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Cen K, Huang Y, Xie Y, Liu Y. The guardian of intracranial vessels: Why the pericyte? Biomed Pharmacother 2024; 176:116870. [PMID: 38850658 DOI: 10.1016/j.biopha.2024.116870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024] Open
Abstract
Intracranial atherosclerotic stenosis (ICAS) is a pathological condition characterized by progressive narrowing or complete blockage of intracranial blood vessels caused by plaque formation. This condition leads to reduced blood flow to the brain, resulting in cerebral ischemia and hypoxia. Ischemic stroke (IS) resulting from ICAS poses a significant global public health challenge, especially among East Asian populations. However, the underlying causes of the notable variations in prevalence among diverse populations, as well as the most effective strategies for preventing and treating the rupture and blockage of intracranial plaques, remain incompletely comprehended. Rupture of plaques, bleeding, and thrombosis serve as precipitating factors in the pathogenesis of luminal obstruction in intracranial arteries. Pericytes play a crucial role in the structure and function of blood vessels and face significant challenges in regulating the Vasa Vasorum (VV)and preventing intraplaque hemorrhage (IPH). This review aims to explore innovative therapeutic strategies that target the pathophysiological mechanisms of vulnerable plaques by modulating pericyte biological function. It also discusses the potential applications of pericytes in central nervous system (CNS) diseases and their prospects as a therapeutic intervention in the field of biological tissue engineering regeneration.
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Affiliation(s)
- Kuan Cen
- Department of Neurology, Zhongnan Hospital Affiliated to Wuhan University, Wuhan 430000, China
| | - YinFei Huang
- Department of Neurology, Zhongnan Hospital Affiliated to Wuhan University, Wuhan 430000, China
| | - Yu Xie
- Department of Neurology, Zhongnan Hospital Affiliated to Wuhan University, Wuhan 430000, China
| | - YuMin Liu
- Department of Neurology, Zhongnan Hospital Affiliated to Wuhan University, Wuhan 430000, China.
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Langanay L, Gonzalez Sanchez R, Hamroun A, Dauchet L, Amouyel P, Dallongeville J, Meirhaeghe A, Gauthier V. Ischemic stroke subtypes: risk factors, treatments, and 1-month prognosis - The Lille, France Stroke Registry. J Stroke Cerebrovasc Dis 2024; 33:107761. [PMID: 38723923 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/02/2024] [Accepted: 05/05/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVES First, this registry-based study aimed to comprehensively analyze patients' medical histories and treatments based on ischemic strokes' etiology. We focused on the management of atrial fibrillation among patients diagnosed with cardioembolic stroke. Then, our objective was to identify prognostic factors associated with 28-day mortality. MATERIALS AND METHODS All ischemic strokes occurring in adults between 2014 and 2021 in Lille, France, were categorized using the TOAST classification. Comparative analyses of patients' medical characteristics were conducted across subtypes. Survival rates within 28 days post-stroke were assessed, and factors influencing mortality were identified using a multivariate Cox model. RESULTS 1912 ischemic strokes were recorded, due to cardioembolism (36%), large-artery atherosclerosis (9%), small-artery occlusion (9%), other determined causes (6%), or undetermined causes (39%). The median NIHSS score after cardioembolic stroke (6, IQR: 3-13) was twice that after small-artery occlusion (3, IQR: 2-5). Among patients with cardioembolic stroke, 26% were diagnosed post-admission with atrial fibrillation. For the 42% diagnosed pre-admission, only 54% had prior prescriptions for oral anticoagulants. Reperfusion therapies were administered in 21% of cases, with significant variations across subtypes. Mortality rates were higher after cardioembolic strokes (17%) than after small-artery occlusions (3%). Prognostic factors included etiology, high NIHSS score, atrial fibrillation, and previous heparin prescription. CONCLUSIONS While atrial fibrillation was underdiagnosed and undertreated, patients with cardioembolic stroke exhibited high severity and elevated mortality rates. Etiology emerged as an independent predictor of early mortality, regardless of NIHSS score upon admission. These findings underscore the importance of targeted prevention to improve patient outcomes after ischemic stroke.
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Affiliation(s)
- Léonie Langanay
- Lille University, Lille University Hospital, INSERM U1167 - RID-AGE, Institut Pasteur de Lille, U1167, 1 rue du Pr Calmette, Lille 59019, France
| | - Roberto Gonzalez Sanchez
- Lille University, Lille University Hospital, INSERM U1167 - RID-AGE, Institut Pasteur de Lille, U1167, 1 rue du Pr Calmette, Lille 59019, France
| | - Aghiles Hamroun
- Lille University, Lille University Hospital, INSERM U1167 - RID-AGE, Institut Pasteur de Lille, U1167, 1 rue du Pr Calmette, Lille 59019, France
| | - Luc Dauchet
- Lille University, Lille University Hospital, INSERM U1167 - RID-AGE, Institut Pasteur de Lille, U1167, 1 rue du Pr Calmette, Lille 59019, France
| | - Philippe Amouyel
- Lille University, Lille University Hospital, INSERM U1167 - RID-AGE, Institut Pasteur de Lille, U1167, 1 rue du Pr Calmette, Lille 59019, France
| | - Jean Dallongeville
- Lille University, Lille University Hospital, INSERM U1167 - RID-AGE, Institut Pasteur de Lille, U1167, 1 rue du Pr Calmette, Lille 59019, France
| | - Aline Meirhaeghe
- Lille University, Lille University Hospital, INSERM U1167 - RID-AGE, Institut Pasteur de Lille, U1167, 1 rue du Pr Calmette, Lille 59019, France.
| | - Victoria Gauthier
- Lille University, Lille University Hospital, INSERM U1167 - RID-AGE, Institut Pasteur de Lille, U1167, 1 rue du Pr Calmette, Lille 59019, France
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Lopez-Espejo M, Poblete R, Bastias G. Social and health determinants related to adverse short-term outcomes after a first-ever stroke in adults younger than 65 years. J Stroke Cerebrovasc Dis 2023; 32:107153. [PMID: 37172471 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/27/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Stroke-related mortality and disability-adjusted life years in adults younger than 65 have increased over the last decade. However, geographical differences in distributing these outcomes could reflect dissimilarity in determinants. Therefore, this cross-sectional study of secondary data from Chilean hospitals aims to analyze the association of sociodemographic and clinical factors with in-hospital case-fatality risk or acquired neurologic deficits (adverse outcomes) in inpatients aged 18 to 64 who experienced their first-ever stroke. METHODOLOGY Adjusted multivariable logistic regression models and interaction analysis using multiple imputation for missing data (4.99%) for 1,043 hospital discharge records from the UC-CHRISTUS Health Network International Refined Diagnosis Related Groups (IR-DRG) system database (2010-2021) were conducted. RESULTS Mean age: 51.47 years (SD, 10.79); female: 39.60%. Stroke types: subarachnoid hemorrhage (SAH): 5.66%, intracerebral hemorrhage (ICH): 11.98%, and ischemic: 82.45%. Adverse outcomes: 25.22% (neurological deficit: 23.59%; in-hospital case-fatality risk: 1.63%). After adjusting for confounders, adverse outcomes were associated with stroke type (patients with ICH and ischemic stroke had higher odds than those with SAH), sociodemographic characteristics (age ≥ 40 years, residence in an area of the capital city other than the center-east, and coverage by public health insurance), and discharge diagnoses (obesity, coronary artery and chronic kidney diseases, and mood and anxiety disorders). For hypertension, women had higher odds of adverse outcomes. CONCLUSIONS In this predominantly Hispanic sample, modifiable social and health determinants are related to adverse short-term outcomes after a first-ever stroke. Longitudinal studies are needed to investigate the causal role of these factors.
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Affiliation(s)
- Mauricio Lopez-Espejo
- Unit of Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, Diagonal Paraguay 362, (postal: 8330077) Santiago, Chile.
| | - Rodrigo Poblete
- Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, Diagonal Paraguay 362, (postal: 8330077) Santiago, Chile.
| | - Gabriel Bastias
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, Diagonal Paraguay 362, (postal: 8330077) Santiago, Chile.
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Ding L, Mane R, Wu Z, Jiang Y, Meng X, Jing J, Ou W, Wang X, Liu Y, Lin J, Zhao X, Li H, Wang Y, Li Z. Data-driven clustering approach to identify novel phenotypes using multiple biomarkers in acute ischaemic stroke: A retrospective, multicentre cohort study. EClinicalMedicine 2022; 53:101639. [PMID: 36105873 PMCID: PMC9465270 DOI: 10.1016/j.eclinm.2022.101639] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/31/2022] [Accepted: 08/10/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Acute ischaemic stroke (AIS) is a highly heterogeneous disorder and warrants further investigation to stratify patients with different outcomes and treatment responses. Using a large-scale stroke registry cohort, we applied data-driven approach to identify novel phenotypes based on multiple biomarkers. METHODS In a nationwide, prospective, 201-hospital registry study taking place in China between August 01, 2015 and March 31, 2018, the patients with AIS who were over 18 years of age and admitted to the hospital within 7 days from symptom onset were included. 92 biomarkers were included in the analysis. In the derivation cohort (n=9539), an unsupervised Gaussian mixture model was applied to categorize patients into distinct phenotypes. A classifier was developed using the most important biomarkers and was applied to categorize patients into their corresponding phenotypes in an validation cohort (n=2496). The differences in biological features, clinical outcomes, and treatment response were compared across the phenotypes. FINDINGS We identified four phenotypes with distinct characteristics in 9288 patients with non-cardioembolic ischaemic stroke. Phenotype 1 was associated with abnormal glucose and lipid metabolism. Phenotype 2 was characterized by inflammation and abnormal renal function. Phenotype 3 had the least laboratory abnormalities and small infarct lesions. Phenotype 4 was characterized by disturbance in homocysteine metabolism. Findings were replicated in the validation cohort. In comparison with phenotype 3, the risk of stroke recurrence (adjusted hazard ratio [aHR] 2.02, 95% confidence intervals [CI] 1.04-3.94), and mortality (aHR 18.14, 95%CI 6.62-49.71) at 3-month post-stroke were highest in phenotype 2, followed by phenotype 4 and phenotype 1, after adjustment for age, gender, smoking, drinking, history of stroke, hypertension, diabetes mellitus, dyslipidemia, and coronary heart disease. The Monte Carlo simulation showed that the patients with phenotype 2 could benefit from high-intensity statin therapy. INTERPRETATION A data-driven approach could aid in the identification of patients at a higher risk of adverse clinical outcomes following non-cardioembolic ischaemic stroke. These phenotypes, based on different pathophysiology, can suggest individualized treatment plans. FUNDING Beijing Natural Science Foundation (grant number Z200016), Beijing Municipal Committee of Science and Technology (grant number Z201100005620010), National Natural Science Foundation of China (grant number 82101360, 92046016, 82171270), Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (grant number 2019-I2M-5-029).
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Affiliation(s)
- Lingling Ding
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Ravikiran Mane
- CNCRC-Hanalytics Artificial Intelligence Research Centre for Neurological Disorders
| | - Zhenzhou Wu
- CNCRC-Hanalytics Artificial Intelligence Research Centre for Neurological Disorders
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Weike Ou
- CNCRC-Hanalytics Artificial Intelligence Research Centre for Neurological Disorders
| | - Xueyun Wang
- CNCRC-Hanalytics Artificial Intelligence Research Centre for Neurological Disorders
| | - Yu Liu
- CNCRC-Hanalytics Artificial Intelligence Research Centre for Neurological Disorders
| | - Jinxi Lin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
- Corresponding author at: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- Corresponding author at: Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No 119 S 4th Ring W Rd, Fengtai District, Beijing 100070, China.
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Nath M, Swarnkar P, Sharma R, Kumar A, Misra S, Kumar P. Association of modifiable risk factors with ischaemic stroke subtypes in Asian versus Caucasian populations: A systematic review and meta-analysis. Eur J Clin Invest 2022; 52:e13849. [PMID: 35906805 DOI: 10.1111/eci.13849] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ischaemic stroke (IS) is associated with various modifiable risk factors but the association of these risk factors based on TOAST classification, which characterises IS into five subtypes: large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolic disease (CE), other determined aetiology (ODE) and undetermined aetiology (UDE), is unknown. We aimed to summarise the published evidence for the association of modifiable risk factors with IS subtypes based on TOAST classification, specifically focussing on the Asian versus Caucasian population. METHOD A comprehensive search for all the published articles was performed in electronic databases including PubMed, EMBASE, Cochrane Library, and Google Scholar from 01st January 1950 to 10th April 2022 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Odds ratio (OR) with 95% confidence interval (CIs) along with random-effect models was used to calculate summary estimates. RESULTS In our meta-analysis, 32 studies with a total of 23,404 IS (14,364 in Asian vs. 9040 in Caucasian population), 7121 LAA (5219 in Asian vs. 1902 in Caucasian), 5532 SVO (3604 in Asian vs. 1928 in Caucasian), 3498 CE (1634 in Asian vs. 1864 in Caucasian), 1131 ODE (546 in Asian vs. 585 in Caucasian) and 4519 UDE (2076 in Asian vs. 2443 in Caucasian) were included. Our findings suggest a significant association between LAA and hypertension (OR = 1.07, 95% CI = 1.02-1.12), smoking (OR = 1.11, 95% CI = 1.04-1.17), dyslipidemia (OR = 1.13, 95% CI = 1.06-1.21), diabetes mellitus (OR = 1.18, 95% CI = 1.11-1.25) and atrial fibrillation (OR = 0.55, 95% CI = 0.40-0.75). Significantly strong association of hypertension, smoking, dyslipidemia, diabetes mellitus and atrial fibrillation was observed with SVO and CE stroke subtypes. Subgroup analysis based on ethnicity revealed a significant association for dyslipidemia, diabetes mellitus and atrial fibrillation in LAA for both Asians and Caucasians. Hypertension was significantly associated with SVO and ODE subtypes in both Asians and Caucasians; however, only Asian population showed significant association of hypertension in LAA and CE subtypes. The other risk factors did not show any statistical difference between the ethnic groups for the different stroke subtypes. The majority of the risk factors depicted positive association with LAA and SVO, negative with CE and neutral with ODE and UDE. CONCLUSION Our findings suggest strong association of smoking, dyslipidemia and diabetes mellitus with LAA and SVO subtypes in the Caucasian population. However, only diabetes mellitus showed significant association with both LAA and SVO subtypes in Asian population as well. Thus, a majority of the traditional modifiable risk factors had a positive association in LAA and SVO, while a negative protective association was observed in CE subtype, among both the Asian and the Caucasian subgroups.
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Affiliation(s)
- Manabesh Nath
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Swarnkar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakhee Sharma
- Department of Paediatrics, Army Hospital Research & Referral, New Delhi, India
| | - Amit Kumar
- Department of Paediatrics, Army Hospital Research & Referral, New Delhi, India
| | - Shubham Misra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Kumar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Gauthier V, Cottel D, Amouyel P, Dallongeville J, Meirhaeghe A. Large disparities in 28-day case fatality by stroke subtype: data from a French stroke registry between 2008 and 2017. Eur J Neurol 2021; 28:2208-2217. [PMID: 33942445 PMCID: PMC8252764 DOI: 10.1111/ene.14876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The objectives of the present analysis were to assess 28-day stroke case fatality according to the stroke aetiology and to identify associated factors. METHODS All stroke events in adults aged ≥35 years between 2008 and 2017 were collected in a population-based stroke registry in northern France. RESULTS Out of a total of 2933 strokes, there were 479 (16%) haemorrhagic strokes and 2454 (84%) ischaemic strokes; the 28-day case fatality rates were 48% and 15%, respectively. Three-quarters of the 28-day case fatalities occurred within 6 days of the event for haemorrhagic strokes and within 16.5 days for ischaemic strokes. After an ischaemic stroke, the case fatality rate was higher for women (18%) than for men (12%, p < 0.0001); however, this difference disappeared after adjustment for age. Cardioembolic strokes (34%) and strokes of undetermined cause (33%) were the most common ischaemic subtypes, with case fatality rates of 16% and 18%, respectively. Large artery atherosclerosis (11%) and lacunar strokes (10%) were less common, and both types had a case fatality rate of 3%. Age at the time of the event and stroke severity were both significantly associated with case fatality. For some types of stroke, a history of cardiovascular events and residence in a nursing home were associated with a poor prognosis. Medical care in a neurology ward was inversely associated with case fatality, for all stroke subtypes. CONCLUSIONS In northern France, post-stroke case fatality remains high, especially for haemorrhagic stroke. Being treated in a neurology ward improved survival by around 80%.
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Affiliation(s)
- Victoria Gauthier
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | - Dominique Cottel
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | - Philippe Amouyel
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | - Jean Dallongeville
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | - Aline Meirhaeghe
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
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Twenty-Year Time Trends in Long-Term Case-Fatality and Recurrence Rates After Ischemic Stroke Stratified by Etiology. Stroke 2020; 51:2778-2785. [DOI: 10.1161/strokeaha.120.029972] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background and Purpose:
Data on long-term survival and recurrence after stroke are lacking. We investigated time trends in ischemic stroke case-fatality and recurrence rates over 20-years stratified by etiological subtype according to the Trial of ORG 10172 in Acute Stroke Treatment classification within a population-based stroke register in Germany.
Methods:
Data was collected within the Erlangen Stroke Project, a prospective, population-based stroke register covering a source population of 105 164 inhabitants (2010). Case fatality and recurrence rates for 3 months, 1 year, and 5 years were estimated with Kaplan-Meier estimates. Sex-specific time trends for case-fatality and recurrence rates were estimated with Cox regression. We adjusted for age, sex, and year of event and stratified for etiological subtypes. A sensitivity analysis with competing risk analysis for time trends in recurrence were performed.
Results:
Between 1996 and 2015, 3346 patients with first ischemic stroke were included; age-standardized incidence per 100 000 was 75.8 in women and 131.6 in men (2015). Overall, 5-year survival probabilities were 50.4% (95% CI, 47.9–53.1) in women and 59.2% (95% CI, 56.4–62.0) in men; 5-year survival was highest in patients with first stroke due to small-artery occlusion (women, 71.8% [95% CI, 67.1–76.9]; men, 75.9% [95% CI, 71.3–80.9]) and lowest in cardioembolic stroke (women, 35.7% [95% CI, 31.0–41.1]; men, 47.8% [95% CI, 42.2–54.3]). Five-year recurrence rates were 20.1% (95% CI, 17.5–22.6) in women and 20.1% (95% CI, 17.5–22.7) in men; 5-year recurrence rate was lowest in women in stroke due to small artery occlusion 16.0% (95% CI, 11.7–20.1) and in men in large-artery atherosclerosis 16.6% (95% CI, 8.7–23.9); highest risk of recurrence was observed in undefined strokes (women, 22.3% [95% CI, 17.8–26.6]; men, 21.4% [95% CI, 16.7–25.9]). Cox regression revealed improvements in case-fatality rates over time with differences in stroke causes. No time trends in recurrence rates were observed.
Conclusions:
Long-term survival and recurrence varied substantially by first stroke cause. Survival probabilities improved over the past 2 decades; no major trends in stroke recurrence rates were observed.
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Malek EG, Elbejjani M, Abbas R, Abed Al Ahad M, Isma'eel H, Makki A. TOAST classification and risk factors of ischemic stroke in Lebanon. Acta Neurol Scand 2020; 141:294-300. [PMID: 31782134 DOI: 10.1111/ane.13201] [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: 11/01/2019] [Revised: 11/21/2019] [Accepted: 11/26/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Ischemic stroke is a common cause of morbidity and mortality especially in the increasingly older population. The variability in ischemic stroke subtypes and its risk factors across different populations suggest that more effort is needed to describe the stroke characteristics in order to develop a more tailored management for each population. We aim to describe the demographic characteristics, risk factors, and subtype distribution of subjects with ischemic stroke in the Lebanese population. MATERIALS AND METHODS We conducted a cross-sectional study based on chart review on patients with ischemic stroke/transient ischemic attack at the American University of Beirut Medical center between 2015 and 2017. RESULTS A total of 284 cases were included with a mean age of 72 years, and 58% male gender. The most commonly identified risk factors were hypertension (77%), dyslipidemia (62%), and diabetes mellitus (42%), while atrial fibrillation was only found in 27% of cases. The cohort distribution according to TOAST classification was as follows: 15% large artery stroke, 31% cardioembolic stroke, 17% small artery stroke, 10% stroke of other determined causes, and 27% stroke of unknown cause. CONCLUSION This is the first study to address ischemic stroke characteristics in Lebanon.
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Affiliation(s)
- Elia G. Malek
- Department of Neurology American University of Beirut Medical Center Beirut Lebanon
| | - Martine Elbejjani
- Clinical Research Institute American University of Beirut Medical Center Beirut Lebanon
- Vascular Medicine Program American University of Beirut Medical Center Beirut Lebanon
| | - Rawad Abbas
- Faculty of Medicine American University of Beirut Beirut Lebanon
| | - Mary Abed Al Ahad
- Clinical Research Institute American University of Beirut Medical Center Beirut Lebanon
| | - Hussein Isma'eel
- Vascular Medicine Program American University of Beirut Medical Center Beirut Lebanon
- Division of Cardiology American University of Beirut Medical Center Beirut Lebanon
| | - Achraf Makki
- Department of Neurology American University of Beirut Medical Center Beirut Lebanon
- Vascular Medicine Program American University of Beirut Medical Center Beirut Lebanon
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Lee SH, Jang MU, Kim Y, Park SY, Kim C, Kim YJ, Sohn JH. Subclinical Hyperthyroidism Could Predict Poor Outcomes in Patients With Acute Ischemic Stroke Treated With Reperfusion Therapy. Front Neurol 2019; 10:782. [PMID: 31379731 PMCID: PMC6652740 DOI: 10.3389/fneur.2019.00782] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/04/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Evidence for the effect of subclinical thyroid dysfunction on the prognosis of patients suffering from acute ischemic stroke and receiving reperfusion therapy remains controversial. We aimed to investigate the association between subclinical thyroid dysfunction and the outcomes of patients with acute ischemic stroke who were treated with reperfusion therapy. Methods: One hundred fifty-six consecutively recruited patients with acute ischemic stroke receiving reperfusion therapy (intravenous thrombolysis, intraarterial thrombectomy and combined intravenous thrombolysis and intraarterial thrombectomy) were included in this prospective observational study. We divided patients with subclinical thyroid dysfunction into the following 2 groups and defined a euthyroid group: subclinical hyperthyroidism (a thyroid-stimulating hormone level <0.35 μU/mL), subclinical hypothyroidism (a thyroid-stimulating hormone level >4.94 μU/mL), and a euthyroid state (0.35 μU/mL ≤ thyroid-stimulating hormone level ≤ 4.94 μU/mL). Patients with overt thyroid dysfunction were excluded. The primary outcome was functional disability at 3 months (modified Rankin Scale, mRS), and the secondary outcome was successful reperfusion. A multivariate analysis was performed to evaluate the associations between subclinical thyroid dysfunction and the primary and secondary outcomes. Results: The subclinical hyperthyroidism group appeared to have poor functional outcomes, but the differences were not significant. However, compared with patients in the euthyroid state, patients with subclinical hyperthyroidism had an increased risk of poor functional outcomes at 3 months after a stroke (adjusted odds ratio [OR] 2.50, 95% confidence interval [CI] 1.01–6.14 for a mRS score of 3 to 6) and a decreased rate of successful reperfusion after reperfusion therapy (OR 0.13, 95% CI 0.04–0.43). Conclusion: Subclinical hyperthyroidism may be independently associated with a poor prognosis at 3 months and unsuccessful reperfusion in patients with acute ischemic stroke receiving reperfusion therapy.
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Affiliation(s)
- Sang-Hwa Lee
- Department of Neurology, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, South Korea
| | - Min Uk Jang
- Department of Neurology, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, South Korea
| | - Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, South Korea
| | - So Young Park
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital, Seoul, South Korea
| | - Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, South Korea
| | - Yeo Jin Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, South Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, South Korea
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10
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Takashima N, Arima H, Kita Y, Fujii T, Miyamatsu N, Komori M, Sugimoto Y, Nagata S, Miura K, Nozaki K. Two-Year Survival After First-Ever Stroke in a General Population of 1.4 Million Japanese - Shiga Stroke Registry. Circ J 2018; 82:2549-2556. [PMID: 30058607 DOI: 10.1253/circj.cj-18-0346] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Stroke is one of the leading causes of disability and mortality in Japan. The aim of the present analysis was to determine the non-acute survival rate after first-ever stroke using data from a large-scale population-based stroke registry in Japan. Methods and Results: Shiga Stroke Registry is an ongoing population-based registry of stroke, which covers approximately 1.4 million residents of Shiga Prefecture in central Japan. A total of 2,176 first-ever stroke patients, who were registered in 2011, were followed up until December 2013. The 2-year cumulative survival rates were estimated using Kaplan-Meier method according to index stroke subtype. Cox proportional hazards models were used to assess predictors of all-cause death. During a 2-year follow-up period, 663 patients (30.5%) died. The 2-year cumulative survival rate after first-ever stroke was 69.5%. There was heterogeneity in 2-year cumulative survival according to stroke subtype: lacunar infarction, 87.2%; large artery infarction, 76.1%; cardioembolic infarction, 55.4%; intracerebral hemorrhage, 65.9%; and subarachnoid hemorrhage, 56.7%. Older age, male sex, medical history, higher Japan coma scale score on admission, and stroke subtype were associated with risk of all-cause death in ≤2 years. CONCLUSIONS In the present population-based stroke registry with a real-world setting in Japan, 2-year cumulative mortality after first-ever stroke is still high (>30%), particularly for cardioembolic infarction, subarachnoid hemorrhage and intracerebral hemorrhage.
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Affiliation(s)
| | - Hisatomi Arima
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University
| | - Yoshikuni Kita
- Department of Public Health, Shiga University of Medical Science.,Tsuruga Nursing University
| | - Takako Fujii
- Department of Neurosurgery, Shiga University of Medical Science
| | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science
| | - Masaru Komori
- Department of Fundamental Biosciences, Shiga University of Medical Science
| | - Yoshihisa Sugimoto
- Department of Medical Informatics and Biomedical Engineering, Shiga University of Medical Science
| | - Satoru Nagata
- Department of Medical Informatics and Biomedical Engineering, Shiga University of Medical Science
| | - Katsuyuki Miura
- Department of Public Health, Shiga University of Medical Science.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science
| | - Kazuhiko Nozaki
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science.,Department of Neurosurgery, Shiga University of Medical Science
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11
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Ischemic Stroke and Impact of Thyroid Profile at Presentation: A Systematic Review and Meta-analysis of Observational Studies. J Stroke Cerebrovasc Dis 2017; 26:2926-2934. [PMID: 28821377 DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 07/11/2017] [Accepted: 07/15/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Stroke is the fifth leading cause of mortality in the United States and a leading cause of disability. A complex relationship between thyroid hormone levels and severity of, and outcome after, stroke has been described. AIM Our objective is to identify the association between baseline thyroid function profile and outcome after acute ischemic stroke. METHODS Studies looking at the association between thyroid function and functional stroke outcomes were identified from available electronic databases from inception to December 16, 2016. Study-specific risk ratios were extracted and combined with a random effects model meta-analysis. RESULTS In the analysis of 12 studies with 5218 patients, we found that subclinical hypothyroidism was associated with better modified Rankin scale scores at 1 and 3 months (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.13-5.91, P = .03 and OR 2.28, 95% CI 1.13-3.91, P = .003, respectively) compared with the euthyroid cases. Likewise, patients with higher initial thyrotropin-releasing hormone (TSH) and fT3 or T3 levels had favorable outcomes at discharge (mean differences of TSH .12 [95% CI .03-.22, P = .009] and of fT3 .36 (CI .20-.53, P < .0001]) and at 3 months (mean differences of TSH .25 [95% CI .03-.47, P = .03] and of T3 8.60 [CI 4.58-12.61, P < .0001]). CONCLUSIONS Elevated initial TSH (clinical or subclinical hypothyroidism) may correspond to better functional outcomes, whereas low initial T3/fT3 might correlate with worse outcomes in acute ischemic stroke among clinically euthyroid patients. This complex relation merits further well-designed investigations. Whether correcting thyroid profile with hormone supplementation or antagonism may lead to improved outcomes will require large, prospective, interventional studies.
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12
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Amaral CHD, Amaral AR, Nagel V, Venancio V, Garcia AC, Magalhaes PSC, Longo AL, Moro CHC, Reis FI, D’Avila A, Cabral NL. Incidence and functional outcome of atrial fibrillation and non-atrial fibrillation- related cardioembolic stroke in Joinville, Brazil: a population-based study. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:288-294. [DOI: 10.1590/0004-282x20170039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 02/03/2017] [Indexed: 11/22/2022]
Abstract
ABSTRACT Among ischemic strokes, cardioembolic (CE) stroke has the worst outcome. We measured the incidence of atrial fibrillation (AF) and non-AF related CE strokes, previous anticoagulant use, and the 90-day functional outcome. Using multiple overlapping sources, we included all CE strokes that occurred in 2015 in Joinville, Brazil. Of the 374 ischemic strokes, 23% (84) were CE. The CE age-adjusted incidence, per 1,000 person-years, was 0.14 (0.11–0.17). Of the 26 patients with known prior AF, 73% (19) were not anticoagulated, 77% (20) had a CHA2DS2VASc score ≥ 3 and 81% (21) had a HAS-BLED score < 3. After three months, approximately one third of those 26 patients died or became disabled. The incidence of CE stroke in our sample was lower than in other population-based studies. The opportunity for anticoagulation was missed in one third of cases.
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13
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Kamp MA, Lieshout JHV, Dibué-Adjei M, Weber JK, Schneider T, Restin T, Fischer I, Steiger HJ. A Systematic and Meta-Analysis of Mortality in Experimental Mouse Models Analyzing Delayed Cerebral Ischemia After Subarachnoid Hemorrhage. Transl Stroke Res 2017; 8:206-219. [DOI: 10.1007/s12975-016-0513-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/23/2016] [Accepted: 11/27/2016] [Indexed: 01/18/2023]
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14
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Saber H, Thrift AG, Kapral MK, Shoamanesh A, Amiri A, Farzadfard MT, Behrouz R, Azarpazhooh MR. Incidence, recurrence, and long-term survival of ischemic stroke subtypes: A population-based study in the Middle East. Int J Stroke 2017; 12:835-843. [PMID: 28043215 DOI: 10.1177/1747493016684843] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Incidence, risk factors, case fatality and survival rates of ischemic stroke subtypes are unknown in the Middle East due to the lack of community-based incidence stroke studies in this region. Aim To characterize ischemic stroke subtypes in a Middle Eastern population. Methods The Mashad Stroke Incidence Study is a community-based study that prospectively ascertained all cases of stroke among the 450,229 inhabitants of Mashhad, Iran between 2006 and 2007. We identified 512 cases of first-ever ischemic stroke [264 men (mean age 65.5 ± 14.4) and 248 women (mean age 64.14 ± 14.5)]. Subtypes of ischemic stroke were classified according to the TOAST criteria. Incidence rates were age standardized to the WHO and European populations. Results The proportion of stroke subtypes was distributed as follows: 14.1% large artery disease, 15% cardioembolic, 22.5% small artery disease, 43.9% undetermined and 4.5% other. The greatest overall incidence rates were attributed to undetermined infarction (49.97/100,000) followed by small artery disease (25.54/100,000). Prevalence of hypertension, diabetes and atrial fibrillation differed among ischemic stroke subtypes. Overall, there were 268 (52.34%) deaths and 73 (14.25%) recurrent strokes at five years after incident ischemic stroke, with the greatest risk of recurrence seen in the large artery disease (35.6%) and cardioembolic (35.5%) subgroups. Survival was similar in men and women for each stroke subtype. Conclusions We observed markedly greater incidence rates of ischemic stroke subtypes than in other countries within the Mashad Stroke Incidence Study after age standardization. Our findings should be considered when planning prevention and stroke care services in this region.
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Affiliation(s)
- Hamidreza Saber
- 1 Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Amanda G Thrift
- 2 Department of Medicine, Monash Medical Centre, Southern Clinical School, Monash University, Clayton, Victoria, Australia
| | - Moira K Kapral
- 3 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ashkan Shoamanesh
- 4 McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada
| | - Amin Amiri
- 5 Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Réza Behrouz
- 6 Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Mahmoud Reza Azarpazhooh
- 5 Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran.,7 Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, London, Ontario, Canada
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15
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Massaro AR, Lip GYH. Stroke Prevention in Atrial Fibrillation: Focus on Latin America. Arq Bras Cardiol 2016; 107:576-589. [PMID: 28558081 PMCID: PMC5210462 DOI: 10.5935/abc.20160116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 12/25/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, with an estimated prevalence of 1-2% in North America and Europe. The increased prevalence of AF in Latin America is associated with an ageing general population, along with poor control of key risk factors, including hypertension. As a result, stroke prevalence and associated mortality have increased dramatically in the region. Therefore, the need for effective anticoagulation strategies in Latin America is clear. The aim of this review is to provide a contemporary overview of anticoagulants for stroke prevention. The use of vitamin K antagonists (VKAs, eg, warfarin) and aspirin in the prevention of stroke in patients with AF in Latin America remains common, although around one fifth of all AF patients receive no anticoagulation. Warfarin use is complicated by a lack of access to effective monitoring services coupled with an unpredictable pharmacokinetic profile. The overuse of aspirin is associated with significant bleeding risks and reduced efficacy for stroke prevention in this patient group. The non-VKA oral anticoagulants (NOACbs) represent a potential means of overcoming many limitations associated with VKA and aspirin use, including a reduction in the need for monitoring and a reduced risk of hemorrhagic events. The ultimate decision of which anticoagulant drug to utilize in AF patients depends on a multitude of factors. More research is needed to appreciate the impact of these factors in the Latin American population and thereby reduce the burden of AF-associated stroke in this region.
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Affiliation(s)
| | - Gregory Y H Lip
- City Hospital, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
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16
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Goulart AC. "EMMA Study: a Brazilian community-based cohort study of stroke mortality and morbidity". SAO PAULO MED J 2016; 134:543-554. [PMID: 28076632 PMCID: PMC11448725 DOI: 10.1590/1516-3180.2016.024227092016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/27/2016] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE: Stroke has a high burden of disability and mortality. The aim here was to evaluate epidemiology, risk factors and prognosis for stroke in the EMMA Study (Study of Stroke Mortality and Morbidity). DESIGN AND SETTINGS: Prospective community-based cohort carried out in Hospital Universitário, University of São Paulo, 2006-2014. METHODS: Stroke data based on fatal and non-fatal events were assessed, including sociodemographic data, mortality and predictors, which were evaluated by means of logistic regression and survival analyses. RESULTS: Stroke subtype was better defined in the hospital setting than in the local community. In the hospital phase, around 70% were first events and the ischemic subtype. Among cerebrovascular risk factors, the frequency of alcohol intake was higher in hemorrhagic stroke (HS) than in ischemic stroke (IS) cases (35.4% versus 12.3%, P < 0.001). Low education was associated with higher risk of death, particularly after six months among IS cases (odds ratio, OR, 4.31; 95% confidence interval, CI, 1.34-13.91). The risk of death due to hemorrhagic stroke was greater than for ischemic stroke and reached its maximum 10 days after the event (OR: 3.31; 95% CI: 1.55-7.05). Four-year survival analysis on 665 cases of first stroke (82.6% ischemic and 17.4% hemorrhagic) showed an overall survival rate of 48%. At four years, the highest risks of death were in relation to ischemic stroke and illiteracy (hazard ratio, HR: 1.83; 95% CI: 1.26-2.68) and diabetes (HR: 1.45; 95% CI: 1.07-1.97). Major depression presented worse one-year survival (HR: 4.60; 95% CI: 1.36-15.55). CONCLUSION: Over the long term, the EMMA database will provide additional information for planning resources destined for the public healthcare system.
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Affiliation(s)
- Alessandra Carvalho Goulart
- MD, PhD. Clinical Epidemiologist and Researcher, Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), São Paulo (SP), Brazil.
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17
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Hu W, Chen S, Song Y, Zhu F, Shi J, Han X, Zhou D, Zhi Z, Zhang F, Shen Y, Ma J, Liu CF, Peng H. Serum Soluble Corin Deficiency Predicts Major Disability within 3 Months after Acute Stroke. PLoS One 2016; 11:e0163731. [PMID: 27658255 PMCID: PMC5033232 DOI: 10.1371/journal.pone.0163731] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 09/13/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Serum soluble corin has been associated with stroke. However, whether it is associated with stroke prognosis has not yet been studied. Therefore, we aimed to study the association of serum soluble corin with risk of poor outcomes within 3 months after stroke. METHODS We followed 522 stroke patients for 3 months to identify major disability, death and vascular events. Serum soluble corin was measured at baseline for all participants. Logistic regression was used to examine the associations of baseline serum soluble corin with outcomes of stroke, adjusting for age, sex, baseline NIHSS score, hours from onset to hospitalization, smoking, drinking, hypertension, diabetes, coronary heart disease, atrial fibrillation, family history of stroke, and stroke subtype. RESULTS Patients with high corin had a significantly lower crude risk for the composite outcome of major disability or death (OR = 0.64, 95%CI: 0.43-0.96) than patients with low corin (the lowest tertile). After adjustment for age and baseline NIHSS score, patients with high corin still had a significantly lower risk for the composite outcome of major disability or death (OR = 0.60, 95%CI: 0.36-0.99). This association became bottom line significant after additionally adjusting for other conventional factors (OR = 0.61, P = 0.058). No association was found between serum soluble corin and other composite outcomes. CONCLUSION Serum soluble corin deficiency predicted risk for major disability within 3 months after stroke, independent of baseline neurological deficient. Our results may indicate a probable role of corin in stroke prognosis.
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Affiliation(s)
- Weidong Hu
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Shi Chen
- School of Nursing, Medical College of Soochow University, Suzhou, China
| | - Yulin Song
- Department of Neurology, Anshan Changda Hospital, Anshan, China
| | - Fangfang Zhu
- Department of Emergency, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jijun Shi
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiujie Han
- Department of Neurology, Anshan Changda Hospital, Anshan, China
| | - Dan Zhou
- Department of Neurology, Anshan Changda Hospital, Anshan, China
| | - Zhongwen Zhi
- Department of Emergency, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Fuding Zhang
- Department of Neurology, Anshan Changda Hospital, Anshan, China
| | - Yun Shen
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Juanjuan Ma
- Department of Emergency, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chun-Feng Liu
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, China
- Institute of Neuroscience, Soochow University, Suzhou, China
- * E-mail: (CFL); (HP)
| | - Hao Peng
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China
- * E-mail: (CFL); (HP)
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18
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Al-Hashel JY, Al-Sabah AA, Ahmed SF, Al-Enezi M, Al-Tawheid N, Al Mesailekh Z, Eliwa J, Alroughani R. Risk Factors, Subtypes, and Outcome of Ischemic Stroke in Kuwait: A National Study. J Stroke Cerebrovasc Dis 2016; 25:2145-52. [PMID: 27321967 DOI: 10.1016/j.jstrokecerebrovasdis.2016.05.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/16/2016] [Accepted: 05/25/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Epidemiological studies of stroke burden in Kuwait are scarce. We aimed to identify the risk factors, subtypes, and outcome of ischemic stroke in the 6 major hospitals in Kuwait between 2008 and 2013. METHODS A cross-sectional survey was carried out using randomly selected ischemic stroke patients. It included data of sociodemographic status, stroke risk factors, stroke subtypes, treatment, and outcomes. RESULTS A total of 1257 ischemic stroke patients (811 men and 446 women; mean age 60.2 ± 13.1) were included. Small-artery ischemic stroke was the most common stroke subgroup (69.8%) whereas hypertension was the most prevalent risk factor (80.9%). History of heart disease was significantly associated (P < .001) with cardioembolic strokes (58.3%) compared to large-artery stroke (37.5%) and small-artery stroke (32.5%). Atrial fibrillation was significantly prevalent (P < .001) in cardioembolic stroke (54.2%) compared to large-artery stroke (13%) and small-artery stroke (7.6%). Presentation at ages less than 45 years was significantly (P < .001) associated with improved neurological status at discharge (82.6%) when compared to patients aged 45-70 years (78.5%) and more than 70 years (63.8%). Similar findings were observed at 6 months follow-up (78.4% versus 72.8% and 46%; P < .001). Cardioembolic stroke was significantly associated with higher mortality rates (25% versus 12.4% and 6.8%; P < .061) in large-vessel and small-vessel strokes, respectively. CONCLUSIONS Small-artery ischemic stroke was the most common stroke subgroup, and hypertension was the most common risk factor. The outcome was better in younger patients. Cardioembolic stroke was associated with worse outcome.
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Affiliation(s)
- Jasem Y Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Safat, Kuwait; Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait.
| | | | - Samar F Ahmed
- Department of Neurology, Ibn Sina Hospital, Safat, Kuwait; Department of Neurology and Psychiatry, Minia University, Minia, Egypt
| | - Maha Al-Enezi
- Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | | | | | - Jasmine Eliwa
- Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait; Neurology Clinic, Dasman Diabetes Institute, Dasman, Kuwait
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19
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Lin SP, Long Y, Chen XH, Lin PY, Jiang HL. STAF score is a new simple approach for diagnosing cardioembolic stroke. Int J Neurosci 2016; 127:261-266. [PMID: 27211997 DOI: 10.1080/00207454.2016.1185715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Detecting cardioembolic stroke soon after acute cerebral ischemia has a major impact on secondary stroke prevention. Recently, the Score for the Targeting of Atrial Fibrillation (STAF) was introduced to identify stroke patients at risk of atrial fibrillation. However, whether the STAF score could be a useful approach to differentiate cardioembolic stroke from other stroke subtypes is unclear. METHODS Consecutive patients with acute ischemic stroke that were admitted to our stroke center were enrolled. Each patient was assessed (age, baseline National Institutes of Health Stroke Scale, left atrial dilatation and absence of vascular etiology) to calculate the STAF score. A follow-up visit was conducted for each patient during hospitalization to determine the diagnosed stroke etiology according to the Trial of Org 10172 in Acute Stroke Treatment criteria. RESULTS The median and interquartile range of the STAF score was significantly higher in the cardioembolic than in the non-cardioembolic group [6 (2) vs. 2 (3), p < 0.001]. The discriminating ability of the STAF score model was good as demonstrated by the receiver operating characteristic curve. The area under the curve (AUC) of STAF score (AUC = 0.98; 95% CI, 0.96-0.99) was significantly greater than B-type natriuretic peptide (AUC = 0.87; 95% CI, 0.83-0.91) (p < 0.05). The optimal STAF cut-off value was ≥ 5, which diagnosed cardioembolic stroke with a sensitivity of 90% and specificity of 95%. CONCLUSIONS The STAF score is a simple and accurate tool that can discriminate the cardioembolic stroke from other types during hospitalization for acute ischemic stroke.
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Affiliation(s)
| | - Youming Long
- b 2 Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , Guangdong Province , China
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20
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Abstract
The burden of stroke is increasing due to aging population and unhealthy lifestyle habits. The considerable rise in atrial fibrillation (AF) is due to greater diffusion of risk factors and screening programs. The link between AF and ischemic stroke is strong. The subtype most commonly associated with AF is cardioembolic stroke, which is particularly severe and shows the highest rates of mortality and permanent disability. A trend toward a higher prevalence of cardioembolic stroke in high-income countries is probably due to the greater diffusion of AF and the control of atherosclerotic of risk factors.
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Affiliation(s)
- Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy.
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy
| | - Cindy Tiseo
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy
| | - Diana Degan
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy
| | - Antonio Carolei
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Via Vetoio, L'Aquila 67100, Italy
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21
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Jacova C, Pearce LA, Roldan AM, Arauz A, Tapia J, Costello R, McClure LA, Hart RG, Benavente OR. Cognitive performance following lacunar stroke in Spanish-speaking patients: results from the SPS3 trial. Int J Stroke 2016; 10:519-28. [PMID: 25973704 DOI: 10.1111/ijs.12511] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 01/06/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cognitive impairment is frequent in lacunar stroke patients. The prevalence and pattern among Spanish-speaking patients are unknown and have not been compared across regions or with English-speaking patients. AIMS The aim of this study was to characterize cognitive impairment in Spanish-speaking patients and compare it with English-speaking patients. METHODS The baseline neuropsychological test performance and the prevalence of mild cognitive impairment, defined as a z-score ≤ -1.5 on memory and/or non-memory tests, were evaluated in Spanish-speaking patients in the Secondary Prevention of Small Subcortical Strokes trial. RESULTS Out of 3020 participants, 1177 were Spanish-speaking patients residing in Latin America (n = 693), the United States (n = 121), and Spain (n = 363). Low education (zero- to eight-years) was frequent in Spanish-speaking patients (49-57%). Latin American Spanish-speaking patients had frequent post-stroke upper extremity motor impairment (83%). Compared with English-speaking patients, all Spanish-speaking patient groups had smaller memory deficits and larger non-memory/motor deficits, with Latin American Spanish-speaking patients showing the largest deficits median z-score -1.3 to -0.6 non-memory tests; ≤5.0 for Grooved Pegboard; -0.7 to -0.3 for memory tests). The prevalence of mild cognitive impairment was high and comparable with English-speaking patients in the United States and Latin American Spanish-speaking patients but not the Spanish group: English-speaking patients = 47%, Latin American Spanish-speaking patients = 51%, US Spanish-speaking patients = 40%, Spanish Spanish-speaking patients = 29%, with >50% characterized as non-amnestic in Spanish-speaking patient groups. Older age [odds ratio per 10 years = 1.52, confidence interval = 1.35-1.71), lower education (odds ratio 0-4 years = 1.23, confidence interval = 0.90-1.67), being a Latin American resident (odds ratio = 1.31, confidence interval = 0.87-1.98), and post-stroke disability (odds ratio Barthel Index <95 = 1.89, confidence interval = 1.43-2.50) were independently associated with mild cognitive impairment. CONCLUSIONS Mild cognitive impairment in Secondary Prevention of Small Subcortical Strokes Spanish-speaking patients with recent lacunar stroke is highly prevalent but has a different pattern to that observed in English-speaking patients. A combination of socio-demographics, stroke biology, and stroke care may account for these differences.
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Affiliation(s)
- Claudia Jacova
- Division of Neurology, School of Professional Psychology, Pacific University, Hillsboro, OR, USA
| | | | - Ana M Roldan
- Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Antonio Arauz
- Neurology and Neurosurgery National Institute, Mexico City, Mexico
| | - Jorge Tapia
- Department of Neurology, Catholic University, Santiago, Chile
| | - Raymond Costello
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Leslie A McClure
- Department of Biostatics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert G Hart
- Division of Neurology, Department of Medicine, McMaster University, Hamilton, Canada
| | - Oscar R Benavente
- Division of Neurology, School of Professional Psychology, Pacific University, Hillsboro, OR, USA
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Demethylation of Circulating Estrogen Receptor Alpha Gene in Cerebral Ischemic Stroke. PLoS One 2015; 10:e0139608. [PMID: 26422690 PMCID: PMC4589317 DOI: 10.1371/journal.pone.0139608] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/14/2015] [Indexed: 11/19/2022] Open
Abstract
Background Estrogen is involved in neuron plasticity and can promote neuronal survival in stroke. Its actions are mostly exerted via estrogen receptor alpha (ERα). Previous animal studies have shown that ERα is upregulated by DNA demethylation following ischemic injury. This study investigated the methylation levels in the ERα promoter in the peripheral blood of ischemic stroke patients. Methods The study included 201 ischemic stroke patients, and 217 age- and sex-comparable healthy controls. The quantitative methylation level in the 14 CpG sites of the ERα promoter was measured by pyrosequencing in each participant. Multivariate regression model was used to adjust for stroke traditional risk factors. Stroke subtypes and sex-specific analysis were also conducted. Results The results demonstrated that the stroke cases had a lower ERα methylation level than controls in all 14 CpG sites, and site13 and site14 had significant adjusted p-values of 0.035 and 0.026, respectively. Stroke subtypes analysis showed that large-artery atherosclerosis and cardio-embolic subtypes had significantly lower methylation levels than the healthy controls at CpG site5, site9, site12, site13 and site14 with adjusted p = 0.039, 0.009, 0.025, 0.046 and 0.027 respectively. However, the methylation level for the patients with small vessel subtype was not significant. We combined the methylation data from the above five sites for further sex-specific analysis. The results showed that the significant association only existed in women (adjusted p = 0.011), but not in men (adjusted p = 0.300). Conclusions Female stroke cases have lower ERα methylation levels than those in the controls, especially in large-artery and cardio-embolic stroke subtypes. The study implies that women suffering from ischemic stroke of specific subtype may undergo different protective mechanisms to reduce the brain injury.
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Shoeibi A, Salehi M, Thrift AG, Kapral MK, Farzadfard MT, Azarpazhooh A, Layegh P, Hashemi P, Amiri A, Mokhber N, Hassankhani B, Azarpazhooh MR. One-year case fatality rate following stroke in the Mashhad Stroke Incidence Study: a population-based study of stroke in Iran. Int J Stroke 2015; 10 Suppl A100:96-102. [DOI: 10.1111/ijs.12611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/28/2015] [Indexed: 11/29/2022]
Abstract
Background In developing countries, there are few comprehensive studies of mortality following stroke. Aims and/or hypothesis We aimed to determine the one-year case fatality rate following stroke and to identify factors associated with death in a population-based stroke incidence study in Iran. Methods Six hundred eighty-four patients who had suffered a stroke between November 21, 2006, and November 20, 2007, and were recruited to the Mashhad Stroke Incidence Study were followed up at one-year. Most patients were seen in an outpatient visit. When patients had died, a verbal autopsy was conducted by telephone with the next of kin. Results A total of 226 (34.3%) patients died during the first year following stroke. The cumulative one-year case fatality rate was 30.6% following ischemic stroke and 53.0% following hemorrhagic stroke (55.8% after intracerebral hemorrhage and 35.7% after subarachnoid hemorrhage). The majority of these deaths occurred in the first 28 days after stroke (17.7% with ischemic and 43.0% with hemorrhagic stroke). Factors associated with greater mortality at one-year (excluding those who died during the first week) were hemorrhagic stroke [hazard ratio (HR) 3.99; 95% confidence interval 1.90-8.37], age (HR 1.05; 95% confidence interval 1.03-1.08), previous transient ischemic attack (HR 2.45; 95% confidence interval 1.00-5.99), and National Institutes of Health Stroke Scale on admission (HR 1.14; 95% confidence interval 1.10-1.17). Conclusion Despite the younger age of stroke occurrence in Iran, the one-year case fatality rate following stroke is similar to that reported in developed countries.
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Affiliation(s)
- Ali Shoeibi
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Salehi
- Departments of Community Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amanda G. Thrift
- Stroke and Ageing Research, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Moira K. Kapral
- Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences and Toronto General Research Institute, Toronto, Canada
| | | | - Amir Azarpazhooh
- Faculty of Dentistry and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Parvaneh Layegh
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Peyman Hashemi
- Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Amiri
- Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naghmeh Mokhber
- School of Medicine, Department of the Elderly, Ave Sina Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Psychiatry and Behavioural Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahare Hassankhani
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Reza Azarpazhooh
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- London Health Science Center, London, Ontario, Canada
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Lange MC, Cabral NL, Moro CHC, Longo AL, Gonçalves AR, Zétola VF, Rundek T. Incidence and mortality of ischemic stroke subtypes in Joinville, Brazil: a population-based study. ARQUIVOS DE NEURO-PSIQUIATRIA 2015. [DOI: 10.1590/0004-282x20150081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aims To measure the incidence and mortality rates of ischemic stroke (IS) subtypes in Joinville, Brazil. Methods All first-ever IS patients that occurred in Joinville from January 2005 to December 2006 were identified. The IS subtypes were classified by the TOAST criteria, and the patients were followed-up for one year after IS onset. Results The age-adjusted incidence per 100,000 inhabitants was 26 (17-39) for large-artery atherosclerosis (LAA), 17 (11-27) for cardioembolic (CE), 29 (20-41) for small vessel occlusion (SVO), 2 (0.6-7) for stroke of other determined etiology (OTH) and 30 (20-43) for stroke of undetermined etiology (UND). The 1-year mortality rate per 100,000 inhabitants was 5 (2-11) for LAA, 6 (3-13) for CE, 1 (0.1-6) for SVO, 0.2 (0-0.9) for OTH and 9 (4-17) for UND. Conclusion In the population of Joinville, the incidences of IS subtypes were similar to those found in other populations. These findings highlight the importance of better detection and control of atherosclerotic risk factors.
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Quinlan EB, Dodakian L, See J, McKenzie A, Le V, Wojnowicz M, Shahbaba B, Cramer SC. Neural function, injury, and stroke subtype predict treatment gains after stroke. Ann Neurol 2015; 77:132-45. [PMID: 25382315 PMCID: PMC4293339 DOI: 10.1002/ana.24309] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/10/2014] [Accepted: 11/07/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study was undertaken to better understand the high variability in response seen when treating human subjects with restorative therapies poststroke. Preclinical studies suggest that neural function, neural injury, and clinical status each influence treatment gains; therefore, the current study hypothesized that a multivariate approach incorporating these 3 measures would have the greatest predictive value. METHODS Patients 3 to 6 months poststroke underwent a battery of assessments before receiving 3 weeks of standardized upper extremity robotic therapy. Candidate predictors included measures of brain injury (including to gray and white matter), neural function (cortical function and cortical connectivity), and clinical status (demographics/medical history, cognitive/mood, and impairment). RESULTS Among all 29 patients, predictors of treatment gains identified measures of brain injury (smaller corticospinal tract [CST] injury), cortical function (greater ipsilesional motor cortex [M1] activation), and cortical connectivity (greater interhemispheric M1-M1 connectivity). Multivariate modeling found that best prediction was achieved using both CST injury and M1-M1 connectivity (r(2) = 0.44, p = 0.002), a result confirmed using Lasso regression. A threshold was defined whereby no subject with >63% CST injury achieved clinically significant gains. Results differed according to stroke subtype; gains in patients with lacunar stroke were best predicted by a measure of intrahemispheric connectivity. INTERPRETATION Response to a restorative therapy after stroke is best predicted by a model that includes measures of both neural injury and function. Neuroimaging measures were the best predictors and may have an ascendant role in clinical decision making for poststroke rehabilitation, which remains largely reliant on behavioral assessments. Results differed across stroke subtypes, suggesting the utility of lesion-specific strategies.
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Affiliation(s)
| | - Lucy Dodakian
- Department of Neurology, University of California, Irvine
| | - Jill See
- Department of Neurology, University of California, Irvine
| | - Alison McKenzie
- Department of Physical Therapy, University of California, Irvine
| | - Vu Le
- Department of Neurology, University of California, Irvine
| | - Mike Wojnowicz
- Department of Statistics; Chapman University, University of California, Irvine
| | - Babak Shahbaba
- Department of Statistics; Chapman University, University of California, Irvine
| | - Steven C. Cramer
- Department of Anatomy & Neurobiology, University of California, Irvine
- Department of Neurology, University of California, Irvine
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Bogiatzi C, Hackam DG, McLeod AI, Spence JD. Secular trends in ischemic stroke subtypes and stroke risk factors. Stroke 2014; 45:3208-13. [PMID: 25213343 DOI: 10.1161/strokeaha.114.006536] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Early diagnosis and treatment of a stroke improves patient outcomes, and knowledge of the cause of the initial event is crucial to identification of the appropriate therapy to maximally reduce risk of recurrence. Assumptions based on historical frequency of ischemic subtypes may need revision if stroke subtypes are changing as a result of recent changes in therapy, such as increased use of statins. METHODS We analyzed secular trends in stroke risk factors and ischemic stroke subtypes among patients with transient ischemic attack or minor or moderate stroke referred to an urgent transient ischemic attack clinic from 2002 to 2012. RESULTS There was a significant decline in low-density lipoprotein cholesterol and blood pressure, associated with a significant decline in large artery stroke and small vessel stroke. The proportion of cardioembolic stroke increased from 26% in 2002 to 56% in 2012 (P<0.05 for trend). Trends remained significant after adjusting for population change. CONCLUSIONS With more intensive medical management in the community, a significant decrease in atherosclerotic risk factors was observed, with a significant decline in stroke/transient ischemic attack caused by large artery atherosclerosis and small vessel disease. As a result, cardioembolic stroke/transient ischemic attack has increased significantly. Our findings suggest that more intensive investigation for cardiac sources of embolism and greater use of anticoagulation may be warranted.
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Affiliation(s)
- Chrysi Bogiatzi
- From the Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute (C.B., D.G.H., J.D.S.), Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry (D.G.H.), Department of Medicine, Division of Clinical Pharmacology (D.G.H., J.D.S.), Department of Clinical Neurological Sciences, Division of Neurology (D.G.H., J.D.S.), and Department of Statistical and Actuarial Sciences (A.I.M.), Western University, London, Ontario, Canada
| | - Daniel G Hackam
- From the Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute (C.B., D.G.H., J.D.S.), Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry (D.G.H.), Department of Medicine, Division of Clinical Pharmacology (D.G.H., J.D.S.), Department of Clinical Neurological Sciences, Division of Neurology (D.G.H., J.D.S.), and Department of Statistical and Actuarial Sciences (A.I.M.), Western University, London, Ontario, Canada
| | - A Ian McLeod
- From the Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute (C.B., D.G.H., J.D.S.), Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry (D.G.H.), Department of Medicine, Division of Clinical Pharmacology (D.G.H., J.D.S.), Department of Clinical Neurological Sciences, Division of Neurology (D.G.H., J.D.S.), and Department of Statistical and Actuarial Sciences (A.I.M.), Western University, London, Ontario, Canada
| | - J David Spence
- From the Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute (C.B., D.G.H., J.D.S.), Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry (D.G.H.), Department of Medicine, Division of Clinical Pharmacology (D.G.H., J.D.S.), Department of Clinical Neurological Sciences, Division of Neurology (D.G.H., J.D.S.), and Department of Statistical and Actuarial Sciences (A.I.M.), Western University, London, Ontario, Canada.
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Cubillos L, Haddad A, Kuznik A, Mould-Quevedo J. Burden of disease from atrial fibrillation in adults from seven countries in Latin America. Int J Gen Med 2014; 7:441-8. [PMID: 25214802 PMCID: PMC4159313 DOI: 10.2147/ijgm.s62819] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND While some international studies have published epidemiologic overviews of atrial fibrillation (AF) for the Latin America region, detailed data at the national level are lacking. The aim of this study was to estimate the burden of disease and morbidity associated with AF in adults over 40 years of age in Argentina, Brazil, Chile, Colombia, Mexico, Peru, and Venezuela. METHODS National health care system databases for each country in the analysis were used to identify cases of AF during 2010 based on ICD-10 codes. Patient comorbidities and treatment patterns in each country were assessed based on available data and extrapolation from relevant published information where local data were incomplete or unavailable. The prevalence of AF in each country was estimated using country-specific, national census data, and assumptions based on a review of the available literature. RESULTS Patients in outpatient or hospital care represented over half of the estimated total cases of AF, of whom around 60% were treated as outpatients. Across the seven countries analyzed, 74.5% of AF cases were adults ≥60 years old. However, with increasing age, the proportion of individuals with AF receiving treatment within the national health care systems decreased overall across all seven countries. The most commonly reported comorbidities associated with AF included arterial hypertension (51%-57%), heart failure (14.5%-30%), diabetes (12%-36.5%), and stroke (3%-12.7%). CONCLUSION This epidemiologic survey quantifies the scale of the challenge posed by AF to the various national health care systems in Latin America. Overall, ambulatory patients in the national health care systems carry a high risk of developing a stroke, yet a significant proportion of these patients do not receive appropriate anticoagulant therapy.
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Affiliation(s)
| | - Alexandra Haddad
- Gerente Médico Portafolio Cardiovascular, Dirección Médica, Pfizer Mexico, Mexico City, Mexico
| | - Andreas Kuznik
- Global Health Economics and Outcomes Research, Pfizer Inc., New York, NY, USA
| | - Joaquin Mould-Quevedo
- Health Economics and Outcomes Research, Latin America and Primary Care, Pfizer Inc., New York, NY, USA
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Wolfe CDA, Rudd AG, McKevitt C. Modelling, evaluating and implementing cost-effective services to reduce the impact of stroke. PROGRAMME GRANTS FOR APPLIED RESEARCH 2014. [DOI: 10.3310/pgfar02020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BackgroundStroke is a leading cause of death and disability but there is little information on the longer-term needs of patients and those of different ethnic groups.ObjectivesTo estimate risk of stroke, longer-term needs and outcomes, risk of recurrence, trends and predictors of effective care, to model cost-effective configurations of care, to understand stakeholders’ perspectives of services and to develop proposals to underpin policy.DesignPopulation-based stroke register, univariate and multivariate analyses, Markov and discrete event simulation, and qualitative methods for stakeholder perspectives of care and outcome.SettingSouth London, UK, with modelling for estimates of cost-effectiveness.ParticipantsInner-city population of 271,817 with first stroke in lifetime between 1995 and 2012.Outcome measuresStroke incidence rates and trends, recurrence, survival, activities of daily living, anxiety, depression, quality of life, appropriateness and cost-effectiveness of care, and qualitative narratives of perspectives.Data sourcesSouth London Stroke Register (SLSR), qualitative data, group discussions.ResultsStroke incidence has decreased since 1995, particularly in the white population, but with a higher stroke risk in black groups. There are variations in risk factors and types of stroke between ethnic groups and a large number of strokes occurred in people with untreated risk factors with no improvement in detection observed over time. A total of 30% of survivors have a poor range of outcomes up to 10 years after stroke with differences in outcomes by sociodemographic group. Depression affects over half of all stroke patients and the prevalence of cognitive impairment remains 22%. Survival has improved significantly, particularly in the older black groups, and the cumulative risk of recurrence at 10 years is 24.5%. The proportion of patients receiving effective acute stroke care has significantly improved, yet inequalities of provision remain. Using register data, the National Audit Office (NAO) compared the levels of stroke care in the UK in 2010 with previous provision levels and demonstrated that improvements have been cost-effective. The treatment of, and productivity loss arising from, stroke results in total societal costs of £8.9B a year and 5% of UK NHS costs. Stroke unit care followed by early supported discharge is a cost-effective strategy, with the main gain being years of life saved. Half of stroke survivors report unmet long-term needs. Needs change over time, but may not be stroke specific. Analysis of patient journeys suggests that provision of care is also influenced by structural, social and personal characteristics.Conclusions/recommendationsThe SLSR has been a platform for a range of health services research activities of international relevance. The programme has produced data to inform policy and practice with estimates of need for stroke prevention and care services, identification of persistent sociodemographic inequalities in risk and care despite a reduction in stroke risk, quantification of the effectiveness and cost-effectiveness of care and development of models to simulate configurations of care. Stroke is a long-term condition with significant social impact and the data on need and economic modelling have been utilised by the Department of Health, the NAO and Healthcare for London to assess need and model cost-effective options for stroke care. Novel approaches are now required to ensure that such information is used effectively to improve population and patient outcomes.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and the Department of Health via the National Institute for Health Research Biomedical Research Centre award to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London.
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Affiliation(s)
- Charles DA Wolfe
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, School of Medicine, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK
| | - Anthony G Rudd
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, School of Medicine, King’s College London, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Christopher McKevitt
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, School of Medicine, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK
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Benavente OR, Pearce LA, Bazan C, Roldan AM, Catanese L, Bhat Livezey VM, Vidal-Pergola G, McClure LA, Hart RG. Clinical-MRI correlations in a multiethnic cohort with recent lacunar stroke: the SPS3 trial. Int J Stroke 2014; 9:1057-64. [PMID: 24862645 DOI: 10.1111/ijs.12282] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/03/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neuroimaging manifestations of small vessel disease are heterogeneous, and correlation with patient features has not been adequately characterized. AIM Our goal was to correlate magnetic resonance imaging findings with clinical features in a large multiethnic cohort with recent lacunar stroke. METHODS Patient characteristics were correlated with neuroimaging results in the Secondary Prevention of Small Subcortical Stroke study participants. RESULTS Among 3005 patients, mean age was 63 years; 62% were men; and 51%, 30%, and 16% were non-Hispanic White, Hispanic, and Black, respectively. Recent lacunar infarcts were distributed between the subcortical hemisphere (31%), thalamus (26%), brainstem/cerebellum (26%), and basal ganglia/internal capsule (16%). Multiple lacunar infarcts (i.e., acute and remote) were present in 40% and associated with increased age (OR 1·3 per 20 years, 95% CI 1·1, 1·5), male gender (OR 1·5, CI 1·3, 1·7), hypertension (OR 1·5, CI 1·2, 1·8), increased systolic blood pressure (OR 1·2 per 20 mmHg, CI 1·1, 1·3), and prior stroke (OR 3·8, CI 2·9, 5·0). Moderate-severe white matter hyperintensities were present in 50% and associated with increased age (OR 4·3 per 20 years, CI 3·4, 5·4), hypertension (OR 1·8, CI 1·4, 2·3), increased systolic blood pressure (OR 1·3 per 20 mmHg, CI 1·1, 1·5), increased diastolic blood pressure (OR 1·2 per 10 mm, CI 1·0, 1·3), and prior stroke (OR 3·3, CI 2·3, 4·5). Infarct location varied significantly by race-ethnicity (P < 0·001), with Blacks and Hispanics having more infarcts in the brainstem/cerebellum than non-Hispanic Whites, and by gender with women more often having thalamic lacunes than men (P ≤ 0·001). CONCLUSIONS In patients with recent lacunar stroke, infarct location and number have distinctie associations with gender, vascular risk factors, and race-ethnicity, demonstrating the complex pathogenesis of lacunar stroke and cerebral small artery disease.
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Affiliation(s)
- Oscar R Benavente
- Department of Medicine, Division of Neurology, Brain Research Center, University of British Columbia, Vancouver, Canada
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Sposato LA, Coppola ML, Altamirano J, Borrego Guerrero B, Casanova J, De Martino M, Díaz A, Feigin VL, Funaro F, Gradillone ME, Lewin ML, Lopes RD, López DH, Louge M, Maccarone P, Martens C, Miguel M, Rabinstein A, Morasso H, Riccio PM, Saposnik G, Silva D, Suasnabar R, Truelsen T, Uzcudun A, Viviani CA, Bahit MC. Program for the epidemiological evaluation of stroke in Tandil, Argentina (PREVISTA) study: rationale and design. Int J Stroke 2014; 8:591-7. [PMID: 24024917 DOI: 10.1111/ijs.12171] [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] [Indexed: 11/29/2022]
Abstract
The availability of population-based epidemiological data on the incident risk of stroke is very scarce in Argentina and other Latin American countries. In response to the priorities established by the World Health Organization and the United Nations, PREVISTA was envisaged as a population-based program to determine the risk of first-ever and recurrent stroke and transient ischemic attack incidence and mortality in Tandil, Buenos Aires, Argentina. The study will be conducted according to Standardized Tools for Stroke Surveillance (STEPS Stroke) methodology and will enroll all new (incident) and recurrent consecutive cases of stroke and transient ischemic attack in the City of Tandil between May 1st, 2013 and April 30, 2015. The study will include patients with ischemic stroke, non-traumatic primary intracerebral hemorrhage, subarachnoid hemorrhage, and transient ischemic attack. To ensure the inclusion of every cerebrovascular event during an observation period of two years, we will instrument an 'intensive screening program', consisting of a comprehensive daily tracking of every potential event of stroke or transient ischemic attack using multiple overlapping sources. Mortality would be determined during follow-up for every enrolled patient. Also, fatal community events would be screened daily through revision of death certificates at funeral homes and local offices of vital statistics. All causes of death will be adjudicated by an ad-hoc committee. The close population of Tandil is representative of a large proportion of Latin-American countries with low- and middle-income economies. The findings and conclusions of PREVISTA may provide data that could support future health policy decision-making in the region.
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Affiliation(s)
- Luciano A Sposato
- Vascular Research Institute at INECO Foundation, Buenos Aires, Argentina; Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada
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Long-term Adherence to National Guidelines for Secondary Prevention of Ischemic Stroke: A Prospective Cohort Study in a Public Hospital in Chile. J Stroke Cerebrovasc Dis 2014; 23:490-5. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/18/2013] [Accepted: 04/10/2013] [Indexed: 01/29/2023] Open
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Short- and Long-term Survival after Stroke in Hospitalized Patients in Chile: A Nationwide 5-Year Study. J Stroke Cerebrovasc Dis 2013; 22:e463-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 04/30/2013] [Accepted: 05/06/2013] [Indexed: 11/20/2022] Open
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Wollenweber FA, Zietemann V, Gschwendtner A, Opherk C, Dichgans M. Subclinical Hyperthyroidism Is a Risk Factor for Poor Functional Outcome After Ischemic Stroke. Stroke 2013; 44:1446-8. [DOI: 10.1161/strokeaha.113.000833] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Frank Arne Wollenweber
- From the Institute for Stroke and Dementia Research (F.A.W., V.Z., A.G., C.O., M.D.), Department of Neurology (C.O.), Interdisciplinary Stroke Center (C.O., M.D.), Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany; and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Vera Zietemann
- From the Institute for Stroke and Dementia Research (F.A.W., V.Z., A.G., C.O., M.D.), Department of Neurology (C.O.), Interdisciplinary Stroke Center (C.O., M.D.), Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany; and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Andreas Gschwendtner
- From the Institute for Stroke and Dementia Research (F.A.W., V.Z., A.G., C.O., M.D.), Department of Neurology (C.O.), Interdisciplinary Stroke Center (C.O., M.D.), Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany; and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Christian Opherk
- From the Institute for Stroke and Dementia Research (F.A.W., V.Z., A.G., C.O., M.D.), Department of Neurology (C.O.), Interdisciplinary Stroke Center (C.O., M.D.), Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany; and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Martin Dichgans
- From the Institute for Stroke and Dementia Research (F.A.W., V.Z., A.G., C.O., M.D.), Department of Neurology (C.O.), Interdisciplinary Stroke Center (C.O., M.D.), Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany; and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
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Hoffmeister L, Lavados PM, Comas M, Vidal C, Cabello R, Castells X. Performance measures for in-hospital care of acute ischemic stroke in public hospitals in Chile. BMC Neurol 2013; 13:23. [PMID: 23496941 PMCID: PMC3599613 DOI: 10.1186/1471-2377-13-23] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 02/27/2013] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The aim of this study were to describe acute care of ischemic stroke patients and adherence to performance measures, as well as the outcomes of these events, in a sample of patients treated in public hospitals in Chile. METHODS We retrospectively reviewed the medical charts of patients with ischemic stroke from a sample of seven public hospitals in the Metropolitan Region of Santiago. We analyzed adherence to the following evidence-based measures: clinical evaluation at admission, use of intravenous thrombolysis, dysphagia screening and prescription of antithrombotic therapy at discharge. As outcome measures we analyzed post-stroke pneumonia and 30-day case-fatality. We used a logistic regression model by each outcome with generalized estimating equations, which accounted for clustering of patients within hospitals and included sex, age (years), clinical status at admission (reduced level of consciousness, speech disturbance, aphasia and hemiplegia), comorbidities, dysphagia screening and neurological evaluation at admission as measures of acute stroke care. RESULTS We reviewed the charts of 677 patients, of which 52.3% were men. The mean age was 69.8 years in women and 66.3 years in men. Diagnosis of stroke was confirmed by a computed tomography scan within 4.5 hours of symptom onset in only 9.6% of the patients. Intravenous thrombolysis was administered in 1.7%. Dysphagia screening was performed in 12.1% (95% CI 9.7-15.0) and antithrombotic therapy was prescribed in 68.9% (95% CI 64.6-72.9). Pneumonia was diagnosed in 23.6% (95% CI 20.4-27.2). Thirty-day fatality was 8.7% (95% CI 6.7-11.3). The variables independently associated with 30-day case fatality were age (OR 1.08, 95% 1.06-1.10), pneumonia (OR 7.7, 95% 95% CI 4.0-14.7), aphasia (OR 2.4, 95% CI 1.1-5.6), reduced level of consciousness (OR 2.4, 95% CI 1.3-4.4), and speech disturbance (OR 1.4, 95% CI 1.0-1.9). No association was found between 30-day case fatality and dysphagia screening or neurological evaluation at admission. The factors associated with post-stroke pneumonia were female sex (OR 1.6, 95% CI 1.0-2.3), age (OR 1.04 95% CI 1.03-1.05), diagnosis of diabetes (OR 1.8, 95% CI 1.4-2.4), aphasia (OR 2.0, 95% CI 1.5-2.7), hemiplegia (OR 1.6, 95% CI 1.1-2.4), and reduced level of consciousness on admission (OR 3.4, 95% CI 2.1-5.5). No association was found between pneumonia and dysphagia screening or neurological evaluation at admission. CONCLUSIONS Adherence to evidence-based performance measures was low. Administration of intravenous thrombolysis was particularly low and diagnostic confirmation of ischemic stroke was delayed. The occurrence of post-stroke pneumonia was frequent and should be reduced. To improve acute stroke care in Chile, organizational change in the health service is urgently needed.
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Affiliation(s)
- Lorena Hoffmeister
- School of Public Health, Facultad de Medicina, Universidad Mayor, Santiago, Chile
| | - Pablo M Lavados
- Neurology Service, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
- Department of Neurological Sciences, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Merce Comas
- Department of Epidemiology and Evaluation, Hospital del Mar, Barcelona; IMIM (Hospital del Mar Medical Research Institute), Barcelona; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Mar Teaching Hospital, 25-29 Passeig Marítim, Barcelona, 08003, Spain
| | - Carolina Vidal
- School of Public Health, Facultad de Medicina, Universidad Mayor, Santiago, Chile
| | - Rodrigo Cabello
- School of Public Health, Facultad de Medicina, Universidad Mayor, Santiago, Chile
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar, Barcelona; IMIM (Hospital del Mar Medical Research Institute), Barcelona; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Mar Teaching Hospital, 25-29 Passeig Marítim, Barcelona, 08003, Spain
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Tratamiento endovascular del accidente vascular encefálico agudo. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70138-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Prognosis of Cryptogenic Ischemic Stroke: A Prospective Single-Center Study in Chile. J Stroke Cerebrovasc Dis 2012; 21:621-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2011.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 01/25/2011] [Accepted: 02/14/2011] [Indexed: 11/20/2022] Open
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Mérida-Rodrigo L, Poveda-Gómez F, Camafort-Babkowski M, Rivas-Ruiz F, Martín-Escalante MD, Quirós-López R, García-Alegría J. [Long-term survival of ischemic stroke]. Rev Clin Esp 2012; 212:223-8. [PMID: 22425144 DOI: 10.1016/j.rce.2011.12.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 12/19/2011] [Accepted: 12/28/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Ischemic stroke is a serious vascular disease whose long term prognosis in all of its dimensions is not known. We have studied the long-term survival and its predictors after a first episode of acute ischemic stroke (atherothrombotic and cardioembolic). PATIENTS AND METHODS A retrospective cohort study was made of patients with a first episode of ischemic stroke. The ictus was classified into atherothrombotic, cardioembolic, lacunar and undetermined. Patients were followed up for 10 years. RESULTS A total of 415 cases (60% men) with mean age of 68.4 years, were included. Mean follow-up was 66 months (95% CI: 24-108 months). Overall survival at 10 years was 55.4% (54.9-55.9) (atherothrombotic, 57.7% vs cardioembolic, 43.7%, P=.002). In the multivariate analysis, variables related to mortality in acute ischemic stroke were age, chronic renal failure, dyslipidemia, history of heart failure, atrial fibrillation (AF), presenting as hemiplegia, signs of acute ischemia and perilesional edema in the brain scan on hospital admission. Involvement of the territory of right middle cerebral artery and treatment with statins were associated to a better prognosis. CONCLUSIONS Survival of patients after ischemic stroke at ten year is over 40%, and atherothrombotic stroke as a better prognosis than cardioembolic one.
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Affiliation(s)
- L Mérida-Rodrigo
- Servicio de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, España.
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Stead LG, Gilmore RM, Bellolio MF, Jain A, Rabinstein AA, Decker WW, Agarwal D, Brown RD. Cardioembolic but not other stroke subtypes predict mortality independent of stroke severity at presentation. Stroke Res Treat 2011; 2011:281496. [PMID: 22007347 PMCID: PMC3191739 DOI: 10.4061/2011/281496] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Accepted: 07/08/2011] [Indexed: 11/20/2022] Open
Abstract
Introduction. Etiology of acute ischemic stroke (AIS) is known to significantly influence management, prognosis, and risk of recurrence.
Objective. To determine if ischemic stroke subtype based on TOAST criteria influences mortality.
Methods. We conducted an observational study of a consecutive cohort of patients presenting with AIS to a single tertiary academic center.
Results. The study population consisted of 500 patients who resided in the local county or the surrounding nine-county area. No patients were lost to followup. Two hundred and sixty one (52.2%) were male, and the mean age at presentation was 73.7 years (standard deviation, SD = 14.3). Subtypes were as follows: large artery atherosclerosis 97 (19.4%), cardioembolic 144 (28.8%), small vessel disease 75 (15%), other causes 19 (3.8%), and unknown 165 (33%). One hundred and sixty patients died: 69 within the first 30 days, 27 within 31–90 days, 29 within 91–365 days, and 35 after 1 year. Low 90-, 180-, and 360-day survival was seen in cardioembolic strokes (67.1%, 65.5%, and 58.2%, resp.), followed for cryptogenic strokes (78.0%, 75.3%, and 71.1%). Interestingly, when looking into the cryptogenic category, those with insufficient information to assign a stroke subtype had the lowest survival estimate (57.7% at 90 days, 56.1% at 180 days, and 51.2% at 1 year).
Conclusion. Cardioembolic ischemic stroke subtype determined by TOAST criteria predicts long-term mortality, even after adjusting for age and stroke severity.
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Affiliation(s)
- Latha Ganti Stead
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Goulart AC, Bensenor IM, Fernandes TG, Alencar AP, Fedeli LM, Lotufo PA. Early and one-year stroke case fatality in Sao Paulo, Brazil: applying the World Health Organization's stroke STEPS. J Stroke Cerebrovasc Dis 2011; 21:832-8. [PMID: 21705233 DOI: 10.1016/j.jstrokecerebrovasdis.2011.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 04/20/2011] [Accepted: 04/21/2011] [Indexed: 11/27/2022] Open
Abstract
Case fatality rate is considered a main determinant of stroke mortality trends. We applied the World Health Organization's Stroke STEPS to identify case fatality rates in a community hospital in Brazil. We evaluated all patients with first-ever stroke seeking acute care at the hospital's emergency ward between April 2006 and December 2008 to verify early and late case fatality according to stroke subtype. We used years of formal education as a surrogate for socioeconomic status. Of 430 first-ever stroke events, 365 (84.9%) were ischemic and 65 (15.1%) were intracerebral hemorrhage. After 1 year, we adjudicated 108 deaths (86 ischemic; 22 hemorrhagic). Age-adjusted case fatality rates for ischemic stroke and intracerebral hemorrhage were 6.0% v 19.8% at 10 days, 10.6% v 22.1% at 28 days, 17.6% v 29.1% at 6 months, and 21.0% v 31.5% at 1 year. Illiteracy or no formal education was a predictor of death at 6 months (odds ratio [OR], 4.31; 95% confidence interval [CI] 1.34-13.91) and 1 year (OR, 4.21; 95% CI, 1.45-12.28) in patients with ischemic stroke, as well as at 6 months (OR, 3.19; 95% CI, 1.17-8.70) and 1 year (OR, 3.30; 95% CI, 1.30-8.45) for all stroke patients. Other variables, including previous cardiovascular risk factors and acute medical care, did not change this association to a statistically significant degree. In conclusion, case fatality, particularly up to 6 months, was higher in hemorrhagic stroke, and lack of formal education was associated with increased stroke mortality.
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Conforto AB, Paulo RBD, Patroclo CB, Pereira SLDA, Miyahara HDS, Fonseca CBD, Yamamoto FI, Marchiori PE, Evaristo EF, Scaff M. Stroke management in a university hospital in the largest South American city. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 66:308-11. [PMID: 18641861 DOI: 10.1590/s0004-282x2008000300004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Accepted: 04/26/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe characteristics and provision of care for patients admitted with cerebrovascular disorders (CVD), focusing on ischemic stroke (IS), in a large, public, academic hospital in São Paulo, Brazil. METHOD We retrieved information about 357 patients with CVD admitted to the Neurology Emergency Department (NED) and Neurology Ward (NW) of our institution. We described patient characteristics and management of IS in NED and in NW. RESULTS IS was diagnosed in 79.6% of CVD patients admitted to NED; 2.7% were submitted to thrombolysis. Extent of IS investigation and management were significantly different in NED and NW. CONCLUSION IS patients in our center were younger than in developed countries. IS management was significantly influenced by patient characteristics. This information can aid in planning strategies to decrease stroke burden.
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Kirchhof P, Bax J, Blomstrom-Lundquist C, Calkins H, Camm AJ, Cappato R, Cosio F, Crijns H, Diener HC, Goette A, Israel CW, Kuck KH, Lip GY, Nattel S, Page RL, Ravens U, Schotten U, Steinbeck G, Vardas P, Waldo A, Wegscheider K, Willems S, Breithardt G. Early and comprehensive management of atrial fibrillation: Proceedings from the 2nd AFNET/EHRA consensus conference on atrial fibrillation entitled 'research perspectives in atrial fibrillation'. Europace 2009; 11:860-85. [DOI: 10.1093/europace/eup124] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Bang OY, Saver JL, Liebeskind DS, Lee PH, Sheen SS, Yoon SR, Yun SW, Kim GM, Chung CS, Lee KH, Ovbiagele B. Age-distinct predictors of symptomatic cervicocephalic atherosclerosis. Cerebrovasc Dis 2008; 27:13-21. [PMID: 19018133 DOI: 10.1159/000172629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 07/22/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about whether vascular risk factors predispose to atherosclerotic stroke depending on age. We evaluated predictors of large vessel atherosclerotic stroke (LVAS) stratified by age in two geographically and racially distinct study populations. METHODS Data collected over a 4-year period in prospectively maintained registries on 3,053 subjects with ischemic cerebrovascular events were analyzed: 1,982 patients from a hospital in South Korea and 1,071 patients admitted to a hospital in Los Angeles, Calif., USA. Independent vascular risk factor associations with LVAS mechanism were evaluated in three groups stratified by age (years) at symptom onset: young (<or=50 years), older (51-75 years), and oldest (>75 years). RESULTS Altogether at both study sites, 972 (31.8%) patients had LVAS mechanism, of whom 391 (40.2%) were female. Risk factor profiles were not significantly different between LVAS versus other stroke mechanisms. Among young patients, after adjusting for covariates, current smoking was the only predictor of atherosclerotic stroke at both Korean (OR 2.04; 95% CI: 1.13-3.69) and Californian sites (OR 4.78, 95% CI 1.54-14.89), while the metabolic syndrome was the only predictor of atherosclerotic stroke among the older patients (OR 1.58, 95% CI 1.17-2.12 for Korean; OR 1.75, 95% CI 1.07-2.84 for Californian), but not in the young or oldest groups. CONCLUSIONS Across race and region, the estimated impact of vascular risk factors for LVAS varies by age, and this is most prominently seen among persons of less than 76 years of age. Some risk factors have an early effect (smoking) and others an effect that plays out over time.
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Affiliation(s)
- Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University, Gangnam-gu, Seoul, South Korea.
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Leoo T, Lindgren A, Petersson J, von Arbin M. Risk factors and treatment at recurrent stroke onset: results from the Recurrent Stroke Quality and Epidemiology (RESQUE) Study. Cerebrovasc Dis 2008; 25:254-60. [PMID: 18216468 PMCID: PMC2814018 DOI: 10.1159/000113864] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Accepted: 10/02/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Much effort has been made to study first-ever stroke patients. However, recurrent stroke has not been investigated as extensively. It is unclear which risk factors dominate, and whether adequate secondary prevention has been provided to patients who suffer from recurrent stroke. Also, the different types of recurrent stroke need further evaluation. METHODS The study included patients with recurrent stroke admitted to twenty-three Swedish stroke centers. The type of previous and recurrent stroke was determined, as well as evaluation (when applicable) of recurrent ischemic stroke according to the TOAST classification. Presence of vascular risk factors was registered and compared to the type of stroke. Also assessed was ongoing secondary prevention treatment at recurrent stroke onset. RESULTS A total of 889 patients with recurrent stroke (mean age 77) were included in the study. Of these, 805 (91%) had ischemic stroke, 78 (9%) had intracerebral hemorrhage and 6 (<1%) stroke of unknown origin. The most frequent vascular risk factors were hypertension (75%) and hyperlipidemia (56%). Among the 889 patients, 29% had atrial fibrillation. Of the patients in the ischemic group with cardiac embolism, only 21% were on anticoagulation treatment. The majority of the patients (75%) had their most recent previous stroke >12 months before admission. CONCLUSIONS Few patients had a recurrent stroke shortly after the previous stroke in this study. This indicates that it is meaningful to prevent a second event with an adequate long-term treatment strategy for secondary prevention after first-ever stroke. There also seems to be a clear potential for improving secondary prevention after stroke.
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Affiliation(s)
- T. Leoo
- Department of Clinical Pharmacology, Sahlgrenska University, Göteborg, Sweden
| | - A. Lindgren
- Department of Neurology, Lund University Hospital, Lund, Sweden
| | - J. Petersson
- Department of Neurology, Malmö University Hospital, Malmö, Sweden
| | - M. von Arbin
- Department of Clinical Sciences, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden
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Affiliation(s)
- George Howard
- Department of Biostatistics, UAB School of Public Health, Birmingham, AL 35294-0022, USA.
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Lavados PM, Hennis AJM, Fernandes JG, Medina MT, Legetic B, Hoppe A, Sacks C, Jadue L, Salinas R. Stroke epidemiology, prevention, and management strategies at a regional level: Latin America and the Caribbean. Lancet Neurol 2007; 6:362-72. [PMID: 17362840 DOI: 10.1016/s1474-4422(07)70003-0] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Stroke is a major health problem in Latin American and Caribbean countries. In this paper, we review the epidemiology, aetiology, and management of stroke in the region based on a systematic search of articles published in Spanish, Portuguese, and English. Stroke mortality is higher than in developed countries but rates are declining. Population-based studies show variations in incidence of strokes: lower rates of ischaemic stroke and similar rates of intracranial haemorrhages, compared with other regions. A significant proportion of strokes in these populations can be attributed to a few preventable risk factors. Some countries have published national clinical guidelines, although much needs to be done in the organisation of care and rehabilitation. Even though the burden of stroke is high, there is a paucity of information for implementing evidence-based management. The Global Stroke Initiative, the WHO STEPS Stroke surveillance, and WHO-PREMISE projects provide opportunities for surveillance at institutional and community levels.
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Affiliation(s)
- Pablo M Lavados
- Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina, Universidad de Chile, Santiago, Chile.
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