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Kim JT, Kang J, Kim BJ, Kim JY, Han MK, Cho KH, Park MS, Choi KH, Park JM, Kang K, Kim YS, Lee SJ, Kim JG, Cha JK, Kim DH, Park TH, Park SS, Choi JK, Lee K, Park KY, Jeong HB, Lee J, Kwon DH, Cho YJ, Hong KS, Park HK, Lee BC, Yu KH, Oh MS, Lee M, Kim DE, Gwak DS, Choi JC, Kim JG, Kang CH, Kwon JH, Kim WJ, Shin DI, Yum KS, Sohn SI, Hong JH, Park H, Kim C, Lee SH, Lee J, Gorelick PB, Norrving B, Bae HJ. Dual antiplatelet Use for extended period taRgeted to AcuTe ischemic stroke with presumed atherosclerotic OrigiN (DURATION) trial: Rationale and design. Int J Stroke 2023; 18:1015-1020. [PMID: 36974902 DOI: 10.1177/17474930231168742] [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] [Indexed: 03/29/2023]
Abstract
RATIONALE The optimal duration of dual antiplatelet therapy (DAPT) with clopidogrel-aspirin for the large artery atherosclerotic (LAA) stroke subtype has been debated. AIMS To determine whether the 1-year risk of recurrent vascular events could be reduced by a longer duration of DAPT in patients with the LAA stroke subtype. METHODS AND STUDY DESIGN A total of 4806 participants will be recruited to detect a statistically significant relative risk reduction of 22% with 80% power and a two-sided alpha error of 0.05, including a 10% loss to follow-up. This is a registry-based, multicenter, prospective, randomized, open-label, blinded end point study designed to evaluate the efficacy and safety of a 12-month duration of DAPT compared with a 3-month duration of DAPT in the LAA stroke subtype. Patients will be randomized (1:1) to either DAPT for 12 months or DAPT for 3 months, followed by monotherapy (either aspirin or clopidogrel) for the remaining 9 months. STUDY OUTCOMES The primary efficacy outcome of the study is a composite of stroke (ischemic or hemorrhagic), myocardial infarction, and all-cause mortality for 1 year after the index stroke. The secondary efficacy outcomes are (1) stroke, (2) ischemic stroke or transient ischemic attack, (3) hemorrhagic stroke, and (4) all-cause mortality. The primary safety outcome is major bleeding. DISCUSSION This study will help stroke physicians determine the appropriate duration of dual therapy with clopidogrel-aspirin for patients with the LAA stroke subtype. TRIAL REGISTRATION URL: https://cris.nih.go.kr/cris. CRIS Registration Number: KCT0004407.
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Affiliation(s)
- Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jihoon Kang
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Beom Joon Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jun Yup Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Moon-Ku Han
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si, Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Yong Soo Kim
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea
| | - Jae Guk Kim
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Sang-Soon Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Jin Kyo Choi
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Kyungbok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea
| | | | - Hae-Bong Jeong
- Department of Neurology, Chung-Ang University, Seoul, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, Korea
| | - Doo Hyuk Kwon
- Department of Neurology, Yeungnam University Hospital, Daegu, Korea
| | - Yong-Jin Cho
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Hong-Kyun Park
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Minwoo Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Dong-Seok Gwak
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Joong-Goo Kim
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Chul-Hoo Kang
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Jee-Hyun Kwon
- Department of Neurology, College of Medicine, University of Ulsan, Ulsan, Korea
| | - Wook-Joo Kim
- Department of Neurology, College of Medicine, University of Ulsan, Ulsan, Korea
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyu Sun Yum
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea
| | - Sung Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Hyungjong Park
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Chulho Kim
- Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si, Republic of Korea
| | - Sang-Hwa Lee
- Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si, Republic of Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Philip B Gorelick
- Division of Stroke and Neurocritical Care, The Ken & Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bo Norrving
- Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Neurology, Skåne University Hospital Lund/Malmö, Malmö, Sweden
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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Jeong J, Park JK, Koh YH, Park JM, Bae HJ, Yun SM. Association of HbA1c with functional outcome by ischemic stroke subtypes and age. Front Neurol 2023; 14:1247693. [PMID: 37840925 PMCID: PMC10568315 DOI: 10.3389/fneur.2023.1247693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Objectives To determine whether high HbA1c levels are related to short-and long-term functional outcomes in patients with ischemic stroke (IS) and whether this association differs according to the IS subtype and the patient's age. Methods The data of 7,380 IS patients admitted to 16 hospitals or regional stroke centers in South-Korea, between May 2017 and December 2019, were obtained from the Clinical Research Collaboration for Stroke-Korea-National Institute of Health database and retrospectively analyzed. Among these patients, 4,598 were followed-up for one-year. The HbA1c levels were classified into three groups (<5.7, 5.7 to <6.5%, ≥6.5%). Short-and long-term poor functional outcomes were defined using the modified Rankin Scale score of 2 to 6 at three-months and one-year, respectively. IS subtypes were categorized according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification. Results There was an association between higher HbA1c (≥6.5%) and poor functional outcomes at three-months in all patients (three-months; OR, 1.299, 95% CI 1.098, 1.535, one-year; OR, 1.181, 95% CI 0.952, 1.465). When grouped by age, the associations after both 3 months and 1 year observed in younger adult group (<65 years), but not in group aged 65 years and older (three-months; <65 years OR, 1.467, 95% CI 1.112, 1.936, ≥65 years OR, 1.220, 95% CI 0.987, 1.507, p for interaction = 0.038, one-year; <65 years OR, 1.622, 95% CI 1.101, 2.388, ≥65 years OR, 1.010, 95% CI 0.778, 1.312, p for interaction = 0.018). Among younger adult group, the higher HbA1c level was related to short-and long-term functional loss in patients with the small vessel occlusion subtype (three-months; OR, 2.337, 95%CI 1.334, 4.095, one-year; OR, 3.004, 95% CI 1.301, 6.938). However, in patients with other TOAST subtypes, a high HbA1c level did not increase the risk of poor outcomes, regardless of the age of onset. Conclusion High HbA1c levels increase the risk of short-and long-term poor functional outcomes after IS onset. However, this association differs according to stroke subtype and age. Thus, pre-stroke hyperglycemia, reflected by HbA1c, may be a significant predictor for a poor prognosis after ischemic stroke, particular in young- and middle-aged adults.
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Affiliation(s)
- Jihyun Jeong
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
- Division of Injury Prevention and Control, Bureau of Chronic Disease Prevention and Control, Korea Disease Control and Prevention Agency, Cheongju-si, Republic of Korea
| | - Jae Kyung Park
- Division of Brain Diseases Research, Department of Chronic Disease Convergence Research, Korea National Institute of Health, Cheongju-si, Republic of Korea
| | - Young Ho Koh
- Division of Brain Diseases Research, Department of Chronic Disease Convergence Research, Korea National Institute of Health, Cheongju-si, Republic of Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si, Republic of Korea
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sang-Moon Yun
- Division of Cardiovascular Disease Research, Department of Chronic Disease Convergence Research, Korea National Institute of Health, Cheongju-si, Republic of Korea
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Liu Z, Lin X, Zeng L, Zhang H, Guo W, Lu Q, Huang C, Wang J, Liu P, Chang Q, Zhang M, Huo Y, Wang Y, Wang F, Wu S. Elevated non-HDL-C/HDL-C ratio increases the 1-year risk of recurrent stroke in older patients with non-disabling ischemic cerebrovascular events: results from the Xi'an Stroke Registry Study of China. BMC Geriatr 2023; 23:410. [PMID: 37407911 DOI: 10.1186/s12877-023-04102-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 06/09/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Few studies have explored the prognostic role of nontraditional lipid-related indicators in non-disabling ischemic cerebrovascular events (NICE). In this study, we aimed to investigate the relationship between the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (non-HDL-C/HDL-C) and the1-year risk of recurrent stroke in patients with NICE. METHODS Total cholesterol (TC), HDL-C, and patient information were collected at admission. Recurrent stroke events were followed up 3, 6, and 12 months after onset. Non-HDL-C levels were calculated by subtracting HDL-C from TC. The non-HDL-C/HDL-C ratio was treated as a continuous variable and in quartiles (Q1-Q4). Stratified multivariate Cox regression was used to investigate the relationship between the non-HDL-C/HDL-C ratio and the 1-year risk of recurrent stroke in patients with NICE. RESULTS Overall, 1,659 patients with NICE were enrolled. For each unit increase in the non-HDL-C/HDL-C ratio, the 1-year risk of recurrent stroke in patients aged ≥ 65 years (older patients) with NICE increased by 64% in the adjusted model (hazard ratio [HR]: 1.64, 95%confidence interval [CI]:1.18-2.27, P = 0.003), and the HRs were 3.21 and 4.24 times higher in the Q3 and Q4 groups than that in the Q1 group, which was considered to be the reference (adjusted model Q3: HR: 3.21, 95%CI: 1.05-9.83, P = 0.041; adjusted model Q4: HR: 4.24, 95%CI: 1.30-13.85, P = 0.017). However, there was no significant difference in patients younger than 65 years. Both curve fitting and Kaplan-Meier cumulative risk analysis showed that an elevated non-HDL-C/HDL-C ratio significantly increased the 1-year risk of recurrent stroke in older patients with NICE. The optimal range for the non-HDL-C/HDL-C ratio should be no higher than the Q2 group (2.256-2.939). Stratified Cox regression analysis showed that these results tended to be stable for different comorbidities (all P for interaction > 0.05). CONCLUSIONS Elevated non-HDL-C/HDL-C ratios significantly increased the 1-year risk of recurrent stroke in older patients with NICE. Therefore, clinicians need to pay more attention to this indicator when managing older patients with NICE.
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Affiliation(s)
- Zhongzhong Liu
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Department of Epidemiology and Biostatistics, School of Public Health of Xi'an Jiaotong University Health Science Center, Xi'an, 71006, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Xuemei Lin
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health of Xi'an Jiaotong University Health Science Center, Xi'an, 71006, China
| | - Huan Zhang
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- College of Life Science, Northwest University, Xi'an, 710069, China
| | - Weiyan Guo
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Qingli Lu
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Congli Huang
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
- Department of Traditional Chinese Medicine, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
| | - Jing Wang
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Pei Liu
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Qiaoqiao Chang
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Mi Zhang
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Yan Huo
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Yan Wang
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Fang Wang
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China
| | - Songdi Wu
- Department of Neurology, Xi'an No.1 Hospital, The First Affiliated Hospital of Northwest University, Xi'an, 710002, China.
- College of Life Science, Northwest University, Xi'an, 710069, China.
- Xi'an Key Laboratory for Innovation and Translation of Neuroimmunological Diseases, Xi'an, 710002, China.
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Jin A, Wang S, Li J, Wang M, Lin J, Li H, Meng X, Wang Y, Pan Y. Mediation of Systemic Inflammation on Insulin Resistance and Prognosis of Nondiabetic Patients With Ischemic Stroke. Stroke 2023; 54:759-769. [PMID: 36722344 DOI: 10.1161/strokeaha.122.039542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Insulin resistance is associated with stroke recurrence and poor functional outcomes of nondiabetic patients with ischemic stroke. The study aimed to investigate whether the association between insulin resistance and the prognosis of nondiabetic patients with ischemic stroke was mediated by systematic inflammation. METHODS Patients with ischemic stroke but without a history of diabetes who were enrolled in CNSR-III (Third China National Stroke Registry) were included in the study and followed up for 1 year after stroke onset. Insulin resistance was determined by using the homeostasis model assessment for insulin resistance (HOMA-IR) method. hs-CRP (high-sensitivity C-reactive protein) and Lp-PLA2 (lipoprotein-associated phospholipase A2) activity were measured at baseline. The primary outcome was stroke recurrence, and other outcomes included composite vascular events, mortality, and poor functional outcome (modified Rankin Scale score, 3-6). Multivariable Cox or logistic regression analyses were performed to estimate the association between HOMA-IR and the study outcomes. A mediation analysis was performed to examine the relationship between insulin resistance and the study outcomes mediated by systemic inflammation. RESULTS Among a total of 3808 nondiabetic patients with ischemic stroke who were included in the study, the median HOMA-IR was 1.79 (interquartile range, 1.05-2.97). After adjustments for potential confounders, higher HOMA-IR quartiles were associated with higher risks of stroke recurrence, ischemic stroke, and composite vascular events, especially in the large artery atherosclerosis subtype. hs-CRP partially mediated the association between the HOMA-IR index and the prognosis of ischemic stroke (mediation proportion, 5.9% for stroke recurrence and 7.5% for composite vascular events). No evidence of Lp-PLA2 activity mediating the association of insulin resistance with stroke outcomes was observed. CONCLUSIONS Our study found that insulin resistance was associated with poor clinical outcomes in nondiabetic patients with ischemic stroke, which was partially mediated by hs-CRP with a modest amount.
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Affiliation(s)
- Aoming Jin
- Department of Neurology, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China
| | - Shukun Wang
- The Brain Science Center, Beijing Institute of Basic Medical Sciences, China (S.W.)
| | - Jiejie Li
- Department of Neurology, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China
| | - Mengxing Wang
- Department of Neurology, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China
| | - Jinxi Lin
- Department of Neurology, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,Advanced Innovation Center for Human Brain Protection (Y.W.), Capital Medical University, China.,Research Unit of Artificial Intelligence in Cerebrovascular Disease (Y.W.), Chinese Academy of Sciences, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital (A.J., J. Li, M.W., J. Lin, H.L., X.M., Y.W., Y.P.), Capital Medical University, China
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Wang Y, Sun W, Miao J, Zhu Z, Liang W, Qiu X, Pan C, Li G, Lan Y, Zhao X, Xu Y. Nomogram including indirect bilirubin for the prediction of post-stroke depression at 3 months after mild acute ischemic stroke onset. Front Neurol 2023; 14:1093146. [PMID: 36846136 PMCID: PMC9945073 DOI: 10.3389/fneur.2023.1093146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/16/2023] [Indexed: 02/11/2023] Open
Abstract
Background Post-stroke depression (PSD) has been proven to be associated with stroke severity. Thus, we hypothesized that the prevalence of PSD would be lower in patients with mild stroke. We aim to explore predictors of depression at 3 months after mild acute ischemic stroke (MAIS) onset and to develop a practical and convenient prediction model for the early identification of patients at high risk. Methods A total of 519 patients with MAIS were consecutively recruited from three hospitals in Wuhan city, Hubei province. MAIS was defined as a National Institute of Health Stroke Scale (NIHSS) score of ≤5 at admission. Meeting the DSM-V diagnostic criteria and a 17-item Hamilton Rating Scale for Depression (HAMD-17) score of >7 at their 3-month follow-up were considered the primary outcomes. A multivariable logistic regression model was used to determine the factors adjusted for potential confounders, and all independent predictors were brought into the construction of a nomogram to predict PSD. Results The prevalence of PSD is up to 32% at 3 months after MAIS onset. After adjusting for potential confounders, indirect bilirubin (p = 0.029), physical activity (p = 0.001), smoking (p = 0.025), hospitalization days (p = 0.014), neuroticism (p < 0.001), and MMSE (p < 0.001) remained independently and significantly related with PSD. The concordance index (C-index) of the nomogram jointly constructed by the aforementioned six factors was 0.723 (95% CI: 0.678-0.768). Conclusion The prevalence of PSD seems equally high even if the ischemic stroke is mild, which calls for great concern from clinicians. In addition, our study found that a higher level of indirect bilirubin can lower the risk of PSD. This finding may provide a potential new approach to PSD treatment. Furthermore, the nomogram including bilirubin is convenient and practical to predict PSD after MAIS onset.
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Affiliation(s)
- Yanyan Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenzhe Sun
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jinfeng Miao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhou Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenwen Liang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiuli Qiu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chensheng Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guo Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yan Lan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xin Zhao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Xu
- Department of Plastic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Predictive Role of hsCRP in Recurrent Stroke Differed According to Severity of Cerebrovascular Disease: Analysis from a Prospective Cohort Study. J Clin Med 2023; 12:jcm12041676. [PMID: 36836211 PMCID: PMC9967664 DOI: 10.3390/jcm12041676] [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: 12/27/2022] [Revised: 01/26/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Elevated levels of high-sensitivity C-reactive protein (hsCRP) were associated with an increased risk of recurrent stroke. However, it is still unknown whether the predictive value of hsCRP differed according to the severity of cerebrovascular disease. We used the cohort of the prospective multicenter cohort study of the Third China National Stroke Registry (CNSR-III), in which 10,765 consecutive patients with acute ischemic stroke or transient ischemic attack (TIA) had hsCRP levels measured. Patients were classified into minor stroke, or TIA, and non-minor stroke. The primary outcome was a new stroke within 1 year. Cox proportional hazards models were used to assess the association of hsCRP and its outcome. Elevated levels of hsCRP were associated with an increased risk of recurrent stroke in minor stroke or TIA patients, irrespective of using a National Institutes of Health Stroke Scale (NIHSS) score of ≤3 (the highest quartile vs. the lowest quartile: adjusted hazard ratio, 1.48; 95% CI, 1.12-1.97; p = 0.007) or ≤5 (the highest quartile vs. the lowest quartile: adjusted hazard ratio, 1.45; 95% CI, 1.15-1.84; p = 0.002) to define minor stroke. Such association was more apparent in the large-artery atherosclerosis subtype. However, for the patients with non-minor stroke, the association of hsCRP with recurrent stroke disappeared.
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Antiplatelet treatment patterns and outcomes of secondary stroke prevention in the United States. Heliyon 2023; 9:e13579. [PMID: 36852046 PMCID: PMC9958290 DOI: 10.1016/j.heliyon.2023.e13579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 01/20/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Objective Patients who have an ischemic stroke (IS) or transient ischemic attack (TIA) are at risk of having a secondary stroke. Single antiplatelet therapy (SAPT) or dual antiplatelet therapy (DAPT) may be recommended for secondary stroke prevention (SSP), depending on severity and etiology. This study evaluated outpatient antiplatelet treatment patterns for SSP and outcomes after first hospitalization for IS/TIA among adults without atrial fibrillation in the United States. Materials and methods This retrospective observational study utilized data from an adjudicated administrative health claims database. Eligible patients had an imputed National Institutes of Health Stroke Scale index event score ≤7. Over-the-counter medication use (eg, aspirin) was not captured. Results Of 154,273 patients, 41,622 (27%) were prescribed antiplatelet therapy within 90 days of the event; 93.8% received SAPT, 6.1% received DAPT. The first line of antiplatelet therapy after discharge was started a mean of 17.0 days after the event; mean treatment duration was 61.9 days. The incidence rate for secondary IS was 5.53, 2.03, and 1.17 per person-year 90-days, 1-year, and 3-years following treatment initiation, respectively. Among patients matched for demographic and clinical characteristics, the risk of secondary IS was increased with DAPT versus SAPT (hazard ratio [95% CI]: 1.27 [1.20-1.34]; p < 0.0001). Conclusions Many patients were not prescribed or discontinued antiplatelet therapy within 90 days of hospitalization for IS/TIA and, in most cases, prescriptions were not compliant with SSP consensus guidelines. Patients remained at risk for IS, which was highest within 90 days. More effective strategies for SSP are needed to improve outcomes in this patient population.
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Yoo SH, Kim GG, Kim SR, Park MS, Kim JT, Choi KH, Park HY, Yi SH, Cha JK, Kim DH, Nah HW. Predictors of long-term medication adherence in stroke survivors: A multicentre, prospective, longitudinal study. J Clin Nurs 2023; 32:58-70. [PMID: 35922959 DOI: 10.1111/jocn.16472] [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: 02/23/2022] [Revised: 06/04/2022] [Accepted: 07/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although the optimal use of prescribed medications for stroke survivors is critical for preventing secondary stroke, longitudinal observations of the natural course of medication persistence and adherence in Korean stroke survivors are rare. Furthermore, studies are needed to identify strong predictors influencing medication adherence and to determine whether these predictors change over time. AIMS AND OBJECTIVES To evaluate the longitudinal medication persistence and adherence at 3 months and 1 year after discharge in all stroke patients and to identify predictors of long-term medication adherence in patients who can self-medicate. DESIGN A multicentre, prospective, longitudinal descriptive study. METHODS A total of 600 consecutive ischaemic stroke patients were recruited from three stroke centres across Korea, from 1 September, 2017 to 28 February, 2019. Various factors related to medication adherence suggested by the World Health Organisation were investigated through face-to-face interviews at each centre during hospitalisation. Medication persistence and adherence were assessed at 3 months and 1 year after discharge using the eight-item Morisky Medication Adherence Scale through telephone interviews. RESULTS Of 537 survivors at 3 months, 526 (98.0%) were persistent and 472 (89.7%) were adherent. Of 493 survivors at 1 year, 477 (96.8%) were persistent and 392 (82.2%) were adherent. Medication belief, income and health literacy were statistically significant predictors of three-month medication adherence, which predicted one-year medication adherence with older age and low income. CONCLUSIONS Among Korean stroke survivors, three-month and one-year medication persistence and adherence were relatively good. Medication beliefs and three-month medication adherence were important and modifiable factors predicting three-month adherence and one-year adherence, respectively. RELEVANCE TO CLINICAL PRACTICE To increase long-term adherence to medication, various strategies are needed to improve beliefs about medication, taking into account the patient's age and level of knowledge. These interventions need to be initiated during hospitalisation to form early medication habits after discharge.
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Affiliation(s)
- Sung-Hee Yoo
- College of Nursing, Chonnam National University, Gwangju, Korea
| | - Gye-Gyoung Kim
- College of Nursing, Chonnam National University, Gwangju, Korea
| | | | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital Medical School, Gwangju, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital Medical School, Gwangju, Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital Medical School, Gwangju, Korea
| | - Hyun-Young Park
- Department of Neurology, Wonkwang University Hospital, Iksan, Korea
| | - Sang-Hak Yi
- Department of Neurology, Wonkwang University Hospital, Iksan, Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Hyun-Wook Nah
- Department of Neurology, Chungnam National University Sejong Hospital, Sejong, Korea
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Wang H, Sun Y, Zhu J, Zhuang Y, Song B. Diffusion-weighted imaging-based radiomics for predicting 1-year ischemic stroke recurrence. Front Neurol 2022; 13:1012896. [PMID: 36388230 PMCID: PMC9649925 DOI: 10.3389/fneur.2022.1012896] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 10/05/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate radiomics based on DWI (diffusion-weighted imaging) for predicting 1-year ischemic stroke recurrence. Methods A total of 1,580 ischemic stroke patients were enrolled in this retrospective study conducted from January 2018 to April 2021. Demographic and clinical characteristics were compared between recurrence and non-recurrence groups. On DWI, lesions were segmented using a 2D U-Net automatic segmentation network. Further, radiomics feature extraction was done using the segmented mask matrix on DWI and the corresponding ADC map. Additionally, radiomics features were extracted. The study participants were divided into a training cohort (n = 157, 57 recurrence patients, and 100 non-recurrence patients) and a test cohort (n = 846, 28 recurrence patients, 818 non-recurrence patients). A sparse representation feature selection model was performed to select features. Further classification was accomplished using a recurrent neural network (RNN). The area under the receiver operating characteristic curve values was obtained for model performance. Results A total of 1,003 ischemic stroke patients (682 men and 321 women; mean age: 65.90 ± 12.44 years) were included in the final analysis. About 85 patients (8.5%) recurred in 1 year, and patients in the recurrence group were older than the non-recurrence group (P = 0.003). The stroke subtype was significantly different between recurrence and non-recurrence groups, and cardioembolic stroke (11.3%) and large artery atherosclerosis patients (10.3%) showed a higher recurrence percentage (P = 0.005). Secondary prevention after discharge (statins, antiplatelets, and anticoagulants) was found significantly different between the two groups (P = 0.004). The area under the curve (AUC) of clinical-based model and radiomics-based model were 0.675 (95% CI: 0.643–0.707) and 0.779 (95% CI: 0.750–0.807), respectively. With an AUC of 0.847 (95% CI: 0.821–0.870), the model that combined clinical and radiomic characteristics performed better. Conclusion DWI-based radiomics could help to predict 1-year ischemic stroke recurrence.
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10
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Yang M, Cheng H, Wang X, Ouyang M, Shajahan S, Carcel C, Anderson C, Kristoffersen ES, Lin Y, Sandset EC, Wang X, Yang J. Antithrombotics prescription and adherence among stroke survivors: A systematic review and meta-analysis. Brain Behav 2022; 12:e2752. [PMID: 36067030 PMCID: PMC9575604 DOI: 10.1002/brb3.2752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/09/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES We aimed to investigate the prescription of antithrombotic drugs (including anticoagulants and antiplatelets) and medication adherence after stroke. METHODS We performed a systematic literature search across MEDLINE and Embase, from January 1, 2015, to February 17, 2022, to identify studies reporting antithrombotic medications (anticoagulants and antiplatelets) post stroke. Two people independently identified reports to include, extracted data, and assessed the quality of included studies according to the Newcastle-Ottawa scale. Where possible, data were pooled using random-effects meta-analysis. RESULTS We included 453,625 stroke patients from 46 studies. The pooled proportion of prescribed antiplatelets and anticoagulants among patients with atrial fibrillation (AF) was 62% (95% CI: 57%-68%), and 68% (95% CI: 58%-79%), respectively. The pooled proportion of patients who were treated according to the recommendation of guidelines of antithrombotic medications from four studies was 67% (95% CI: 41%-93%). It was reported that 11% (95% CI: 2%-19%) of patients did not receive antithrombotic medications. Good adherence to antiplatelet, anticoagulant, and antithrombotic medications was 78% (95% CI: 67%-89%), 71% (95% CI: 57%-84%), and 73% (95% CI: 59%-86%), respectively. CONCLUSION In conclusion, we found that less than 70% of patients were prescribed and treated according to the recommended guidelines of antithrombotic medications, and good adherence to antithrombotic medications is only 73%. Prescription rate and good adherence to antithrombotic medications still need to be improved among stroke survivors.
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Affiliation(s)
- Min Yang
- Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Hang Cheng
- Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Xia Wang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Menglu Ouyang
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Sultana Shajahan
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia
| | - Cheryl Carcel
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, The University of Sydney, NSW, Australia
| | - Craig Anderson
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, The University of Sydney, NSW, Australia.,The George Institute China at Peking University Health Science Centre, Beijing, PR China
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway.,Department of General Practice, Helsam, University of Oslo, Oslo, Norway
| | - Yapeng Lin
- Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China.,International Clinical Research Center, Chengdu Medical College, Chengdu, China
| | - Else Charlotte Sandset
- Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway.,The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Xiaoyun Wang
- Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jie Yang
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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11
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Yuan B, Meng X, Wang A, Niu S, Xie X, Jing J, Li H, Chang L, Wang Y, Li J. Effect of different doses of colchicine on high sensitivity C-reactive protein in patients with acute minor stroke or transient ischemic attack: A pilot randomized controlled trial. Eur J Pharm Sci 2022; 178:106288. [PMID: 36041708 DOI: 10.1016/j.ejps.2022.106288] [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: 05/20/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Patients with elevated levels of high-sensitivity C-reactive protein (hsCRP) are at increased risk of recurrent stroke. Colchicine is a unique anti-inflammatory medication that has shown promise in reducing cardiovascular event. The current study mainly tested the ability of colchicine at different doses to reduce hsCRP levels after stroke. METHODS This was a randomized controlled and open label trial. Eligible patients with acute minor ischemic stroke or transient ischemic attack (TIA) were randomized within 24 hours after symptom onset in a 1:1:1:1 ratio to four groups with different doses of colchicine. Group 1: 0.5 mg of colchicine per day for 14 days; groups 2: starting with 1mg of colchicine on days 1 through 7, and maintaining with 0.5 mg per day on days 8 through 14; group 3 and 4: respectively 2 mg and 3 mg of colchicine on day 1, following with 1mg per day on days 2 through 7 and continuing with 0.5 mg per day on days 8 through 14. Blood specimens were collected at randomization, 24 hours, 72 hours, 7 days and 14 days after index event for hsCRP measurements. The primary outcome was the change of hsCRP levels between baseline and 14 days. RESULTS A total of 39 patients were enrolled. Patients in group 2 had reduced level of hsCRP at 14-day compared with baseline value (p=0.005). Time-course analyses showed that patients in groups of 1 and 2 had lower hsCRP level at 7-day than that at baseline, and patients in groups of 1, 2 and 3 had lower ratios of hsCRP levels at 72 hours to those at baseline. Low dose of colchicine was well tolerated without discontinuation of drug. CONCLUSION Early treatment with low dose of colchicine reduced hsCRP levels in the patients with acute minor ischemic stroke and TIA.
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Affiliation(s)
- Baoshi Yuan
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Anxin Wang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Siying Niu
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xuewei Xie
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Jing
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liguo Chang
- Third People's Hospital of Liaocheng, Shandong, 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, 2019RU018, Beijing, China; Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Beijing, China
| | - Jiejie Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
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Lee KJ, Shin DW, Park HK, Kim BJ, Park JM, Kang K, Park TH, Lee KB, Hong KS, Cho YJ, Kim DE, Ryu WS, Lee BC, Yu KH, Oh MS, Lee SJ, Kim JG, Lee J, Cha JK, Kim DH, Kim JT, Choi KH, Choi JC, Lesén E, Hedberg J, Tank A, Fita EG, Song JE, Lee JS, Lee J, Bae HJ. Risk of Subsequent Events in Patients With Minor Ischemic Stroke or High-Risk Transient Ischemic Attack. J Korean Med Sci 2022; 37:e254. [PMID: 35996931 PMCID: PMC9424742 DOI: 10.3346/jkms.2022.37.e254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/21/2022] [Indexed: 11/21/2022] Open
Abstract
This study aimed to present the prognosis after minor acute ischemic stroke (AIS) or transient ischemic attack (TIA), using a definition of subsequent stroke in accordance with recent clinical trials. In total, 9,506 patients with minor AIS (National Institutes of Health Stroke Scale ≤ 5) or high-risk TIA (acute lesions or ≥ 50% cerebral artery steno-occlusion) admitted between November 2010 and October 2013 were included. The primary outcome was the composite of stroke (progression of initial event or a subsequent event) and all-cause mortality. The cumulative incidence of stroke or death was 11.2% at 1 month, 13.3% at 3 months and 16.7% at 1 year. Incidence rate of stroke or death in the first month was 12.5 per 100 person-months: highest in patients with large artery atherosclerosis (17.0). The risk of subsequent events shortly after a minor AIS or high-risk TIA was substantial, particularly in patients with large artery atherosclerosis.
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Affiliation(s)
- Keon-Joo Lee
- Department of Neurology, Korea University Guro Hospital, Seoul, Korea
| | - Dong Woo Shin
- Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Beom Joon Kim
- Department of Neurology and Cerebrovascular Disease Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym Neurological Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym Neurological Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Mi-Sun Oh
- Department of Neurology, Hallym Neurological Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Soo Joo Lee
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Jae Guk Kim
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Medical Center, Daegu, Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju, Korea
| | | | | | | | | | - Ji Eun Song
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
- BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
- BK21 FOUR Program in Learning Health Systems, Korea University, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology and Cerebrovascular Disease Center, Seoul National University Bundang Hospital, Seongnam, Korea.
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13
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Zhang R, Wang J. Machine Learning-Based Prediction of Subsequent Vascular Events After 6 Months in Chinese Patients with Minor Ischemic Stroke. Int J Gen Med 2022; 15:3797-3808. [PMID: 35418774 PMCID: PMC9000551 DOI: 10.2147/ijgm.s356373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background To develop and validate a machine learning model for predicting subsequent vascular events (SVE) 6 months after mild ischemic stroke (MIS) in Chinese patients. Methods A retrospective analysis was performed on 495 newly diagnosed MIS patients by collecting their basic information, past medical history, initial NIHSS score, symptoms, obstruction sites of MIS, and MRI results. According to the ratio of 7:3, the dataset was divided into a training set (n=346) and a testing set (n=149) through stratified random sampling. In the training set, the recursive feature elimination (RFE) was used to select the optimal combination of features, and two machine learning algorithms, including the logistic regression (LR) and support vector machines (SVM), were used to build the prediction model, which was further validated by using 5-fold cross-validation. The receiver operating characteristic (ROC) curve was used on the testing set to evaluate the model’s performance, and the area under the curve (AUC), sensitivity, specificity, and accuracy were calculated. The calibration curve and decision curve of the two models were further compared. Results SVE occurred in 56 cases (11.3%) of 495 patients with MIS during the 6-month follow-up. Finally, the best 15 predictive features were selected, and the top three predictive features were diabetes, posterior cerebral artery lesion, and fasting blood glucose in order. In the testing set, the AUC of the LR model was 0.929 (95% CI: 0.875–0.964), and its accuracy, sensitivity, and specificity were 0.832, 0.765, and 0.841, respectively. The AUC of the SVM model was 0.992 (95% CI: 0.962–1.000), and its accuracy, sensitivity, and specificity were 0.966, 0.824, and 0.985, respectively. The SVM model’s discrimination, calibration, and clinical validity are better than those of the LR model. Conclusion The predictive models developed using machine learning methods can predict the risk of SVE after 6 months following MIS in Chinese patients.
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Affiliation(s)
- Rong Zhang
- Department of Neurology, Traditional Chinese Medicine Hospital of Kunshan, Suzhou, 215300, People’s Republic of China
| | - Jingfeng Wang
- Department of Neurology, The Second People’s Hospital of Kunshan, Suzhou, 215300, People’s Republic of China
- Correspondence: Jingfeng Wang, Department of Neurology, The Second People’s Hospital of Kunshan, Suzhou, 215300, People’s Republic of China, Tel +86-15962508528, Fax +86-512-57557843, Email
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14
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Tomari S, Levi CR, Holliday E, Lasserson D, Valderas JM, Dewey HM, Barber PA, Spratt NJ, Cadilhac DA, Feigin VL, Rothwell PM, Zareie H, Garcia-Esperon C, Davey A, Najib N, Sales M, Magin P. One-Year Risk of Stroke After Transient Ischemic Attack or Minor Stroke in Hunter New England, Australia (INSIST Study). Front Neurol 2022; 12:791193. [PMID: 34987471 PMCID: PMC8721144 DOI: 10.3389/fneur.2021.791193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: One-year risk of stroke in transient ischemic attack and minor stroke (TIAMS) managed in secondary care settings has been reported as 5-8%. However, evidence for the outcomes of TIAMS in community care settings is limited. Methods: The INternational comparison of Systems of care and patient outcomes In minor Stroke and TIA (INSIST) study was a prospective inception cohort community-based study of patients of 16 general practices in the Hunter-Manning region (New South Wales, Australia). Possible-TIAMS patients were recruited from 2012 to 2016 and followed-up for 12 months post-index event. Adjudication as TIAMS or TIAMS-mimics was by an expert panel. We established 7-days, 90-days, and 1-year risk of stroke, TIA, myocardial infarction (MI), coronary or carotid revascularization procedure and death; and medications use at 24 h post-index event. Results: Of 613 participants (mean age; 70 ± 12 years), 298 (49%) were adjudicated as TIAMS. TIAMS-group participants had ischemic strokes at 7-days, 90-days, and 1-year, at Kaplan-Meier (KM) rates of 1% (95% confidence interval; 0.3, 3.1), 2.1% (0.9, 4.6), and 3.2% (1.7, 6.1), respectively, compared to 0.3, 0.3, and 0.6% of TIAMS-mimic-group participants. At one year, TIAMS-group-participants had twenty-five TIA events (KM rate: 8.8%), two MI events (0.6%), four coronary revascularizations (1.5%), eleven carotid revascularizations (3.9%), and three deaths (1.1%), compared to 1.6, 0.6, 1.0, 0.3, and 0.6% of TIAMS-mimic-group participants. Of 167 TIAMS-group participants who commenced or received enhanced therapies, 95 (57%) were treated within 24 h post-index event. For TIAMS-group participants who commenced or received enhanced therapies, time from symptom onset to treatment was median 9.5 h [IQR 1.8-89.9]. Conclusion: One-year risk of stroke in TIAMS participants was lower than reported in previous studies. Early implementation of antiplatelet/anticoagulant therapies may have contributed to the low stroke recurrence.
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Affiliation(s)
- Shinya Tomari
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Christopher R Levi
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Elizabeth Holliday
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Daniel Lasserson
- Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Jose M Valderas
- Health Service and Policy Research Group, University of Exeter, Exeter, United Kingdom
| | - Helen M Dewey
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - P Alan Barber
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Neil J Spratt
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia.,Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Peter M Rothwell
- Nuffield Department of Clinical Neuroscience, Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, United Kingdom
| | - Hossein Zareie
- Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Carlos Garcia-Esperon
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.,Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
| | - Andrew Davey
- Discipline of General Practice, University of Newcastle, Newcastle, NSW, Australia
| | - Nashwa Najib
- Discipline of General Practice, University of Newcastle, Newcastle, NSW, Australia
| | - Milton Sales
- Brunker Road General Practice, Newcastle, NSW, Australia
| | - Parker Magin
- Discipline of General Practice, University of Newcastle, Newcastle, NSW, Australia
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15
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Chang JY, Kim WJ, Kwon JH, Lee JS, Kim BJ, Kim JT, Lee J, Cha JK, Kim DH, Cho YJ, Hong KS, Lee SJ, Park JM, Lee BC, Oh MS, Lee SH, Kim C, Kim DE, Lee KB, Park TH, Choi JC, Shin DI, Sohn SI, Hong JH, Bae HJ, Han MK. Association of Prestroke Glycemic Control With Vascular Events During 1-Year Follow-up. Neurology 2021; 97:e1717-e1726. [DOI: 10.1212/wnl.0000000000012729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/04/2021] [Indexed: 01/14/2023] Open
Abstract
Background and ObjectivesWe evaluated the association between admission glycated hemoglobin (HbA1c) and subsequent risk of composite vascular events, including stroke, myocardial infarction (MI), and vascular death, in patients with acute ischemic stroke and diabetes.MethodsPatients who had a TIA or an acute ischemic stroke within 7 days of symptom onset and diabetes were included in a retrospective cohort design using the stroke registry of the Clinical Research Center for Stroke in Korea. The association between admission HbA1c and composite vascular events, including stroke, MI, and vascular death, during 1-year follow-up was estimated using the Fine-Gray model. The risk of composite vascular events according to the ischemic stroke subtype was explored using fractional polynomial and linear-quadratic models.ResultsOf the 18,567 patients, 1,437 developed composite vascular events during follow-up. In multivariable analysis using HbA1c as a categorical variable, the risk significantly increased at a threshold of 6.8%–7.0%. The influence of admission HbA1c level on the risk of composite vascular events was pronounced particularly among those in whom fasting glucose at admission was ≤130 mg/dL. The optimal ranges of HbA1c associated with minimal risks for composite vascular events were lowest for the small vessel occlusion subtype (6.6 [95% confidence internal [CI], 6.3–6.9]) compared to the large artery atherosclerosis (7.3 [95% CI, 6.8–7.9]) or the cardioembolic subtype (7.4 [95% CI, 6.3–8.5]).DicussionIn patients with ischemic stroke and diabetes, the risks of composite vascular events were significantly associated with admission HbA1c. The optimal range of admission HbA1c was below 6.8%–7.0% and differed according to the ischemic stroke subtype.
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16
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Ahmed Burq HSI, Karimi H, Ahmad A, Gilani SA, Hanif A. Effect of whole-body vibration on obstacle clearance and stair negotiation time in chronic stroke patients; A randomized controlled trial. J Bodyw Mov Ther 2021; 27:698-704. [PMID: 34391309 DOI: 10.1016/j.jbmt.2021.05.012] [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: 08/09/2020] [Revised: 03/19/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the effect of Whole-Body Vibration (WBV) and Routine Physiotherapy (RP) on obstacle crossing and stair negotiation time in chronic stroke patients. METHODS The current study was randomized, parallel-group, assessor-blinded, clinical trial conducted in Physiotherapy Department of Lahore General Hospital, involving 64 patients with chronic stroke. Patients were randomly allocated to 2 groups, i.e., the WBV group (n = 32) and the RP group (n = 32). The WBV group was given additional twelve sessions of vibration therapy (amplitude of 3 mm and frequency of 20 Hz), 6 days/week for 2 weeks. The outcome measures were change in score of height and depth of obstacles cleared, i.e., 6, 8, 10 & 12 inches height and 6, 8, 10 & 12 inches depth and stair negotiation time, i.e., Stair-Climb Test. Chi square test, Independent sample t-test and Paired sample t-test were used to analyze the data. RESULTS Results show that higher number of patients improved in crossing the maximum height and maximum depth of obstacles in the WBV group but improvement was significant only in height, i.e., (p < 0.05). In the WBV group, Stair Negotiation Time decreased significantly as compared to the RP group, i.e., (p < 0.05). CONCLUSIONS The present study concluded that both study groups, i.e., RP and WBV, improved despite better results for the latter. Speed of stair climbing and capacity to cross obstacles improved with the WBV therapy in chronic stroke survivors. TRIAL REGISTRATION IRCT, IRCT20190328043131N1. Registered 03 august 2019 - Retrospectively registered, https://www.irct.ir/user/trial/38832/view.
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Affiliation(s)
- Hafiz Syed Ijaz Ahmed Burq
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan.
| | - Hossein Karimi
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan.
| | - Ashfaq Ahmad
- University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan.
| | - Syed Amir Gilani
- Dean Faculty of Allied Health Sciences, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan.
| | - Asif Hanif
- University Institute of Public Health, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan.
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17
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Nonleisure-Time Physical Activity Guidance Following Minor Ischemic Stroke: A Randomized Clinical Trial. Adapt Phys Activ Q 2021; 38:329-347. [PMID: 33631714 DOI: 10.1123/apaq.2020-0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
Abstract
The purpose of this single-masked randomized clinical trial was to examine whether nonleisure-time physical activity guidance (NLTPAG) improves physical activity levels in patients after minor ischemic stroke. Patients who had been hospitalized for minor ischemic stroke in an acute care hospital (National Health Institute Stroke Scale ≤ 5) were randomized to either an NLTPAG group (n = 17) or a leisure-time physical activity guidance group (n = 16). NLTPAG focused on reducing sedentary behavior and increasing the frequency of walking for shopping and household activities to improve physical activity levels in daily life. Physical activity levels significantly improved only in participants in the NLTPAG group (initial assessment: metabolic equivalents of task = 12.6; final assessment: metabolic equivalents of task = 14.8; p = .035, r = .51). These results suggest that NLTPAG may be effective for improving physical activity levels in patients after minor ischemic stroke.
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18
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Leng X, Hurford R, Feng X, Chan KL, Wolters FJ, Li L, Soo YO, Wong KSL, Mok VC, Leung TW, Rothwell PM. Intracranial arterial stenosis in Caucasian versus Chinese patients with TIA and minor stroke: two contemporaneous cohorts and a systematic review. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-325630. [PMID: 33785575 PMCID: PMC8142447 DOI: 10.1136/jnnp-2020-325630] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intracranial arterial stenosis (ICAS) is an important cause of stroke worldwide. Separate reports in Caucasians and Asians with stroke/transient ischaemic attack (TIA) have suggested lower ICAS prevalence in Caucasians, but there has been no direct comparisons of the two ethnic groups with the same criteria to define ICAS. METHODS Acute minor stroke or TIA patients in two cohorts respectively recruiting patients in Oxford (2011-2018, predominantly Caucasians) and Hong Kong (2011-2015, predominantly Chinese) were compared. ICAS was defined as ≥50% stenosis/occlusion in any major intracranial artery in MR/CT angiography. Prevalence, distribution and risk factors of ICAS were compared between the two cohorts. We also systematically reviewed literature on ICAS prevalence in stroke/TIA patients in different populations. RESULTS Among 1287 patients from Oxford and 691 from Hong Kong (mean age 69 vs 66), ICAS prevalence was higher in Chinese than in Caucasians (43.0% vs 20.0%; OR 3.02; 95% CI 2.47 to 3.70; p<0.001), independent of age (age-adjusted OR 3.73; 95% CI 3.00 to 4.63; p<0.001) and vascular risk factors (multivariable-adjusted OR 3.21; 95% CI 2.56 to 4.02; p<0.001). This ethnic difference was greater (p interaction=0.005) at age <70 years (OR 5.33; 95% CI 3.79 to 7.50; p<0.001) than at ≥70 years (OR 2.81; 95% CI 2.11 to 3.74; p<0.001). ICAS prevalence increased with age and with vascular risk factors in both cohorts, with equivalent prevalence in Chinese aged <60 years and Caucasians aged ≥80, and in Chinese with no vascular risk factor and Caucasians with two vascular risk factors. ICAS locations also differed between Chinese and Caucasian patients. CONCLUSIONS Chinese are more susceptible to ICAS than Caucasians, with an earlier onset age and a higher prevalence, independent of vascular risk factors.
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Affiliation(s)
- Xinyi Leng
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Robert Hurford
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Xueyan Feng
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Lung Chan
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Frank J Wolters
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Linxin Li
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Yannie Oy Soo
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Sing Lawrence Wong
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Ct Mok
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W Leung
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter M Rothwell
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
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19
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Xiong Y, Gu H, Zhao XQ, Yang X, Wang C, Wang YL, Liu LP, Zhou Q, Fisher M, Li Z, Wang Y. Clinical Characteristics and In-Hospital Outcomes of Varying Definitions of Minor Stroke: From a Large-Scale Nation-Wide Longitudinal Registry. Stroke 2021; 52:1253-1258. [PMID: 33588598 DOI: 10.1161/strokeaha.120.031329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE A variety of definitions for minor stroke have been proposed. We aimed to compare the clinical characteristics and outcomes of minor stroke defined as the National Institutes of Health Stroke Scale (NIHSS) score ≤5 versus ≤3. METHODS We retrieved acute ischemic stroke patients with NIHSS score ≤5 in the CSCA study (China Stroke Center Alliance) between August 2015 and 2019. In-hospital clinical outcomes including all-cause mortality, stroke, and myocardial infarction were compared between the NIHSS score ≤5 and NIHSS score ≤3 groups using absolute standardized differences (ASD). RESULTS A total of 1 006 798 patients were registered in the CSCA program from 1476 hospitals, 472 352 patients had NIHSS score ≤5, of whom 356 314 patients had NIHSS score ≤3. The in-hospital composite events of death, myocardial infarction, or recurrent stroke were not significantly different between the NIHSS score ≤5 and NIHSS score ≤3 groups (5.6% [26 346/472 352] versus 5.2% [18 682/356 314]; ASD, 1.8). The in-hospital all-cause mortality (0.1% [443/472 352] versus 0.1% [255/356 314]; ASD, <0.01), recurrent ischemic stroke (5.3% [25 026/472 352] versus 5.0% [17 777/356 314]; ASD, 1.4), and hemorrhagic stroke (0.5% [2151/472 352] versus 0.4% [1475/356 314]; ASD, 1.5) were not significantly different between both the NIHSS score ≤5 and NIHSS score ≤3 groups. CONCLUSIONS Our large-scale study identified that minor stroke using NIHSS scores ≤5 and ≤3 as the definition was comparable with each other regarding in-hospital all-cause mortality, recurrent stroke, and hemorrhagic stroke. This observation may be useful for future comparison studies and clinical trial design.
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Affiliation(s)
- Yunyun Xiong
- Vascular Neurology, Department of Neurology (Y.X., X.-Q.Z., X.Y., C.W., Y.-L.W., Z.L., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.X., H.G., X.-Q.Z., Y.-L.W., L.-P.L., Q.Z., Z.L., Y.W.)
| | - Hongqiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing (Y.X., H.G., X.-Q.Z., Y.-L.W., L.-P.L., Q.Z., Z.L., Y.W.).,National Center for Healthcare Quality Management in Neurological Diseases, Beijing (H.G., X.Y., C.W., Z.L., Y.W.)
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology (Y.X., X.-Q.Z., X.Y., C.W., Y.-L.W., Z.L., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.X., H.G., X.-Q.Z., Y.-L.W., L.-P.L., Q.Z., Z.L., Y.W.)
| | - Xin Yang
- Vascular Neurology, Department of Neurology (Y.X., X.-Q.Z., X.Y., C.W., Y.-L.W., Z.L., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing (H.G., X.Y., C.W., Z.L., Y.W.)
| | - Chunjuan Wang
- Vascular Neurology, Department of Neurology (Y.X., X.-Q.Z., X.Y., C.W., Y.-L.W., Z.L., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing (H.G., X.Y., C.W., Z.L., Y.W.)
| | - Yi-Long Wang
- Vascular Neurology, Department of Neurology (Y.X., X.-Q.Z., X.Y., C.W., Y.-L.W., Z.L., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.X., H.G., X.-Q.Z., Y.-L.W., L.-P.L., Q.Z., Z.L., Y.W.)
| | - Li-Ping Liu
- Neuro-Intensive Care Unit, Department of Neurology (L.-P.L.), Beijing Tiantan Hospital, Capital Medical University, China.,China National Clinical Research Center for Neurological Diseases, Beijing (Y.X., H.G., X.-Q.Z., Y.-L.W., L.-P.L., Q.Z., Z.L., Y.W.)
| | - Qi Zhou
- China National Clinical Research Center for Neurological Diseases, Beijing (Y.X., H.G., X.-Q.Z., Y.-L.W., L.-P.L., Q.Z., Z.L., Y.W.)
| | - Marc Fisher
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.F.)
| | - Zixiao Li
- Vascular Neurology, Department of Neurology (Y.X., X.-Q.Z., X.Y., C.W., Y.-L.W., Z.L., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing (H.G., X.Y., C.W., Z.L., Y.W.).,Center for Stroke, Beijing Institute for Brain Disorders, China (Z.L., Y.W.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Z.L., Y.W.)
| | - Yongjun Wang
- Vascular Neurology, Department of Neurology (Y.X., X.-Q.Z., X.Y., C.W., Y.-L.W., Z.L., Y.W.), Beijing Tiantan Hospital, Capital Medical University, China.,National Center for Healthcare Quality Management in Neurological Diseases, Beijing (H.G., X.Y., C.W., Z.L., Y.W.).,Center for Stroke, Beijing Institute for Brain Disorders, China (Z.L., Y.W.).,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China (Z.L., Y.W.)
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20
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Kim BG, Kim GY, Cha JK. Pre-diabetes is a predictor of short-term poor outcomes after acute ischemic stroke using IV thrombolysis. BMC Neurol 2021; 21:72. [PMID: 33581738 PMCID: PMC7881609 DOI: 10.1186/s12883-021-02102-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/31/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUNDS Pre-diabetes is an intermediate state between normal glucose metabolism and diabetes. Recent studies suggest that the presence of pre-diabetes is associated with poor outcomes after AIS. However, the results have been controversial. This study examines whether pre-diabetes influences the patients' short and long-term outcomes for AIS using IV thrombolysis. METHODS We enrolled 661 AIS patients with IV thrombolysis. Based on the 2010 ADA guidelines, patients were classified as pre-diabetes, with HbA1c levels of 5.7-6.4%; diabetes, with HbA1c levels more than 6.5%; and NGM (normal glucose metabolism), with HbA1c levels less than 5.7%. We investigated short-term outcomes, including early neurologic deterioration (END), in-hospital death, and poor functional outcomes (mRS > 2) at 90 days. As for long-term outcomes, poor functional outcomes were measured at 1 year. RESULTS Of the 661 AIS patients treated with IV thrombolysis, 197 patients (29.8%) were diagnosed with pre-diabetes, and 210 (31.8%) were diagnosed with diabetes. In a multivariate analysis, pre-diabetes was an independent predictor for END (OR = 2.02; 95% CI 1.12-3.62; p = 0.02) and in-hospital death (OR = 3.12; 95% CI 1.06-9.09; p = 0.04). On the other hand, diabetes was a significant independent factor for poor long-term outcomes (OR = 1.75; 95% CI 1.09-2.78; p = 0.02) after correcting confounding factors. CONCLUSIONS Unlike diabetes, pre-diabetes can be an important predictor of short-term outcomes after AIS. However, a more detailed research is needed to specify the precise mechanisms through which pre-diabetes affects the prognosis of acute ischemic stroke.
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Affiliation(s)
- Byoung-Gwon Kim
- Department of Preventive Medicine, College Of Medicine, Dong-A University, Busan, Korea
| | - Ga Yeon Kim
- Stroke Center, Department of Neurology, College of Medicine, Dong-A University, 1,3Ga, Dongdaeshin-Dong, Seo-Gu, Busan, 602-715, South Korea
| | - Jae-Kwan Cha
- Stroke Center, Department of Neurology, College of Medicine, Dong-A University, 1,3Ga, Dongdaeshin-Dong, Seo-Gu, Busan, 602-715, South Korea.
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21
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Kang HJ, Lee EH, Kim JW, Kim SW, Shin IS, Kim JT, Park MS, Cho KH, Han JS, Lyoo IK, Kim JM. Association of SLC6A4 methylation with long-term outcomes after stroke: focus on the interaction with suicidal ideation. Sci Rep 2021; 11:2710. [PMID: 33526821 PMCID: PMC7851135 DOI: 10.1038/s41598-021-81854-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/31/2020] [Indexed: 12/15/2022] Open
Abstract
Serotonin (5-HT) plays an important role in cerebrovascular homeostasis and psychiatric disorders, including suicidality. Methylation of the serotonin transporter gene (SLC6A4) is associated with 5-HT expression. However, the prognostic roles of SLC6A4 methylation and suicidal ideation (SI) in long-term outcomes of stroke have not been evaluated. We investigated the independent and interactive effects of SLC6A4 methylation and SI immediately after stroke on long-term outcomes. Blood SLC6A4 methylation status and SI based on the suicide item of the Montgomery–Åsberg Depression Rating Scale were assessed in 278 patients at 2 weeks after stroke. After the index stroke, cerebro-cardiovascular events by SLC6A4 methylation status and SI were investigated over an 8–14-year follow-up period and using Cox regression models adjusted for a range of covariates. SLC6A4 hypermethylation and SI within 2 weeks of stroke both predicted worse long-term outcomes, independent of covariates. A significant interaction effect of SI and the methylation status of CpG 4 on long-term stroke outcomes was also identified. The association between SLC6A4 methylation and long-term adverse outcomes may be strengthened in the presence of SI within 2 weeks after stroke. Evaluation of methylation and SI status during the acute phase can be helpful when assessing stroke patients.
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Affiliation(s)
- Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, 160 Baekseoro, Dong-gu, Gwangju, 61669, Republic of Korea
| | - Eun-Hye Lee
- Department of Psychiatry, Chonnam National University Medical School, 160 Baekseoro, Dong-gu, Gwangju, 61669, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, 160 Baekseoro, Dong-gu, Gwangju, 61669, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, 160 Baekseoro, Dong-gu, Gwangju, 61669, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, 160 Baekseoro, Dong-gu, Gwangju, 61669, Republic of Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jung-Soo Han
- Department of Biological Science, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul, 05029, Republic of Korea
| | - In Kyoon Lyoo
- Ewha Brain Institute, Graduate School of Pharmaceutical Sciences, and Department of Brain and Cognitive Sciences, Ewha W. University, Seoul, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, 160 Baekseoro, Dong-gu, Gwangju, 61669, Republic of Korea.
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22
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Li L, Pan Y, Wang M, Jing J, Meng X, Jiang Y, Guo C, Jin Z, Wang Y. Trends and predictors of myocardial infarction or vascular death after ischaemic stroke or TIA in China, 2007-2018: insights from China National Stroke Registries. Stroke Vasc Neurol 2020; 6:214-221. [PMID: 33127855 PMCID: PMC8258052 DOI: 10.1136/svn-2020-000503] [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] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/09/2020] [Accepted: 09/24/2020] [Indexed: 11/04/2022] Open
Abstract
Background Although stroke management, primary and secondary preventions have been improved in China last decades, the trends and predictors of major vascular events after ischaemic stroke or transient ischaemic attack (TIA) at national scale are less known. Methods Data were obtained from the three phases of China National Stroke Registry (CNSR), including CNSR-Ⅰ (years 2007–2008), CNSR-Ⅱ (years 2012–2013) and CNSR-III (years 2015–2018). For comparison, patients who were diagnosed as ischaemic stroke or TIA were included. Kaplan-Meier estimates of myocardial infarction (MI) or vascular death were calculated at 1 year. Independent predictors were further assessed with a Cox proportional hazards regression. Results From 2007 to 2018, a total of 50 284 patients with ischaemic stroke or TIA were enrolled in this study. A declining trend was found in 1-year MI or vascular death (p for trend <0.001), while recurrent stroke depicted a U-shape curve with a nadir in 2012–2013 cohort. A similar trend was also observed in patients who were admitted to 26 hospitals in all three CNSRs. In 2015–2018 cohort, only 251 (1.7%; 95% CI 1.5% to 1.9%) MI or vascular death had occurred at 1 year. Older age, previous stroke or TIA, history of coronary artery disease and the National Institutes of Health Stroke Scale >6 were associated with both an increased risk of MI or vascular death and recurrent stroke. While early antiplatelet therapy and lipid-lowering agents at discharge predicted a reduced risk. Conclusion A declining trend and current low incidence of MI or vascular death, rather than recurrent stroke, after ischaemic stroke or TIA were observed in China. Traditional factors were found as independent predictors. These findings suggested there is still much room to improve for stroke management.
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Affiliation(s)
- Long Li
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Mengxing Wang
- 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
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Caixia Guo
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zening Jin
- Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 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
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23
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Liu Z, Lin W, Lu Q, Wang J, Liu P, Lin X, Wang F, Shi Y, Wang Q, Liu G, Wu S. Risk factors affecting the 1-year outcomes of minor ischemic stroke: results from Xi'an stroke registry study of China. BMC Neurol 2020; 20:379. [PMID: 33081723 PMCID: PMC7574206 DOI: 10.1186/s12883-020-01954-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/07/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The prevalence of stroke recurrence, disability, and all-cause mortality of patients with minor ischemic stroke (MIS) remains problematic. The aim of the present study was to identify risk factors associated with adverse outcomes at 1 year after MIS in the Xi'an region of China. METHODS This prospective cohort study included MIS patients above 18 years old with National Institutes of Health Stroke Scale (NIHSS) score ≤ 3 who were treated in any of four hospitals in Xi'an region of China between January and December 2015. The 1-year prevalence of stroke recurrence, disability, and all-cause mortality were evaluated, respectively. Multivariate logistic regression analysis was performed to assess the association between the identified risk factors and clinical outcomes. RESULTS In this study, 131(10.5%, 131/1252) patients were lost to follow-up at 1 year. A total of 1121 patients were included for analysis, the prevalence of stroke recurrence, disability, and all-cause mortality at 1 year after MIS were 3.4% (38/1121), 9.3% (104/1121), and 3.3% (37/1121), respectively. Multivariate logistic regression analysis identified age, current smoking, and pneumonia as independent risk factors for stroke recurrence. Age, pneumonia, and alkaline phosphatase were independent risk factors for all-cause mortality. Independent risk factors for disability were age, pneumonia, NIHSS score on admission, and leukocyte count. CONCLUSIONS The 1-year outcomes of MIS in Xi'an region of China were not optimistic, especially with a high prevalence of disability. The present study indicated that age and pneumonia were the common independent risk factors affecting the 1-year outcomes of MIS in Xi'an region of China.
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Affiliation(s)
- Zhongzhong Liu
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Wenjuan Lin
- College of life Science, Northwest University, Xi'an, 710069, Shaanxi, China
| | - Qingli Lu
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Jing Wang
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Pei Liu
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Xuemei Lin
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Fang Wang
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Yaling Shi
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Qing Wang
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Guozheng Liu
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China.,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China
| | - Songdi Wu
- The First Affiliated Hospital of Northwest University, Xi'an, 710069, Shaanxi, China. .,Department of Neurology, The First Hospital of Xi'an, No.30, Fenxiang Road, South Street, Xi'an, 710002, Shaanxi, China. .,College of life Science, Northwest University, Xi'an, 710069, Shaanxi, China.
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Reduction in Stroke After Transient Ischemic Attack in a Province-Wide Cohort Between 2003 and 2015. Can J Neurol Sci 2020; 48:335-343. [PMID: 32959741 DOI: 10.1017/cjn.2020.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Improvements in management of transient ischemic attack (TIA) have decreased stroke and mortality post-TIA. Studies examining trends over time on a provincial level are limited. We analyzed whether efforts to improve management have decreased the rate of stroke and mortality after TIA from 2003 to 2015 across an entire province. METHODS Using administrative data from the Canadian Institute for Health Information's (CIHI) databases from 2003 to 2015, we identified a cohort of patients with a diagnosis of TIA upon discharge from the emergency department (ED). We examined stroke rates at Day 1, 2, 7, 30, 90, 180, and 365 post-TIA and 1-year mortality rates and compared trends over time between 2003 and 2015. RESULTS From 2003 to 2015 in Ontario, there were 61,710 patients with an ED diagnosis of TIA. Linear regressions of stroke after the index TIA showed a significant decline between 2003 and 2015, decreasing by 25% at Day 180 and 32% at 1 year (p < 0.01). The 1-year stroke rate decreased from 6.0% in 2003 to 3.4% in 2015. Early (within 48 h) stroke after TIA continued to represent approximately half of the 1-year event rates. The 1-year mortality rate after ED discharge following a TIA decreased from 1.3% in 2003 to 0.3% in 2015 (p < 0.001). INTERPRETATION At a province-wide level, 1-year rates of stroke and mortality after TIA have declined significantly between 2003 and 2015, suggesting that efforts to improve management may have contributed toward the decline in long-term risk of stroke and mortality. Continued efforts are needed to further reduce the immediate risk of stroke following a TIA.
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Chen Y, Li J, Ou Z, Zhang Y, Liang Z, Deng W, Huang W, Wu Z, Jiang H, Liu Q, Ouyang F, Xing S, Zeng J. Safety and efficacy of low-dose aspirin in ischemic stroke patients with different G6PD conditions. Int J Stroke 2020; 16:411-419. [PMID: 32878589 DOI: 10.1177/1747493020950903] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Aspirin is the first recommended antiplatelet agent to prevention secondary stroke, but its safety and efficacy in stroke patients with glucose-6-phosphate dehydrogenase deficiency remain unclear. We sought to evaluate its safety and efficacy in ischemic stroke patients with and without glucose-6-phosphate dehydrogenase deficiency. METHODS Patients with ischemic stroke receiving aspirin (100 mg/day) for three months were recruited for a multicenter, prospective, cohort study. Blood glucose-6-phosphate dehydrogenase activity was examined after stroke. Safety outcomes including acute hemolysis, moderate-to-severe bleeding, and death (vascular, all-cause), and efficacy outcome indicated as stroke recurrence were evaluated at three months. Risk factors associated with moderate-to-severe bleeding and all-cause death were determined using multivariate or Cox regression analysis. RESULTS Among the included 1121 patients, 81 of 130 glucose-6-phosphate dehydrogenase deficient and 576 of 991 glucose-6-phosphate dehydrogenase normal patients received aspirin for three months. Acute hemolysis was observed in one of the glucose-6-phosphate dehydrogenase deficient and in none of the glucose-6-phosphate dehydrogenase normal patients (p = 0.876). The rates of moderate-to-severe bleeding were 2.5% and 0.3% (p = 0.045), and the percentages of all-cause death were 6.2% and 1.4% (p = 0.008) in the glucose-6-phosphate dehydrogenase deficient and glucose-6-phosphate dehydrogenase normal patients. Stroke recurrence rate was similar in the two groups (2.5% vs. 1.7%; p = 0.608). Glucose-6-phosphate dehydrogenase deficiency was significantly associated with increased risk of moderate-to-severe bleeding (adjust p = 0.048) and all-cause death during aspirin use (adjust p = 0.008). CONCLUSIONS Long-term low-dose aspirin therapy might relate to worse safety outcomes in patients with glucose-6-phosphate dehydrogenase deficiency and large clinical trials are needed to further confirm these findings.
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Affiliation(s)
- Yicong Chen
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jianle Li
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Zilin Ou
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Yusheng Zhang
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhijian Liang
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Weisheng Deng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Weixian Huang
- Department of Neurology, Meizhou People's Hospital, Meizhou, China
| | - Zhengdong Wu
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Haihong Jiang
- Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qinghua Liu
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fubing Ouyang
- Department of Neurology, Meizhou People's Hospital, Meizhou, China
| | - Shihui Xing
- Section II, Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jinsheng Zeng
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
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26
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Nomura E, Takemaru M, Himeno T, Kono R, Fukushima T, Ota S. Clinical features and efficacy of reperfusion therapy in minor ischemic stroke patients with atrial fibrillation. J Thromb Thrombolysis 2020; 50:608-613. [PMID: 32048168 DOI: 10.1007/s11239-020-02057-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The efficacy of reperfusion therapy (RT) using intravenous infusion of recombinant tissue plasminogen activator and/or endovascular therapy for minor ischemic stroke (MIS) has not yet been established. The present study aimed to elucidate the clinical features of MIS patients with atrial fibrillation (AF) and examine whether they could be potential candidates for RT. Data of MIS patients, defined as those with a score ≤ 5 on the National Institute of Health Stroke Scale, were extracted from patients admitted to our hospital between 2006 and 2018, and clinical characteristics were compared between the AF and non-AF groups. Thereafter, the impact of RT on outcomes in the AF- group was evaluated using the modified Rankin scale (mRS) score 3 months after onset and compared to that of standard medical therapy (SMT) using propensity score matching (PSM). Of 10,483 stroke patients, 3003 were shortlisted, and 457 AF patients and 2546 non-AF patients were finally selected. Patients in the AF group had more RT (13.3% vs. 5.7%, p < 0.001) than those in the non-AF group. Using PSM, 53 patients each were extracted from the AF-RT and AF-SMT groups. The frequencies of mRS = 0 or 1 for the AF-RT and AF-SMT groups were 69.8% and 64.2% (p = 0.536), respectively, with a significant difference in mRS = 0 (56.5% vs. 34.0%, p = 0.019). The present study found that MIS patients with AF underwent more RT than those without AF and that RT compared favorably with SMT for them; further study is warranted to examine whether these patients could be good candidates for RT.
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Affiliation(s)
- Eiichi Nomura
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, 3-6-28, Okinogami, Fukuyama, 720-0825, Japan.
| | - Makoto Takemaru
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, 3-6-28, Okinogami, Fukuyama, 720-0825, Japan
| | - Takahiro Himeno
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, 3-6-28, Okinogami, Fukuyama, 720-0825, Japan
| | - Ryuhei Kono
- Department of Neurology, Brain Attack Center Ota Memorial Hospital, 3-6-28, Okinogami, Fukuyama, 720-0825, Japan
| | - Tomoko Fukushima
- Department of Cerebrovascular Research, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
| | - Shinzo Ota
- Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan
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27
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Lan L, Rong X, Shen Q, Gong H, Li X, Wang H, Li M, Pan J, Zhang X, Peng Y. Effect of alteplase versus aspirin plus clopidogrel in acute minor stroke. Int J Neurosci 2020; 130:857-864. [PMID: 31928267 DOI: 10.1080/00207454.2019.1707822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and purpose: The optimal treatment for acute ischemic stroke with mild neurologic deficits is unclear. We aimed to compare the efficacy and safety of alteplase versus dual-antiplatelet therapy in acute minor stroke.Methods: We performed a retrospective cohort study of patients with minor ischemic stroke and National Institutes of Health Stroke Scale scores ≤5 presenting within 24 h from last seen normal. Patients were divided into intravenous alteplase or dual-antiplatelet therapy group. The primary outcome was a modified Rankin Scale (mRS) score of 0 or 1 at 90 days. Secondary outcomes included mRS score at 7 days, and composite outcome of vascular events within 90 days. The safety outcome was any intracranial hemorrhage (ICH) according to the ECASS II criteria. Clinical outcomes were compared using a multivariable logistic regression after adjusting for confounding factors. We then performed the propensity score matching as a sensitivity analysis.Results: Two hundred twenty-eight patients met the eligibility criteria were included for analysis between January 2015 and September 2018. In the aspirin-clopidogrel group, 109 patients (91.6%) achieved a favorable functional outcome at 3-month versus 85(78.0%) in the alteplase group (OR 4.463, 95%CI 1.708-11.662, p = .002). The difference of the composite outcome of vascular events were not statistical significance between the two groups (p > .05). Asymptomatic ICH occurred in 0.8% patients who received aspirin-clopidogrel, as compared with 3.7% patients in alteplase group (p = .030).Conclusions: Patients treated with dual-antiplatelet therapy with acute minor ischemic stroke had greater functional outcome at 3 months compared with patients who received alteplase therapy.Classification of evidence: This study provides Class IV evidence that dual-antiplatelet therapy is superior to alteplase for achieving a better functional outcome and does not increase the risk of hemorrhage in acute minor ischemic stroke.
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Affiliation(s)
- Lihuan Lan
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qingyu Shen
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.,Department of Neurology, The People's Hospital of Zengcheng District, Guangzhou, China
| | - Hanxian Gong
- Department of Neurology, The People's Hospital of Nanhai District, Foshan, China
| | - Xiangpen Li
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hongxuan Wang
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Mei Li
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jingrui Pan
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoni Zhang
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ying Peng
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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28
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Morsund ÅH, Ellekjær H, Gramstad A, Reiestad MT, Midgard R, Sando SB, Jonsbu E, Næss H. The development of cognitive and emotional impairment after a minor stroke: A longitudinal study. Acta Neurol Scand 2019; 140:281-289. [PMID: 31265131 DOI: 10.1111/ane.13143] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/05/2019] [Accepted: 06/26/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To study the development of cognitive and emotional symptoms between 3 and 12 months after a minor stroke. MATERIAL AND METHODS We included patients from stroke units at hospitals in the Central Norway Health Authority and from Haukeland University Hospital. We administered a selection of cognitive tests, and the patients completed a questionnaire 3 and 12 months post-stroke. Cognitive impairment was defined as impairment of ≥2 cognitive tests. RESULTS A total of 324 patients completed the 3-month testing, whereas 37 patients were lost to follow-up at 12 months. The results showed significant improvement of cognitive function defined as impairment of ≥2 cognitive tests (P = .03) from months 3 to 12. However, most patients still showed cognitive impairment at 12 months with a prevalence of 35.4%. There is significant association between several of the cognitive tests and hypertension and smoking (P = .002 and .05). The prevalence of depression, but not anxiety, increased from 3 to 12 months (P = .04). The prevalence of fatigue did not change and was thus still high with 29.5% after 12 months. CONCLUSIONS This study shows that an improvement of cognitive function still occurs between 3 and 12 months. Despite this, the prevalence of mostly minor cognitive impairment still remains high 12 months after the stroke. The increasing prevalence of depressive symptoms highlights the importance of being vigilant of depressive symptoms throughout the rehabilitation period. Furthermore, high prevalence of fatigue persisted.
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Affiliation(s)
- Åse H. Morsund
- Department of Neurology Møre and Romsdal Health Trust, Molde Hospital Molde Norway
- Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
| | - Hanne Ellekjær
- Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
- Stroke Unit, Department of Internal Medicine, St Olav's Hospital University Hospital of Trondheim Trondheim Norway
| | - Arne Gramstad
- Department of Neurology Haukeland University Hospital Bergen Norway
- Department of Biological and Medical Psychology University of Bergen Bergen Norway
| | - Magnus T. Reiestad
- Department of Psychiatry Møre and Romsdal Health Trust, Molde Hospital Molde Norway
| | - Rune Midgard
- Department of Neurology Møre and Romsdal Health Trust, Molde Hospital Molde Norway
- Unit for Applied Clinical Research Norwegian University of Science and Technology Trondheim Norway
| | - Sigrid B. Sando
- Department of Neuromedicine and Movement Science Norwegian University of Science and Technology Trondheim Norway
- Department of Neurology, St Olavs Hospital University Hospital of Trondheim Trondheim Norway
| | - Egil Jonsbu
- Department of Psychiatry Møre og Romsdal Health Trust Molde Norway
- Department of Mental Health Norwegian University of Science and Technology Trondheim Norway
| | - Halvor Næss
- Department of Neurology Haukeland University Hospital Bergen Norway
- Centre for Age‐related Medicine Stavanger University Hospital Stavanger Norway
- Institute of Clinical Medicine University of Bergen Bergen Norway
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29
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Patti G, Sticchi A, Bisignani A, Pelliccia F, Pasceri V, Speciale G, Penco M. Meta-Regression to Identify Patients Deriving the Greatest Benefit from Dual Antiplatelet Therapy after Stroke or Transient Ischemic Attack Without Thrombolytic or Thrombectomy Treatment. Am J Cardiol 2019; 124:627-635. [PMID: 31248591 DOI: 10.1016/j.amjcard.2019.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/01/2019] [Accepted: 05/13/2019] [Indexed: 12/24/2022]
Abstract
The patient's profile drawing the greatest benefit from dual antiplatelet therapy (DAPT) after a noncardioembolic, ischemic cerebrovascular event is not well characterized. Aim of this metaregression analysis was to compare DAPT versus single antiplatelet therapy (SAPT) in patients with stroke or transient ischemic attack (TIA). We searched randomized trials evaluating clinical outcome with aspirin plus a P2Y12 inhibitor versus SAPT in patients with noncardioembolic stroke or TIA. Primary end point was the incidence of recurrent stroke; safety outcome measure was major bleeding. Eleven trials were included in the analysis, enrolling 24,175 patients treated with DAPT (aspirin plus clopidogrel, n = 12,074) or SAPT (n = 12,101) after a stroke or TIA event. In the DAPT group the rates of recurrent stroke were lower (7.1% vs 8.8% with SAPT; odds ratios [OR] 0.74, 95% confidence interval 0.62 to 0.88; p = 0.0007) and the incidence of major bleeding was twofold higher (OR 2.01, 1.35 to 3.01; p = 0.0006). Metaregression indicated a positive correlation between prevention of recurrent stroke by DAPT and baseline stroke severity (p = 0.019), baseline risk profile (p = 0.0001), or prevalence of carotid atherosclerosis (p = 0.040). DAPT was more effective when initiated ≤7 days (OR 0.67, 0.58 to 0.77; p < 0.00001) and used for ≤3 months (OR 0.66, 0.58 to 0.76; p < 0.00001) after the event. In conclusion, in patients with stroke or TIA, the highest benefit of DAPT was observed in patients with higher baseline risk profile, greater stroke severity, or concomitant carotid disease, and when DAPT was initiated early and given for ≤3 months.
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Affiliation(s)
- Giuseppe Patti
- University of L'Aquila, L'Aquila, Italy; Campus Bio-Medico Hospital, Rome, Italy.
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30
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Ryu WS, Schellingerhout D, Hong KS, Jeong SW, Jang MU, Park MS, Choi KH, Kim JT, Kim BJ, Lee J, Cha JK, Kim DH, Nah HW, Lee SJ, Kim JG, Cho YJ, Lee BC, Yu KH, Oh MS, Park JM, Kang K, Lee KB, Park TH, Park SS, Lee J, Bae HJ, Kim DE. White matter hyperintensity load on stroke recurrence and mortality at 1 year after ischemic stroke. Neurology 2019; 93:e578-e589. [DOI: 10.1212/wnl.0000000000007896] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 03/18/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo define the role and risks associated with white matter hyperintensity (WMH) load in a stroke population with respect to recurrent stroke and mortality after ischemic stroke.MethodsA total of 7,101 patients at a network of university hospitals presenting with ischemic strokes were followed up for 1 year. Multivariable Cox proportional hazards model and competing risk analysis were used to examine the independent association between quartiles of WMH load and stroke recurrence and mortality at 1 year.ResultsOverall recurrent stroke risk at 1 year was 6.7%/y, divided between 5.6%/y for recurrent ischemic and 0.5%/y for recurrent hemorrhagic strokes. There was a stronger association between WMH volume and recurrent hemorrhagic stroke by quartile (hazard ratio [HR] 7.32, 14.12, and 33.52, respectively) than for ischemic recurrence (HR 1.03, 1.37, and 1.61, respectively), but the absolute incidence of ischemic recurrence by quartile was higher (3.8%/y, 4.5%/y, 6.3%/y, and 8.2%/y by quartiles) vs hemorrhagic recurrence (0.1%/y, 0.4%/y, 0.6%/y, and 1.3%/y). All-cause mortality (10.5%) showed a marked association with WMH volume (HR 1.06, 1.46, and 1.60), but this was attributable to nonvascular rather than vascular causes.ConclusionsThere is an association between WMH volume load and stroke recurrence, and this association is stronger for hemorrhagic than for ischemic stroke, although the absolute risk of ischemic recurrence remains higher. These data should be helpful to practitioners seeking to find the optimal preventive/treatment regimen for poststroke patients and to individualize risk-benefit ratios.
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Sadighi A, Abedi V, Stanciu A, El Andary N, Banciu M, Holland N, Zand R. Six-Month Outcome of Transient Ischemic Attack and Its Mimics. Front Neurol 2019; 10:294. [PMID: 30972019 PMCID: PMC6445867 DOI: 10.3389/fneur.2019.00294] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/06/2019] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: Although the risk of recurrent cerebral ischemia is higher after a transient ischemic attack (TIA), there is limited data on the outcome of TIA mimics. The goal of this study is to compare the 6-month outcome of patients with negative and positive diffusion-weighted imaging (DWI) TIAs (DWI-neg TIA vs. DWI-pos TIA) and also TIA mimics. Methods: We prospectively studied consecutive patients with an initial diagnosis of TIA in our tertiary stroke centers in a 2-year period. Every included patient had an initial magnetic resonance (MR) with DWI and one-, three-, and six-month follow-up visits. The primary outcome was defined as the composition of intracerebral hemorrhage, ischemic stroke, TIA, coronary artery disease, and death. Results: Out of 269 patients with the initial diagnosis of TIA, 259 patients (mean age 70.5 ± 15.0 [30-100] years old, 56.8% men) were included in the final analysis. Twenty-one (8.1%, 95% confidence interval [CI] 5.1-12.1%) patients had a composite outcome event within the six-month follow-up. Five (23.8%) and 13 (61.9%) composite outcome events occurred in the first 30 and 90 days, respectively. Among patients with DWI-neg TIA, the one- and six-month ischemic stroke rate was 1.5 and 4.6%, respectively. The incidence proportion of composite outcome event was significantly higher among patients who had the diagnosis of DWI-neg TIA compared with those who had the diagnosis of TIA mimics (12.2 vs. 2.1%-relative risk 5.9; 95% CI, 1.4-25.2). In our univariable analysis among patients with DWI-neg TIA and DWI-pos TIA, age (P = 0.017) was the only factor that was significantly associated with the occurrence of the composite outcome. Conclusion: Our study indicated that the overall six-month rate of the composite outcome among patients DWI-neg TIA, DWI-pos TIA, and TIA mimics were 12.2, 9.7, and 2.1%, respectively. Age was the only factor that was significantly associated with the occurrence of the composite outcome.
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Affiliation(s)
- Alireza Sadighi
- Department of Neurology, Geisinger Medical Center, Danville, PA, United States
| | - Vida Abedi
- Department of Bioinformatics, Geisinger Medical Center, Danville, PA, United States
| | - Alia Stanciu
- Freeman College of Management, Bucknell University, Lewisburg, PA, United States
| | - Nada El Andary
- Department of Neurology, Geisinger Medical Center, Danville, PA, United States
| | - Mihai Banciu
- Freeman College of Management, Bucknell University, Lewisburg, PA, United States
| | - Neil Holland
- Department of Neurology, Geisinger Medical Center, Danville, PA, United States
| | - Ramin Zand
- Department of Neurology, Geisinger Medical Center, Danville, PA, United States
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32
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Song B, Hu R, Pei L, Cao Y, Chen P, Sun S, Wang X, Tian X, Guo Y, Xu Y. Dual antiplatelet therapy reduced stroke risk in high-risk patients with transient ischaemic attack assessed by ABCD3-I score. Eur J Neurol 2018; 26:610-616. [PMID: 30414298 DOI: 10.1111/ene.13864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/06/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Several clinical trials have demonstrated that dual antiplatelet therapy (DAPT) benefited patients with transient ischaemic attack (TIA) with an ABCD2 score ≥4. The present study aimed to investigate whether the ABCD3-I score could be a more appropriate tool for selection of patients with TIA to receive DAPT in real-world settings. METHODS We derived data from the TIA database of The First Affiliated Hospital of Zhengzhou University. The predictive outcome was ischaemic stroke at 90 days. The additive interaction effect was presented by the attributable proportion due to interaction. Kaplan-Meier curves were plotted to present cumulative stroke rates in different risk categories with monotherapy and DAPT. Cox proportional hazards regression was used to determine risk factors associated with stroke. RESULTS Among 785 patients, the mean (SD) age was 56.95 (12.73) years and 77 patients (9.8%) had an ischaemic stroke at 90 days. A total of 55.8% of patients (attributable proportion due to interaction; 95% confidence interval, 20.8%-90.9%) were attributed to additive interaction of ABCD3-I score and antiplatelet therapy. Kaplan-Meier curves showed a significant difference between patients receiving monotherapy and DAPT in high-risk patients with TIA (P = 0.021). DAPT reduced 90-day stroke risk in high-risk patients with TIA as assessed independently by ABCD3-I score (adjusted hazard ratio, 0.43; 95% confidence interval, 0.20-0.92, P = 0.031). The benefit did not exist in low- and medium-risk patients by ABCD3-I score (patients with ABCD2 score ≥ 4 or <4). CONCLUSIONS High-risk patients with TIA assessed by ABCD3-I score received the most pronounced clinical benefit from early use of DAPT in real-world clinical experience.
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Affiliation(s)
- B Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - R Hu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - L Pei
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Y Cao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - P Chen
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - S Sun
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - X Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - X Tian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Y Guo
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Y Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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33
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Moris D, Spartalis M, Georgopoulos S. Letter by Moris et al Regarding Article, "One-Year Outcomes After Minor Stroke or High-Risk Transient Ischemic Attack: Korean Multicenter Stroke Registry Analysis". Stroke 2018; 49:e129. [PMID: 29438079 DOI: 10.1161/strokeaha.117.019762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Affiliation(s)
| | - Michael Spartalis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
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Park HK, Bae HJ. Response by Park and Bae to Letter Regarding Article, "One-Year Outcomes After Minor Stroke or High-Risk Transient Ischemic Attack: Korean Multicenter Stroke Registry Analysis". Stroke 2018; 49:e130. [PMID: 29438076 DOI: 10.1161/strokeaha.117.019815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hong-Kyun Park
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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