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Hu G, Gu H, Jiang Y, Yang X, Jiang Y, Wang C, Li Z, Wang Y, Wang Y. Revisiting the Smoking Paradox in Acute Ischemic Stroke Patients: Findings From the Chinese Stroke Center Alliance Study. J Am Heart Assoc 2023; 12:e029963. [PMID: 37548171 PMCID: PMC10492953 DOI: 10.1161/jaha.123.029963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/16/2023] [Indexed: 08/08/2023]
Abstract
Background Smoking is a well-established risk factor for the development of acute ischemic stroke (AIS). However, the "smoker's paradox" suggests that it is associated with favorable clinical outcomes following stroke. We aimed to reevaluate the association between smoking and in-hospital outcomes in patients with AIS in contemporary practice. Methods and Results A total of 649 610 inpatients with AIS from 1476 participating hospitals in the Chinese Stroke Center Alliance were included. In-hospital outcomes measurement included all-cause mortality, discharge against medical advice, and complications. Multivariable logistic regression models adjusting for baseline characteristics, clinical profiles at presentation, and in-hospital management were used to evaluate the association between smoking and in-hospital outcomes. A propensity score-matched analysis was also conducted. Of these patients with AIS, 36.8% (n=238 912) were smokers. Smokers were younger, had fewer comorbidities, and had slightly lower rates of adverse in-hospital outcomes than nonsmokers (all-cause death or discharge against medical advice: 6.0% versus 6.1%; in-hospital complications: 14.5% versus 15.1%). Multivariable analysis revealed that smoking was associated with higher risk of adverse in-hospital outcomes (all-cause death or discharge against medical advice: odds ratio [OR], 1.05 [95% CI, 1.02-1.08]; P<0.001; complications: OR, 1.06 [95% CI, 1.04-1.08]; P<0.001). The excess risk of adverse in-hospital outcomes remained in smoking patients with AIS after propensity score-matching analysis (all-cause death or discharge against medical advice: OR, 1.04 [95% CI, 1.00-1.08]; P=0.034; complications: OR, 1.05 [95% CI, 1.03-1.08]; P<0.001). Conclusions Smoking was associated with increased risk of adverse in-hospital outcomes among patients with AIS in contemporary practice, reinforcing the importance of smoking cessation in patients with AIS.
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Affiliation(s)
- Guoliang Hu
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
- National Center for Neurological DiseasesBeijingChina
| | - Hongqiu Gu
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yingyu Jiang
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Xin Yang
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yong Jiang
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Chunjuan Wang
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Chinese Institute for Brain ResearchBeijingChina
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
- National Center for Neurological DiseasesBeijingChina
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Advanced Innovation Center for Human Brain ProtectionCapital Medical UniversityBeijingChina
- National Center for Neurological DiseasesBeijingChina
- Chinese Institute for Brain ResearchBeijingChina
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Luo J, Tang X, Li F, Wen H, Wang L, Ge S, Tang C, Xu N, Lu L. Cigarette Smoking and Risk of Different Pathologic Types of Stroke: A Systematic Review and Dose-Response Meta-Analysis. Front Neurol 2022; 12:772373. [PMID: 35145466 PMCID: PMC8821532 DOI: 10.3389/fneur.2021.772373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/06/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives To quantify the association of cigarette smoking, including cigarettes per day and quitting duration, with the risk of different types of stroke morbidity and mortality in the general population, and to clarify the shape of the dose-response relations. Study Selection Prospective cohort studies and reported on the association between smoking, quitting and the incidence or mortality of stroke were included. Data Extraction and Synthesis All available data were converted uniformly to odds ratios (ORs) and were pooled using random-effects meta-analysis with inverse variance weighting. A dose-response meta-analysis was performed to explore the quantitative relationship between different smoking characteristics and the risk of different pathologic types of stroke incidence. Results Twenty-five studies with 3,734,216 individuals were included. Compared to never smokers, the pooled ORs of stroke morbidity and mortality were 1.45 (1.24–1.70) and 1.44 (1.23–1.67) among ever smokers and 1.90 (1.55–2.34) and 1.70 (1.45–1.98) among current smokers. The risk of different pathologic types of stroke was also increased among ever and current smokers. There was a significant non-linear dose-response association between the number of cigarette smoking and the risk of stroke incidence. Comparing no smoking, the ORs for smoking five and 35 cigarettes per day were 1.44 (1.35–1.53) and 1.86 (1.71–2.02). Other pathologic types of stroke have a similar dose-response relationship. There was also non-linear dose-response association between the length of time since quitting and risk of stroke. The risk of stroke decreased significantly after quitting for 3 years [OR = 0.56 (0.42–0.74)]. Conclusion The risk of different types of stroke among smokers is remarkably high. Our findings revealed a more detailed dose-response relationship and have important implications for developing smoking control strategies for stroke prevention. Systematic Review Registration https://inplasy.com/inplasy-2020-6-0062/, identifier: INPLASY202060062.
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Affiliation(s)
- Jianyu Luo
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaorong Tang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fan Li
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, United States
| | - Hao Wen
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lin Wang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuqi Ge
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chunzhi Tang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
- Chunzhi Tang
| | - Nenggui Xu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
- Nenggui Xu
| | - Liming Lu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Liming Lu
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Riou-Comte N, Gory B, Soudant M, Zhu F, Xie Y, Humbertjean L, Mione G, Oppenheim C, Guillemin F, Bracard S, Richard S. Clinical imaging factors of excellent outcome after thrombolysis in large-vessel stroke: a THRACE subgroup analysis. Stroke Vasc Neurol 2021; 6:631-639. [PMID: 34103393 PMCID: PMC8717776 DOI: 10.1136/svn-2020-000852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background For patients with stroke with large-vessel occlusion (LVO), study of factors predicting response to intravenous thrombolysis (IVT) would allow identifying subgroups with high expected gain, and those for whom it could be considered as futile, and even detrimental. From patients included in the Mechanical Thrombectomy After Intravenous Alteplase vs Alteplase Alone After Stroke trial, we investigated clinical-imaging factors associated with optimal response to IVT. Methods We included patients receiving IVT alone. Excellent outcome was defined by a 3-month modified Rankin Scale (mRS) score ≤1. Clinical-imaging predictors were assessed on multivariate analysis after multiple imputations. The predictive performance of the model was assessed with the C-statistic. Results Among 247 patients with LVO treated with IVT alone, 77 (31%) showed 3-month mRS ≤1. Predictors of 3-month mRS ≤1 were no medical history of hypertension (OR 2.43; 95% CI 1.74 to 3.38; p=0.007); no current smoking (OR 2.76; 95% CI 1.79 to 4.26; p=0.02); onset-to-IVT time (OR 0.47 per hour increase; 95% CI 0.23 to 0.78; p=0.003); diffusion-weighted imaging (DWI) volume (OR 0.78 per 10 mL increase; 95% CI 0.68 to 0.89; p=0.0004); presence of susceptibility vessel sign (SVS) (OR 7.89; 95% CI 1.65 to 37.78; p=0.01) and SVS length (OR 0.87 per mm increase; 95% CI 0.80 to 0.94; p=0.001). The prediction models showed a C-statistic=0.79 (95% CI 0.79 to 0.80). Conclusions In patients with stroke with anterior-circulation LVO treated with IVT alone, predictors of excellent outcome at 3 months were no medical history of hypertension or current smoking, reduced onset-to-IVT time, small DWI volume, presence of SVS and short SVS length. These predictive factors could help practitioners in decision-making for IVT implementation in reperfusion strategies, all the more for the drip and ship paradigm. Trial registration number NCT01062698.
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Affiliation(s)
- Nolwenn Riou-Comte
- Department of Neurology-Stroke Unit, CIC-P 1433, INSERMU1116, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, IADI, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Marc Soudant
- Clinical Investigation Centre-Clinical Epidemiology 1433, INSERM, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - François Zhu
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, IADI, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Yu Xie
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, IADI, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Lisa Humbertjean
- Department of Neurology-Stroke Unit, CIC-P 1433, INSERMU1116, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Gioia Mione
- Department of Neurology-Stroke Unit, CIC-P 1433, INSERMU1116, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Catherine Oppenheim
- Department of Neuroradiology, INSERM U894, Université Paris-Descartes, Sainte-Anne Hospital, Paris, France
| | - Francis Guillemin
- Clinical Investigation Centre-Clinical Epidemiology 1433, INSERM, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Serge Bracard
- Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, IADI, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
| | - Sébastien Richard
- Department of Neurology-Stroke Unit, CIC-P 1433, INSERMU1116, Université de Lorraine, Nancy Regional University Hospital Center, Nancy, France
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Lee SR, Choi EK, Jung JH, Han KD, Oh S, Lip GYH. Smoking Cessation after Diagnosis of New-Onset Atrial Fibrillation and the Risk of Stroke and Death. J Clin Med 2021; 10:jcm10112238. [PMID: 34064089 PMCID: PMC8196704 DOI: 10.3390/jcm10112238] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/19/2022] Open
Abstract
Limited data are available regarding the impact of smoking cessation after atrial fibrillation (AF) diagnosis on clinical outcomes. Using the Korean National Health Insurance Service database, we included patients newly diagnosed with AF and categorized them into four groups as follows: (i) never smokers, (ii) ex-smokers, (iii) smoking cessation after AF diagnosis ("quitters"), and (iv) current smokers. The primary outcomes were incident ischemic stroke and all-cause death during follow-up. Fatal ischemic stroke and death from cerebrovascular events were evaluated as secondary outcomes. Among 97,637 patients (mean age, 61 years; mean CHA2DS2-VASc score, 2.3), 6.9% stopped smoking after AF diagnosis. The mean follow-up duration was 3.2 ± 2.0 years. After multivariable adjustment, quitters had lower risks of ischemic stroke (hazard ratio (HR), 0.702; 95% confidence interval (CI), 0.595-0.827) and all-cause death (HR, 0.842; 95% CI, 0.748-0.948) than current smokers. Quitters after AF diagnosis were associated with lower risks of fatal ischemic stroke (HR, 0.454; 95% CI, 0.287-0.718) and death from cerebrovascular events (HR, 0.664; 95% CI, 0.465-0.949) compared with current smokers. Quitting smoking may reduce the risk of ischemic stroke, the severity of ischemic stroke, and the incidence of cerebrovascular events in patients with new-onset AF.
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Affiliation(s)
- So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (S.-R.L.); (S.O.)
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (S.-R.L.); (S.O.)
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea;
- Correspondence: ; Tel.: +82-2-2072-0688
| | - Jin-Hyung Jung
- Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul 06591, Korea;
| | - Kyung-Do Han
- Statistics and Actuarial Science, Soongsil University, Seoul 06978, Korea;
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea; (S.-R.L.); (S.O.)
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Gregory Y. H. Lip
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea;
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest & Heart Hospital, Liverpool L14 3PE, UK
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
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Quan W, Yang X, Li Y, Li J, Ye W, Zhang O, Zhang X. Left atrial size and risk of recurrent ischemic stroke in cardiogenic cerebral embolism. Brain Behav 2020; 10:e01798. [PMID: 32783327 PMCID: PMC7559598 DOI: 10.1002/brb3.1798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Left atrial enlargement (LAE) was reported to be associated with ischemic stroke and its recurrence. Limited data are available on the relationship of LAE and cardiogenic cerebral embolism (CCE). Our aim is to access the association of left atrial size and the recurrence of ischemic stroke in CCE. METHODS We prospectively included 303 CCE patients who underwent transthoracic echocardiography (TTE). Left atrial size was estimated with left atrial diameter (LAD), diameter/height (LAD/H), and left atrial diameter/body surface area (LAD/BSA). The endpoint was one-year recurrent ischemic stroke. Cox proportional hazard models were performed to access the association between left atrial size and recurrent ischemic stroke. RESULTS During follow-up, 27 patients suffered recurrent ischemic stroke. In multivariate COX regression models adjusted for confounders including age, gender, hypertension, diabetes, and history of stroke or transient ischemic attack (TIA), platelet count, fasting blood glucose (FBG), antithrombotic drugs at discharge, stroke volume, and cardiac output, LAD, LAD/H, and LAD/BSA all were independent risk factors of recurrent ischemic stroke [LAD: HR 1.065, 95% CI (1.006-1.128), p = .029; LAD/H: HR 1.157, 95% CI (1.066-1.255), p < .001; LAD/BSA: HR 1.128, 95% CI (1.059-1.202), p < .001]. Receiver-operator characteristic curves showed that LAD/BSA had better predicting effect. The area under the curve (AUC) was 0.543 [95%CI (0.444-0.642), p = .461) for LAD, 0.626 [95%CI (0.530-0.723), p = .03] for LAD/H, and 0.655 [95%CI (0.558-0.752), p = .008] for LAD/BSA. CONCLUSION LAE is an independent risk factor for one-year recurrence of ischemic stroke in patients with CCE.
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Affiliation(s)
- Weiwei Quan
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xuezhi Yang
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Youyu Li
- Department of Emergency Medicine, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jia Li
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weiyi Ye
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ou Zhang
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xu Zhang
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Li B, Li D, Liu JF, Wang L, Li BZ, Yan XJ, Liu W, Wu K, Xiang RL. "Smoking paradox" is not true in patients with ischemic stroke: a systematic review and meta-analysis. J Neurol 2019; 268:2042-2054. [PMID: 31664548 PMCID: PMC8179908 DOI: 10.1007/s00415-019-09596-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 11/05/2022]
Abstract
Background Ischemic stroke (IS) is a common cause of death from vascular diseases. Studies have found that smoking increases the risk of ischemic stroke, but the association of smoking with the outcome of IS remains unclear. This meta-analysis aims to investigate the effect of smoking on the prognosis of IS. Methods We searched four electronic databases including PubMed, EMBASE, Cochrane library and Web of science for papers, published before January 2019. In this meta-analysis, Review Manager 5.3 software was used to calculate for the pooled estimate effect, as well as the inverse-variance method for pooled mean difference (MD) and odds ratio (OR) of incidence in two groups of population. Results A total of 14,789 citations were identified during the literature search, 21 studies were included in the meta-analyses after screening. The full-adjusted OR of poor prognostic outcome in smoking and nonsmoking patients with stroke was pooled as 0.96 (95% CI 0.77–1.21), suggested that smoking or not has no impact on prognosis of IS. The pooled MD of onset age between smoking and nonsmoking IS patients was − 10.05 (− 12.91, − 7.19), indicated that smoking causes first onset of IS to occur 10 years earlier. Conclusions This meta-analysis showed that smoking was not a protective factor for poor prognosis of IS. Smoking patients with IS are 10 years younger than nonsmoking patients at time of the first onset of stroke.
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Affiliation(s)
- Bo Li
- Department of Neurology, Beijing Hepingli Hospital, No.18 North Street Hepingli, Dongcheng District, Beijing, 100013, China.
| | - Dan Li
- Department of Neurology, Beijing Hepingli Hospital, No.18 North Street Hepingli, Dongcheng District, Beijing, 100013, China
| | - Jing-Feng Liu
- Department of Neurology, Beijing Hepingli Hospital, No.18 North Street Hepingli, Dongcheng District, Beijing, 100013, China
| | - Lin Wang
- Department of Neurology, Beijing Hepingli Hospital, No.18 North Street Hepingli, Dongcheng District, Beijing, 100013, China
| | - Bao-Zhu Li
- Department of Neurology, Beijing Hepingli Hospital, No.18 North Street Hepingli, Dongcheng District, Beijing, 100013, China
| | - Xiu-Juan Yan
- Department of Neurology, Beijing Hepingli Hospital, No.18 North Street Hepingli, Dongcheng District, Beijing, 100013, China
| | - Wei Liu
- Department of Neurology, Beijing Hepingli Hospital, No.18 North Street Hepingli, Dongcheng District, Beijing, 100013, China
| | - Kun Wu
- Department of Neurology, Beijing Hepingli Hospital, No.18 North Street Hepingli, Dongcheng District, Beijing, 100013, China
| | - Ruo-Lan Xiang
- Department of Physiology and Pathophysiology, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, and Beijing Key Laboratory of Cardiovascular Receptors Research, Peking University School of Basic Medical Sciences, No.38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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Hoyer C, Schmidt HL, Kranaster L, Alonso A. Impact of psychiatric comorbidity on the severity, short-term functional outcome, and psychiatric complications after acute stroke. Neuropsychiatr Dis Treat 2019; 15:1823-1831. [PMID: 31308675 PMCID: PMC6614829 DOI: 10.2147/ndt.s206771] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/03/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND PURPOSE The comorbidity of psychiatric disorders and cerebrovascular disease appears to be complex with underlying bidirectional influences. Hitherto, research has focused mainly on the evaluation of stroke risk in particular psychiatric disorders; only a few studies have assessed their role in the acute natural history of stroke. The aim of this study was to provide a perspective on psychiatric premorbidity and its impact on stroke severity, psychiatric complications during the initial treatment phase, and the short-term functional outcome of stroke. PATIENTS AND METHODS We retrospectively studied the impact of a predocumented psychiatric diagnosis (PDPD) on stroke severity, short-term functional outcome, and psychiatric complications in a sample of 798 patients consecutively admitted for acute ischemic or hemorrhagic stroke by performing a chart review. Group comparisons (PDPD vs non-PDPD) with adjustment for covariates were carried out either using multivariate analysis of variance or logistic regression analysis. RESULTS More severe strokes (ie, mean National Institute of Health Stroke Scale score on admission 10.1±7.9 vs 7.5±7.4; F(10,796)=18.5, p<0.0001) and higher prevalence of poor outcome (73.7 vs 54.9%; OR: 2.6, standard error: 0.5, z=4.82, p<0.0001) was found in patients with a documented psychiatric diagnosis at the time of stroke, as well as a higher rate of psychiatric complications during the initial treatment phase (46.7 vs 28.9%; OR: -0.78, z=4.59, p<0.0001). CONCLUSION Our data have clinical implications in that they call for identification of psychiatric premorbidity or comorbidity through careful history-taking and particularly close monitoring for psychiatric complications with respect to their potentially negative impact on outcome after stroke.
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Affiliation(s)
- Carolin Hoyer
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hanna Luise Schmidt
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Laura Kranaster
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Angelika Alonso
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
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Abstract
Despite major improvements in primary prevention and acute treatment over the last decades, stroke is still a devastating disease. At the beginning of the 21st century, the age-standardized incidence of stroke in Europe ranged from 95 to 290/100,000 per year, with one-month case-fatality rates ranging from 13 to 35%. Approximately 1.1 million inhabitants of Europe suffered a stroke each year, and ischemic stroke accounted for approximately 80% of cases. Although global stroke incidence is declining, rates observed in young adults are on the rise, thus suggesting a need for strategies to improve prevention. In addition, because of the ageing population, the absolute number of stroke is expected to dramatically increase in coming years: by 2025, 1.5 million European people will suffer a stroke each year. Beyond vital prognosis, stroke patients are also at increased risk of poor outcome within the first year of the event including re-hospitalisation (33%), recurrent event (7 to 13%), dementia (7 to 23%) mild cognitive disorder (35 to 47%), depression (30 to 50%), and fatigue (35% to 92%), all of them contributing to affect health related quality of life. Given these observations, an urgent development of acute care provision, as well as resources for post-stroke therapeutic strategies, is needed.
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Leo A, De Luca R, Russo M, Naro A, Bramanti P, Calabrò RS. Role of tDCS in potentiating poststroke computerized cognitive rehabilitation: Lessons learned from a case study. APPLIED NEUROPSYCHOLOGY-ADULT 2015; 23:162-6. [PMID: 26506950 DOI: 10.1080/23279095.2015.1027344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cognitive impairment after stroke is quite common and can cause important disability with a relevant impact on quality of life. Cognitive rehabilitation (CR) and related assistive technology may improve functional outcomes. A 30-year-old woman came to our research institute for an intensive CR cycle following a right parieto-temporal stroke. Because the patient was in the chronic phase, we decided to use 3 different rehabilitative protocols: (a) traditional cognitive training (TCT), (b) computerized cognitive training (CCT), and (c) CCT combined with transcranial direct stimulation (CCT plus) with a 2-week interval separating each session. Cognitive and language deficits were investigated using an ad-hoc psychometric battery at baseline (T0), post-TCT (T1), post-CCT (T2), and post-CCT plus (T3). Our patient showed the best neuropsychological improvement, with regard to attention processes and language domain, after T3. Our data showed that CCT plus should be considered a promising tool in the treatment of poststroke neuropsychological deficits.
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Affiliation(s)
- Antonino Leo
- Robotic and Behavioral Neurorehabilitation Laboratory, IRCCS Centro Neurolesi “Bonino-Pulejo,”, Messina, Italy
| | - Rosario De Luca
- Robotic and Behavioral Neurorehabilitation Laboratory, IRCCS Centro Neurolesi “Bonino-Pulejo,”, Messina, Italy
| | - Margherita Russo
- Robotic and Behavioral Neurorehabilitation Laboratory, IRCCS Centro Neurolesi “Bonino-Pulejo,”, Messina, Italy
| | - Antonino Naro
- Robotic and Behavioral Neurorehabilitation Laboratory, IRCCS Centro Neurolesi “Bonino-Pulejo,”, Messina, Italy
| | - Placido Bramanti
- Robotic and Behavioral Neurorehabilitation Laboratory, IRCCS Centro Neurolesi “Bonino-Pulejo,”, Messina, Italy
| | - Rocco S. Calabrò
- Robotic and Behavioral Neurorehabilitation Laboratory, IRCCS Centro Neurolesi “Bonino-Pulejo,”, Messina, Italy
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Hachet O, Guenancia C, Stamboul K, Daubail B, Richard C, Béjot Y, Yameogo V, Gudjoncik A, Cottin Y, Giroud M, Lorgis L. Frequency and Predictors of Stroke After Acute Myocardial Infarction. Stroke 2014; 45:3514-20. [DOI: 10.1161/strokeaha.114.006707] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Stroke is a serious complication after acute myocardial infarction (AMI) and is closely associated with decreased survival. This study aimed to investigate the frequency, characteristics, and factors associated with in-hospital and postdischarge stroke in patients with AMI.
Methods—
Eight thousand four hundred eighty-five consecutive patients admitted to a cardiology intensive care unit for AMI, between January 2001 and July 2010. Stroke/transient ischemic attack were collected during 1-year follow-up.
Results—
One hundred twenty-three in-hospital strokes were recorded: 65 (52.8%) occurred on the first day after admission for AMI, and 108 (87%) within the first 5 days. One hundred six patients (86.2%-incidence rate 1.25%) experienced in-hospital ischemic stroke, and 14 patients (11.4%-incidence rate 0.16%) were diagnosed with an in-hospital hemorrhagic stroke. In-hospital ischemic stroke subtypes according to the Trial of Org 10 172 in Acute Stroke Treatment (TOAST) classification showed that only 2 types of stroke were identified more frequently. As expected, the leading subtype of in-hospital ischemic stroke was cardioembolic stroke (n=64, 60%), the second was stroke of undetermined pathogenesis (n=38, 36%). After multivariable backward regression analysis, female sex, previous transient ischemic attack (TIA)/stroke, new-onset atrial fibrillation, left ventricular ejection fraction (odds ratio per point of left ventricular ejection fraction), and C-reactive protein were independently associated with in-hospital ischemic stroke. When antiplatelet and anticoagulation therapy within the first 48 hours was introduced into the multivariable model, we found that implementing these treatments (≥1) was an independent protective factor of in-hospital stroke. In-hospital hemorrhagic stroke was dramatically increased (5-fold) when thrombolysis was prescribed as the reperfusion treatment. However, the different parenteral anticoagulants were not predictors of risk in univariable analysis. Finally, only 45 postdischarge strokes were recorded. Postdischarge stroke subtypes showed a more heterogeneous distribution of mechanisms. The annual rate of stroke post-AMI remained stable throughout the 10-year study period.
Conclusions—
The present study describes specific predictors of in-hospital and postdischarge stroke in patients with AMI. It showed a marked increase in the risk of death, both during hospitalization and in the year after AMI. After hospital discharge, stroke remains a rare event and is mostly associated with high cardiovascular risk.
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Affiliation(s)
- Olivier Hachet
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Charles Guenancia
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Karim Stamboul
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Benoit Daubail
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Carole Richard
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Yannick Béjot
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Valentin Yameogo
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Aurélie Gudjoncik
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Yves Cottin
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Maurice Giroud
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
| | - Luc Lorgis
- From the Department of Cardiology, University Hospital, Dijon, France (H.O., G.C., S.K., R.C., Y.V., G.A., C.Y., L.L.); LPPCM, INSERM U866, University of Burgundy, Dijon, France (H.O., G.C., S.K., R.C., G.A., C.Y., L.L.); and The Dijon Stroke Registry (EA 4184), University of Burgundy, University Hospital and Faculty of Medicine of Dijon, Dijon, France (D.B., B.Y., G.M.)
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