
- Jessica K Paulus
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Lana Y H Lai
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Christine Lundquist
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Ali Daneshmand
- Department of Neurology, Tufts Medical Center, Boston, MA
| | | | - Jennifer S Lutz
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Gowri Raman
- Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Benjamin S Wessler
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA Division of Cardiology, Tufts Medical Center, Boston, MA
| | - David M Kent
- Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
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Mattishent K, Kwok CS, Mahtani A, Pelpola K, Myint PK, Loke YK. Prognostic indices for early mortality in ischaemic stroke - meta-analysis. Acta Neurol Scand 2016; 133:41-8. [PMID: 25968234 DOI: 10.1111/ane.12421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Several models have been developed to predict mortality in ischaemic stroke. We aimed to evaluate systematically the performance of published stroke prognostic scores. METHODS We searched MEDLINE and EMBASE in February 2014 for prognostic models (published between 2003 and 2014) used in predicting early mortality (<6 months) after ischaemic stroke. We evaluated discriminant ability of the tools through meta-analysis of the area under the curve receiver operating characteristic curve (AUROC) or c-statistic. We evaluated the following components of study validity: collection of prognostic variables, neuroimaging, treatment pathways and missing data. RESULTS We identified 18 articles (involving 163 240 patients) reporting on the performance of prognostic models for mortality in ischaemic stroke, with 15 articles providing AUC for meta-analysis. Most studies were either retrospective, or post hoc analyses of prospectively collected data; all but three reported validation data. The iSCORE had the largest number of validation cohorts (five) within our systematic review and showed good performance in four different countries, pooled AUC 0.84 (95% CI 0.82-0.87). We identified other potentially useful prognostic tools that have yet to be as extensively validated as iSCORE - these include SOAR (2 studies, pooled AUC 0.79, 95% CI 0.78-0.80), GWTG (2 studies, pooled AUC 0.72, 95% CI 0.72-0.72) and PLAN (1 study, pooled AUC 0.85, 95% CI 0.84-0.87). CONCLUSIONS Our meta-analysis has identified and summarized the performance of several prognostic scores with modest to good predictive accuracy for early mortality in ischaemic stroke, with the iSCORE having the broadest evidence base.
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Affiliation(s)
- K. Mattishent
- Norwich Medical School; University of East Anglia; Norwich UK
| | - C. S. Kwok
- Norwich Medical School; University of East Anglia; Norwich UK
| | - A. Mahtani
- Norwich Medical School; University of East Anglia; Norwich UK
| | - K. Pelpola
- Southend University Hospital Trust; Westcliff-on-Sea UK
| | - P. K. Myint
- Epidemiology Group; Institute of Applied Health Sciences; School of Medicine & Dentistry; University of Aberdeen; Aberdeen UK
| | - Y. K. Loke
- Norwich Medical School; University of East Anglia; Norwich UK
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8
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Cha JK, Lim JH, Kim DH, Nah HW, Park HS, Choi JH, Suh HK, Huh JT. Prognostic factors for long-term poor outcomes after acute ischemic stroke in very old age (>80 years) patients: Total cholesterol level might differently influence long-term outcomes after acute ischemic stroke at ages above 80 years. Geriatr Gerontol Int 2014; 15:1227-33. [PMID: 25496005 DOI: 10.1111/ggi.12419] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2014] [Indexed: 11/28/2022]
Abstract
AIM We investigated the differences in determinant factors for functional outcomes between patients aged >80 years and those aged <80 years after acute ischemic stroke (AIS). In particular, we would like to know the differential impacts of initial total cholesterol (TC) levels between the two groups. METHODS We defined a poor outcome as 3-6 modified Rankin Scale 90 days after AIS. RESULTS In the present study, 2772 participants were enrolled. Among them, 374 patients (13.5%) were aged >80 years, and 1061 patients had a poor outcome 90 days after AIS. The proportion was significantly higher in patients aged >80 years than in those aged <80 years after AIS. Regarding factors relating to poor outcomes, previous history of stroke, stroke severity and stroke subtypes of ischemic stroke were independent factors in patients aged <80 years, and the stroke severity and initial TC level independently influenced the outcome for patients aged >80 years. In particular, risk of poor outcome adjusted for age, stroke severity and subtypes of ischemic stroke for patients (OR [95% CI]) in the first quartile range (≤157 mg%) were 2.21 (1.06-4.62), in the third quartile range (184-210 mg%) 2.76 (1.27-6.01) and in the fourth quartile range (≥211 mg%) 2.75 (1.21-6.24) compared with those in the second quartile range (158-183 mg%) in patients aged >80 years. CONCLUSIONS There were also some differences in related factors regarding occurrences of poor outcome between the two groups. In particular, the initial TC level might play a crucial role for the outcome after AIS in the very old population.
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Affiliation(s)
- Jae-Kwan Cha
- Stroke Center, Dong-A University Hospital, Busan, Korea
| | - Jun-Ho Lim
- Stroke Center, Dong-A University Hospital, Busan, Korea
| | - Dae-Hyun Kim
- Stroke Center, Dong-A University Hospital, Busan, Korea
| | - Hyun-Wook Nah
- Stroke Center, Dong-A University Hospital, Busan, Korea
| | | | | | - Hyun-Kyung Suh
- Department of Visual Optics, KyungWoon University, Gumi, Korea
| | - Jae-Taeck Huh
- Stroke Center, Dong-A University Hospital, Busan, Korea
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9
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Poor Awareness of Stroke—A Hospital-Based Study from South India: An Urgent Need For Awareness Programs. J Stroke Cerebrovasc Dis 2014; 23:2091-2098. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.03.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 03/17/2014] [Accepted: 03/21/2014] [Indexed: 11/20/2022] Open
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10
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Ankolekar S, Rewell S, Howells DW, Bath PMW. The Influence of Stroke Risk Factors and Comorbidities on Assessment of Stroke Therapies in Humans and Animals. Int J Stroke 2012; 7:386-97. [DOI: 10.1111/j.1747-4949.2012.00802.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The main driving force behind the assessment of novel pharmacological agents in animal models of stroke is to deliver new drugs to treat the human disease rather than to increase knowledge of stroke pathophysiology. There are numerous animal models of the ischaemic process and it appears that the same processes operate in humans. Yet, despite these similarities, the drugs that appear effective in animal models have not worked in clinical trials. To date, tissue plasminogen activator is the only drug that has been successfully used at the bedside in hyperacute stroke management. Several reasons have been put forth to explain this, but the failure to consider comorbidities and risk factors common in older people is an important one. In this article, we review the impact of the risk factors most studied in animal models of acute stroke and highlight the parallels with human stroke, and, where possible, their influence on evaluation of therapeutic strategies.
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Affiliation(s)
| | - Sarah Rewell
- Florey Neuroscience Institutes, Melbourne Brain Centre, Heidelberg, Australia
| | - David W. Howells
- Florey Neuroscience Institutes, Melbourne Brain Centre, Heidelberg, Australia
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Koton S, Molshatzki N, Bornstein NM, Tanne D. Low Cholesterol, Statins and Outcomes in Patients with First-Ever Acute Ischemic Stroke. Cerebrovasc Dis 2012; 34:213-20. [DOI: 10.1159/000342302] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 08/01/2012] [Indexed: 11/19/2022] Open
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Smith EE, Shobha N, Dai D, Olson DM, Reeves MJ, Saver JL, Hernandez AF, Peterson ED, Fonarow GC, Schwamm LH. Risk Score for In-Hospital Ischemic Stroke Mortality Derived and Validated Within the Get With The Guidelines–Stroke Program. Circulation 2010; 122:1496-504. [DOI: 10.1161/circulationaha.109.932822] [Citation(s) in RCA: 187] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
There are few validated models for prediction of in-hospital mortality after ischemic stroke. We used Get With the Guidelines–Stroke Program data to derive and validate prediction models for a patient's risk of in-hospital ischemic stroke mortality.
Methods and Results—
Between October 2001 and December 2007, there were 1036 hospitals that contributed 274 988 ischemic stroke patients to this study. The sample was randomly divided into a derivation (60%) and validation (40%) sample. Logistic regression was used to determine the independent predictors of mortality and to assign point scores for a prediction model. We also separately derived and validated a model in the 109 187 patients (39.7%) with a National Institutes of Health Stroke Scale (NIHSS) score recorded. Model discrimination was quantified by calculating the C statistic from the validation sample. In-hospital mortality was 5.5% overall and 5.2% in the subset in which NIHSS score was recorded. Characteristics associated with in-hospital mortality were age, arrival mode (eg, via ambulance versus other mode), history of atrial fibrillation, previous stroke, previous myocardial infarction, carotid stenosis, diabetes mellitus, peripheral vascular disease, hypertension, history of dyslipidemia, current smoking, and weekend or night admission. The C statistic was 0.72 in the overall validation sample and 0.85 in the model that included NIHSS score. A model with NIHSS score alone provided nearly as good discrimination (C statistic 0.83). Plots of observed versus predicted mortality showed excellent model calibration in the validation sample.
Conclusions—
The Get With the Guidelines–Stroke risk model provides clinicians with a well-validated, practical bedside tool for mortality risk stratification. The NIHSS score provides substantial incremental information on a patient's short-term mortality risk and is the strongest predictor of mortality.
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Affiliation(s)
- Eric E. Smith
- From the Calgary Stroke Program (E.E.S., N.S.), Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Duke Clinical Research Institute (D.D., D.M.O., A.F.H., E.D.P.), Durham, NC; Department of Epidemiology (M.J.R.), Michigan State University, East Lansing; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; and Stroke Service (L.H.S.), Massachusetts General Hospital, Boston, Mass
| | - Nandavar Shobha
- From the Calgary Stroke Program (E.E.S., N.S.), Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Duke Clinical Research Institute (D.D., D.M.O., A.F.H., E.D.P.), Durham, NC; Department of Epidemiology (M.J.R.), Michigan State University, East Lansing; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; and Stroke Service (L.H.S.), Massachusetts General Hospital, Boston, Mass
| | - David Dai
- From the Calgary Stroke Program (E.E.S., N.S.), Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Duke Clinical Research Institute (D.D., D.M.O., A.F.H., E.D.P.), Durham, NC; Department of Epidemiology (M.J.R.), Michigan State University, East Lansing; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; and Stroke Service (L.H.S.), Massachusetts General Hospital, Boston, Mass
| | - DaiWai M. Olson
- From the Calgary Stroke Program (E.E.S., N.S.), Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Duke Clinical Research Institute (D.D., D.M.O., A.F.H., E.D.P.), Durham, NC; Department of Epidemiology (M.J.R.), Michigan State University, East Lansing; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; and Stroke Service (L.H.S.), Massachusetts General Hospital, Boston, Mass
| | - Mathew J. Reeves
- From the Calgary Stroke Program (E.E.S., N.S.), Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Duke Clinical Research Institute (D.D., D.M.O., A.F.H., E.D.P.), Durham, NC; Department of Epidemiology (M.J.R.), Michigan State University, East Lansing; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; and Stroke Service (L.H.S.), Massachusetts General Hospital, Boston, Mass
| | - Jeffrey L. Saver
- From the Calgary Stroke Program (E.E.S., N.S.), Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Duke Clinical Research Institute (D.D., D.M.O., A.F.H., E.D.P.), Durham, NC; Department of Epidemiology (M.J.R.), Michigan State University, East Lansing; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; and Stroke Service (L.H.S.), Massachusetts General Hospital, Boston, Mass
| | - Adrian F. Hernandez
- From the Calgary Stroke Program (E.E.S., N.S.), Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Duke Clinical Research Institute (D.D., D.M.O., A.F.H., E.D.P.), Durham, NC; Department of Epidemiology (M.J.R.), Michigan State University, East Lansing; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; and Stroke Service (L.H.S.), Massachusetts General Hospital, Boston, Mass
| | - Eric D. Peterson
- From the Calgary Stroke Program (E.E.S., N.S.), Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Duke Clinical Research Institute (D.D., D.M.O., A.F.H., E.D.P.), Durham, NC; Department of Epidemiology (M.J.R.), Michigan State University, East Lansing; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; and Stroke Service (L.H.S.), Massachusetts General Hospital, Boston, Mass
| | - Gregg C. Fonarow
- From the Calgary Stroke Program (E.E.S., N.S.), Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Duke Clinical Research Institute (D.D., D.M.O., A.F.H., E.D.P.), Durham, NC; Department of Epidemiology (M.J.R.), Michigan State University, East Lansing; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; and Stroke Service (L.H.S.), Massachusetts General Hospital, Boston, Mass
| | - Lee H. Schwamm
- From the Calgary Stroke Program (E.E.S., N.S.), Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Duke Clinical Research Institute (D.D., D.M.O., A.F.H., E.D.P.), Durham, NC; Department of Epidemiology (M.J.R.), Michigan State University, East Lansing; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; and Stroke Service (L.H.S.), Massachusetts General Hospital, Boston, Mass
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Telemedicine in acute stroke: remote video-examination compared to simple telephone consultation. J Neurol 2008; 255:1792-7. [PMID: 19156491 DOI: 10.1007/s00415-008-0066-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 06/24/2008] [Accepted: 07/22/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Telemedicine is increasingly being used in acute stroke care. Some of the first studies and network projects are already applying remote audiovisual communication for patient evaluation. Formerly the telephone was the method of choice to contact experts for case discussion. We compared remote video-examination and telephone consultation in acute stroke care. METHODS Two district hospitals were linked to stroke centers in Northern Bavaria. Patients with symptoms suggestive of an acute stroke were included. Remote video examination (RVE) was provided by live audiovisual communication and access to brain images; telephone consultation (TC) was done via standard telephone using a structured interview. There was a weekly rotation of the two methods. Demographic data and other data concerning process and quality of care as well as outcome 10 days after stroke were recorded and compared between the two groups. RESULTS Within the study period 151 consultations were made in acute stroke patients (mean age 66.8 years). 77 patients were seen by RVE and 74 by TC. Total examination times were 49.8 min for RVE and 27.2 min for TC (p < 0.01). Patients were more frequently transferred to the stroke center after TC consultation (9.1 % vs. 14.9 %, p < 0.05) and had a higher mortality 10 days after stroke (6.8 % vs. 1.3 %, p < 0.05). Diagnosis made by TC had to be corrected more frequently (17.6 % vs. 7.1 %; p < 0.05). CONCLUSIONS Creating a network improves stroke care by establishing cooperation between hospitals. Telephone consultation could be a simple method of telemedicine to support cooperation as it is easy and widely available. However, outcome parameters like mortality indicate that remote video examination is superior to TC. Therefore, full-scale audiovisual communication is recommended for remote consultation in acute stroke care.
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