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Thomas RG, Kim JH, Kim JH, Yoon J, Choi KH, Jeong YY. Treatment of Ischemic Stroke by Atorvastatin-Loaded PEGylated Liposome. Transl Stroke Res 2024; 15:388-398. [PMID: 36639607 DOI: 10.1007/s12975-023-01125-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/16/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
There is insufficient evidence on the effect of nanoparticles, particularly liposomes loaded with a statin, on acute ischemic stroke. We investigated the impact of atorvastatin-loaded PEG (polyethylene glycol) conjugated liposomes (LipoStatin) on the outcomes in rats with cerebral ischemia-reperfusion. PEGylated liposome loaded with atorvastatin was developed as a nanoparticle to specifically accumulate in an ischemic region and release the drug to ameliorate the harmful effects of the stroke. LipoStatin was administered to rats with transient middle cerebral artery occlusion through the tail vein immediately after reperfusion (LipoStatin group). LipoStatin efficiently accumulated at the cerebral ischemic injury site of the rat. The LipoStatin group showed a significantly reduced infarct volume (p < 0.01) in brain micro-MR imaging and improved neurological function recovery compared to the control group (p < 0.05). In addition, markedly improved brain metabolism using fluorine-18 fluorodeoxyglucose micro-PET/CT imaging was demonstrated in the LipoStatin group compared with the control group (p < 0.01). Mechanistically, as a result of evaluation through IL-1 beta, TNF-alpha, ICAM-1, and Iba-1 mRNA expression levels at 5 days after cerebral ischemia, LipoStatin showed significant anti-inflammatory effects. Protein expression of occludin, JAM-A, Caveolin-1, and eNOS by western blot at 3 days and fluorescent images at 7 days showed considerable recovery of blood-brain barrier breakdown and endothelial dysfunction. PEGylated LipoStatin can be more effectively delivered to the ischemic brain and may have significant neuroprotective effects. Thus, PEGylated LipoStatin can be further developed as a promising targeted therapy for ischemic stroke and other major vascular diseases.
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Affiliation(s)
- Reju George Thomas
- Department of Radiology, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-Ro, Hwasun-Eup, Hwasun-Gun, Jeollanam-Do, 58128, South Korea
| | - Ja-Hae Kim
- Department of Nuclear Medicine, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Ji-Hye Kim
- Department of Neurology, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-Ro, Hwasun-Eup, Hwasun-Gun, Jeollanam-Do, 58128, South Korea
| | - Jungwon Yoon
- School of Integrated Technology, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-Ro, Hwasun-Eup, Hwasun-Gun, Jeollanam-Do, 58128, South Korea.
| | - Yong-Yeon Jeong
- Department of Radiology, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-Ro, Hwasun-Eup, Hwasun-Gun, Jeollanam-Do, 58128, South Korea.
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Lee M, Lee BC, Yu KH, Oh MS, Kim BJ, Kim JY, Kang J, Lee KJ, Kim DY, Park JM, Kang K, Park TH, Lee KB, Hong KS, Park HK, Cho YJ, Kim DE, Lee SJ, Kim JG, Lee J, Cha JK, Kim DH, Kim JT, Choi KH, Choi JC, Sohn SI, Hong JH, Lee SH, Kim C, Shin DI, Yum KS, Lee J, Lee JS, Gorelick PB, Bae HJ. Secular Trends in Outcomes and Impact of Novel Oral Anticoagulants in Atrial Fibrillation-Related Acute Ischemic Stroke. Stroke 2024; 55:625-633. [PMID: 38328909 DOI: 10.1161/strokeaha.123.044487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Novel oral anticoagulants (NOACs) are currently recommended for the secondary prevention of stroke in patients with acute ischemic stroke (AIS) accompanied by atrial fibrillation (AF). However, the impact of NOACs on clinical outcomes in real-world practice remains ambiguous. This study analyzes the trend of clinical events in patients with AF-related AIS and determines how much the introduction of NOACs has mediated this trend. METHODS We identified patients with AIS and AF between January 2011 and December 2019 using a multicenter stroke registry. Annual rates of NOAC prescriptions and clinical events within 1 year were evaluated. The primary outcome was a composite of recurrent stroke, myocardial infarction, and all-cause mortality. To assess the mediation effect of NOACs on the relationship between the calendar year and these outcomes, we used natural effect models and conducted exposure-mediator, exposure-outcome, and mediator-outcome analyses using multivariable regression models or accelerated failure time models, adjusting for potential confounders. RESULTS Among the 12 977 patients with AF-related AIS, 12 500 (average age: 74.4 years; 51.3% male) were analyzed after excluding cases of valvular AF. Between 2011 and 2019, there was a significant decrease in the 1-year incidence of the primary composite outcome from 28.3% to 21.7%, while the NOAC prescription rate increased from 0% to 75.6%. A 1-year increase in the calendar year was independently associated with delayed occurrence of the primary outcome (adjusted time ratio, 1.10 [95% CI, 1.07-1.14]) and increased NOAC prescription (adjusted odds ratio, 2.20 [95% CI, 2.14-2.27]). Increased NOAC prescription was associated with delayed occurrence of the primary outcome (adjusted time ratio, 3.82 [95% CI, 3.17 to 4.61]). Upon controlling for NOAC prescription (mediator), the calendar year no longer influenced the primary outcome (adjusted time ratio, 0.97 [95% CI, 0.94-1.00]). This suggests that NOAC prescription mediates the association between the calendar year and the primary outcome. CONCLUSIONS Our study highlights a temporal reduction in major clinical events or death in Korean patients with AF-related AIS, mediated by increased NOAC prescription, emphasizing NOAC use in this population.
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Affiliation(s)
- Minwoo Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Republic of Korea (M.L., B.-C.L., K.-H.Y., M.-S.O.)
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Republic of Korea (M.L., B.-C.L., K.-H.Y., M.-S.O.)
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Republic of Korea (M.L., B.-C.L., K.-H.Y., M.-S.O.)
| | - Mi-Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Republic of Korea (M.L., B.-C.L., K.-H.Y., M.-S.O.)
| | - Beom Joon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea (B.J.K., J.Y.K., J.K., D.Y.K., H.-J.B.)
| | - Jun Yup Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea (B.J.K., J.Y.K., J.K., D.Y.K., H.-J.B.)
| | - Jihoon Kang
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea (B.J.K., J.Y.K., J.K., D.Y.K., H.-J.B.)
| | - Keon-Joo Lee
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (K.-J.L.)
| | - Do Yeon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea (B.J.K., J.Y.K., J.K., D.Y.K., H.-J.B.)
| | - Jong-Moo Park
- Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea (J.-M.P.)
| | - Kyusik Kang
- Nowon Elji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea (K.K.)
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Republic of Korea (T.H.P.)
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital Seoul, Republic of Korea (K.B.L.)
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang-si, Republic of Korea (K.-S.H., H.-K.P., Y.-J.C.)
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang-si, Republic of Korea (K.-S.H., H.-K.P., Y.-J.C.)
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang-si, Republic of Korea (K.-S.H., H.-K.P., Y.-J.C.)
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang-si, Republic of Korea (D.-E.K., S.J.L.)
| | - Soo Joo Lee
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang-si, Republic of Korea (D.-E.K., S.J.L.)
| | - Jae Guk Kim
- Department of Neurology, Eulji University Hospital, Daejeon, Republic of Korea (J.G.K.)
| | - Jun Lee
- Department of Neurology, Yeungnam University Medical Center, Daegu, Republic of Korea (Jun Lee)
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea (J.-K.C., D.-H.K.)
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea (J.-K.C., D.-H.K.)
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea (J.-T.K., K.-H.C.)
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea (J.-T.K., K.-H.C.)
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Republic of Korea (J.C.C.)
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Hospital, Daegu, Republic of Korea (S.-I.S., J.-H.H.)
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Hospital, Daegu, Republic of Korea (S.-I.S., J.-H.H.)
| | - Sang-Hwa Lee
- Department of Neurology, Chuncheon Sacred Heart Hospital, Republic of Korea (S.-H.L., C.K.)
| | - Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Republic of Korea (S.-H.L., C.K.)
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.-I.S., K.S.Y.)
| | - Kyu Sun Yum
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.-I.S., K.S.Y.)
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea (Juneyoung Lee)
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Philip B Gorelick
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.B.G.)
| | - Hee-Joon Bae
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnamsi, Republic of Korea (B.J.K., J.Y.K., J.K., D.Y.K., H.-J.B.)
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Nam KW, Kim CK, Yu S, Oh K, Chung JW, Oh YB, Kim GM, Jung JM, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Seo WK. Corrigendum to "D-dimer to fibrinogen ratio predicts early neurological deterioration in ischemic stroke with atrial fibrillation" [Thromb. Res. 229 (2023) 219-224]. Thromb Res 2024; 233:173. [PMID: 38070220 DOI: 10.1016/j.thromres.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2024]
Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Bang Oh
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University, School of Medicine, Seoul, South Korea
| | - Yong-Jae Kim
- Department of Neurology, the Catholic University of Korea, Seoul, South Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of medicine, Seoul, South Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju, South Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Yang Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Dae-gu, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Digital Health, SHAIST, Sungkyunkwan University, Seoul, South Korea
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Kim J, Kim JY, Kang J, Kim BJ, Han MK, Lee JY, Park TH, Lee KJ, Kim JT, Choi KH, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Lee K, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DI, Yum KS, Sohn SI, Hong JH, Lee SH, Lee JS, Lee J, Gorelick PB, Bae HJ. Improvement in Delivery of Ischemic Stroke Treatments but Stagnation of Clinical Outcomes in Young Adults in South Korea. Stroke 2023; 54:3002-3011. [PMID: 37942640 DOI: 10.1161/strokeaha.123.044619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND There is limited information on the delivery of acute stroke therapies and secondary preventive measures and clinical outcomes over time in young adults with acute ischemic stroke. This study investigated whether advances in these treatments improved outcomes in this population. METHODS Using a prospective multicenter stroke registry in Korea, young adults (aged 18-50 years) with acute ischemic stroke hospitalized between 2008 and 2019 were identified. The observation period was divided into 4 epochs: 2008 to 2010, 2011 to 2013, 2014 to 2016, and 2017 to 2019. Secular trends for patient characteristics, treatments, and outcomes were analyzed. RESULTS A total of 7050 eligible patients (mean age, 43.1; men, 71.9%) were registered. The mean age decreased from 43.6 to 42.9 years (Ptrend=0.01). Current smoking decreased, whereas obesity increased. Other risk factors remained unchanged. Intravenous thrombolysis and mechanical thrombectomy rates increased over time from 2008 to 2010 to 2017 to 2019 (9.5%-13.8% and 3.2%-9.2%, respectively; Ptrend<0.01). Door-to-needle time improved (Ptrend <.001), but onset-to-door and door-to-puncture times remained constant. Secondary prevention, including dual antiplatelets for noncardioembolic minor stroke (26.7%-47.0%), direct oral anticoagulants for atrial fibrillation (0.0%-56.2%), and statins for large artery atherosclerosis (76.1%-95.3%) increased (Ptrend<0.01). Outcome data were available from 2011. One-year mortality (2.5% in 2011-2013 and 2.3% in 2017-2019) and 3-month modified Rankin Scale scores 0 to 1 (68.3%-69.1%) and 0 to 2 (87.6%-86.2%) remained unchanged. The 1-year stroke recurrence rate increased (4.1%-5.5%; Ptrend=0.04), although the difference was not significant after adjusting for sex and age. CONCLUSIONS Improvements in the delivery of acute stroke treatments did not necessarily lead to better outcomes in young adults with acute ischemic stroke over the past decade, indicating a need for further progress.
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Affiliation(s)
- Jonguk Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (J. Kim , J.Y.K., J.K., B.J.K., M.-K.H., J.-Y.L., H.-J.B.)
| | - Jun Yup Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (J. Kim , J.Y.K., J.K., B.J.K., M.-K.H., J.-Y.L., H.-J.B.)
| | - Jihoon Kang
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (J. Kim , J.Y.K., J.K., B.J.K., M.-K.H., J.-Y.L., H.-J.B.)
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (J. Kim , J.Y.K., J.K., B.J.K., M.-K.H., J.-Y.L., H.-J.B.)
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (J. Kim , J.Y.K., J.K., B.J.K., M.-K.H., J.-Y.L., H.-J.B.)
| | - Jeong-Yoon Lee
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (J. Kim , J.Y.K., J.K., B.J.K., M.-K.H., J.-Y.L., H.-J.B.)
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Korea (T.H.P.)
| | - Keon-Joo Lee
- Korea University Guro Hospital, Seoul, Korea (K.-J.L.)
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K., K.-H.C.)
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K., K.-H.C.)
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Korea (J.-M.P.)
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Department of Neurology, Eulji University School of Medicine, Seoul, Korea (K.K.)
| | - Soo Joo Lee
- Eulji University Hospital, Daejeon, Korea (S.J.L., J.G.K.)
| | - Jae Guk Kim
- Eulji University Hospital, Daejeon, Korea (S.J.L., J.G.K.)
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K.)
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K.)
| | - Kyungbok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea (K.L.)
| | - Jun Lee
- Department of Neurology, Yeungnam University Medical Center, Daegu, Korea (J.L.)
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea (K.-S.H., Y.-J.C., H.-K.P.)
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea (K.-S.H., Y.-J.C., H.-K.P.)
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea (K.-S.H., Y.-J.C., H.-K.P.)
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.-S.O.)
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.-S.O.)
| | - Mi-Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.-S.O.)
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea (D.-E.K., W.-S.R.)
| | - Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea (D.-E.K., W.-S.R.)
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Korea (J.C.C.)
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, Korea (J.-H.W., W.-J.K.)
| | - Wook-Joo Kim
- Department of Neurology, Ulsan University Hospital, Korea (J.-H.W., W.-J.K.)
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University and Hospital, Cheongju, Korea (D.-I.S., K.S.Y.)
| | - Kyu Sun Yum
- Department of Neurology, Chungbuk National University and Hospital, Cheongju, Korea (D.-I.S., K.S.Y.)
| | - Sung Il Sohn
- Department of Neurology, Keimyung University Dongsan Hospital, Daegu, Korea (S.I.S., J.H.)
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Hospital, Daegu, Korea (S.I.S., J.H.)
| | - Sang-Hwa Lee
- Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea (S.-H.L.)
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Korea (J.S.L.)
| | - Juneyoung Lee
- Department of Biostatistics, Korea University, Seoul, Korea (J.L.)
| | - Philip B Gorelick
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.B.G)
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (J. Kim , J.Y.K., J.K., B.J.K., M.-K.H., J.-Y.L., H.-J.B.)
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Choi KH, Mun SM, Seol Y, Lee YK, Lee JH, Lee IK, Lee YS, Jang H. The Role of Postoperative Radiotherapy in T4 Rectal Cancer with Synchronous Distant Metastasis. Int J Radiat Oncol Biol Phys 2023; 117:e288. [PMID: 37785066 DOI: 10.1016/j.ijrobp.2023.06.1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Studieson the role of surgery and local treatment in M1 rectal cancer have been actively studied recently. However, there is still controversy because no significant results have been reported for local control. The purpose of this study was to analyze the local control rates of postoperative radiotherapy for tumor stage T4 in M1 rectal cancer. MATERIALS/METHODS We investigated local recurrence after surgery for M1 rectal cancer that was operated at Seoul St. Mary's Hospital between 1995 and 2021. Locoregional recurrence rates were compared in patients who received postoperative pelvic radiotherapy and those who did not. In addition, an analytical comparison was performed only for patients with T4 rectal cancer. Statistical analysis was performed using the log rank test, and a p-value of less than 0.05 was considered significant. RESULTS During the investigation period, a total of 206 patients underwent surgery for M1 rectal cancer. There were 55 patients with T4 tumor stage. Of the 55 patients, 11 patients received radiotherapy after surgery, and 44 patients received systemic treatment such as chemotherapy after surgery without radiotherapy. During a median follow-up of 22 months, locoregional recurrence occurred in 1 (RT group) and 25 (no RT group) patients, respectively. Log-rank analysis of locoregional recurrence showed a significant difference between the two groups (p- value = 0.008). Death occurred in 10 (RT group) and 38 (no RT group) patients, respectively. The 2-year locoregional recurrence free-survival rates were 45.5% and 53.0%, respectively, and there was no significant difference between the two groups in the log-rank analysis. CONCLUSION Pelvic radiotherapy could be expected to improve locoregional recurrence in stage T4 of rectal cancer with synchronous distant metastasis. It would be warranted to prove this in a large-scale prospective study.
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Affiliation(s)
- K H Choi
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South) Korea
| | - S M Mun
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South) Korea
| | - Y Seol
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South) Korea
| | - Y K Lee
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South) Korea
| | - J H Lee
- Department of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea, Republic of (South) Korea
| | - I K Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South) Korea
| | - Y S Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South) Korea
| | - H Jang
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South) Korea
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Park CB, Kang YN, Jang H, Kim YS, Choi BO, Son SH, Song JH, Choi KH, Lee YK, Sung W, Kim JL. Evaluation of Usefulness of Yeast-Based Biological Phantom and Preliminary Study for Verification of Hypoxic Effect of Flash Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e704. [PMID: 37786063 DOI: 10.1016/j.ijrobp.2023.06.2193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) As a basic hypothesis for the effectiveness of flash radiation therapy, the effect of preserving normal tissue during flash radiation is due to the instantaneous chemical depletion of oxygen. A yeast-based biological phantom was created to verify the hypoxic effect of flash radiation therapy. A study to upgrade the previously developed X-Band LINAC to a flash irradiation mode is in progress, and a preceding study is conducted to evaluate the usefulness of a yeast-based biological phantom manufactured by analyzing the change in oxygen by irradiating a high dose in a general radiation therapy device. MATERIALS/METHODS Freeze-dried yeast sample (Saccharomyces cerevisiae, S288C) is activated and sub-cultured. For mass production of yeast samples, yeast culture medium is prepared by adding yeast colonies to the ypd medium. This study was conducted to verify the hypoxic effect among the biological mechanisms that occur during flash radiation therapy at the basic stage, and the oxygen concentration change during general radiation irradiation was measured in real time using a DO (Dissolved oxygen) meter and fiber optic sensor designed to do that. To prevent scatter, which is a concern during flash irradiation, the fiber form was used, and precise experiments are possible as a non-invasive oxygen concentration measurement method. Based on 10MV of general radiation therapy device, high-dose radiation of 500-10,000 cGy is irradiated to measure real-time oxygen concentration change. RESULTS As a result of irradiation with high-dose (500-10,000 cGy) radiation of general LINAC, it was confirmed that the oxygen concentration of the yeast culture medium decreased by 5.7-63.2%, and the usefulness of the biological phantom fabricated based on the yeast culture medium was evaluated. CONCLUSION Prior to the analysis of oxygen concentration change in yeast cells during X-Band LINAC flash irradiation, a preliminary study was conducted at a high dose in a general LINAC to obtain a significant result of oxygen concentration change and confirm the usefulness of the yeast-based biological phantom. Prior research was conducted and verified as a general irradiation experiment using a yeast-based biological phantom manufactured based on a DO meter and a fiber optic oxygen sensor. After irradiation with high-dose radiation, the oxygen concentration of the yeast culture medium was measured 5 times, and it was confirmed that there was a change in oxygen concentration of 5.7-63.2%, verifying the usefulness and stability of the biological phantom. The usefulness of the yeast-based biological phantom for high doses was confirmed, and it is expected that the usefulness of the biological phantom for flash radiation can be verified by additionally measuring the change in oxygen concentration of the biological phantom according to the high dose rate in the future.
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Affiliation(s)
- C B Park
- Department of Biomedicine & Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South) Korea
| | - Y N Kang
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South) Korea
| | - H Jang
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South) Korea
| | - Y S Kim
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South) Korea
| | - B O Choi
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South) Korea
| | - S H Son
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South) Korea
| | - J H Song
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South) Korea
| | - K H Choi
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South) Korea
| | - Y K Lee
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South) Korea
| | - W Sung
- Department of Biomedical Engineering and Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, Korea, Republic of (South) Korea
| | - J L Kim
- Electro-Medical Device Research Center, Korea Electrotechnology Research Institute, Ansan, Korea, Republic of (South) Korea
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7
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nam KW, Kim CK, Yu S, Oh K, Chung JW, Bang OY, Kim GM, Jung JM, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Seo WK. D-dimer to fibrinogen ratio predicts early neurological deterioration in ischemic stroke with atrial fibrillation. Thromb Res 2023; 229:219-224. [PMID: 37562164 DOI: 10.1016/j.thromres.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION The D-dimer to fibrinogen ratio (DFR) is a good indicator of clot-producing activity in thrombotic disease, but its clinical usefulness in stroke patients with nonvalvular atrial fibrillation (NVAF) has not been studied. We evaluated the association between the DFR and early neurological deterioration (END) in acute ischemic stroke (AIS) patients with NVAF. METHODS We included consecutive AIS patients with NVAF between 2013 and 2015 from the registry of a real-world prospective cohort from 11 large centers in South Korea. END was defined as an increase ≥2 in the total NIHSS score or ≥ 1 in the motor NIHSS score within the first 72 h of admission. The DFR was calculated as follows: DFR = D-dimer (mg/L)/fibrinogen (mg/dL) x 100. RESULTS A total of 1018 AIS patients with NVAF were evaluated. In multivariable logistic regression analysis, the highest DFR tertile was closely associated with END (adjusted odds ratio [aOR] = 2.14, 95 % confidence interval [CI]: 1.24-3.69). Hypertension (aOR = 1.71, 95 % CI: 1.09-2.70), initial NIHSS score (aOR = 1.05, 95 % CI: 1.02-1.07) and use of anticoagulants (aOR = 0.41, 95 % CI: 0.28-0.60) were also correlated with END. In addition to END, the DFR was correlated with discharge NIHSS and modified Rankin Scale (mRS) scores and the 3-month mRS score. CONCLUSIONS High DFR values were associated with END in AIS patients with NVAF. As the DFR is an indicator directly related to the main pathological mechanism of NVAF patients (fibrinolysis and coagulation), it may be useful in predicting their prognosis.
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Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University, School of Medicine, Seoul, South Korea
| | - Yong-Jae Kim
- Department of Neurology, the Catholic University of Korea, Seoul, South Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of medicine, Seoul, South Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju, South Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Yang Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Dae-gu, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Departement of Digital Health, SHAIST, Sungkyunkwan University, Seoul, South Korea
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Kim JT, Lee JS, Kim BJ, Kang J, Lee KJ, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Park TH, Lee K, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DI, Yum KS, Sohn SI, Hong JH, Lee SH, Park MS, Choi KH, Lee J, Park KY, Bae HJ. Admission LDL-cholesterol, statin pretreatment and early outcomes in acute ischemic stroke. J Clin Lipidol 2023; 17:612-621. [PMID: 37574400 DOI: 10.1016/j.jacl.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Lipid paradox of low LDL-C may cause physicians to be reluctant to use statins in acute ischemic stroke (AIS) patients with low LDL-C levels at admission. OBJECTIVE This study investigated the association between LDL-C levels and early vascular outcomes and assessed the potential interaction effect between LDL-C and statin pretreatment on early outcomes. PATIENTS AND METHODS This was a study of a prospective, multicenter, registry of AIS patients with admission LDL-C. The subjects were divided into 3 groups according to LDL-C levels: low LDL-C (≤100 mg/dL); intermediate LDL-C (>100, <130 mg/dL); and high LDL-C (≥130 mg/dL). The primary early vascular outcome was a composite of stroke (ischemic or hemorrhagic), myocardial infarction and all-cause mortality within 3 months. The associations of LDL-C levels as a continuous variable and the risks of primary outcome using Cox proportional hazards models with restricted cubic splines were explored. RESULTS A total of 32,505 patients (age, 69 ± 12; male, 58.6%) were analyzed. The 3 groups showed significant differences in the 3-month primary outcome, with highest events in the low LDL-C group; after adjustment, no significant associations with the 3-month primary outcome remained. U-shaped nonlinear relationships of LDL-C levels with the 3-month primary outcome were observed (Pnon-linearity<0.001), with substantial relationships in the no pretreatment subgroup. CONCLUSIONS The relationships between admission LDL-C levels and early outcomes are complex but appear to be paradoxical in patients with low LDL-C and no statin pretreatment. The results suggest that statin pretreatment might offset the paradoxical response of low LDL-C on early vascular outcomes. Further study would be warranted.
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Affiliation(s)
- Joon-Tae Kim
- Department of Neurology (Drs Kim, Park, Choi), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
| | - Ji Sung Lee
- Clinical Research Center (Dr Lee), Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Joon Kim
- Department of Neurology (Drs Kim, Kang, Lee, Bae), Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jihoon Kang
- Department of Neurology (Drs Kim, Kang, Lee, Bae), Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Keon-Joo Lee
- Department of Neurology (Dr Lee), Korea University Guro Hospital, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology (Dr Park), Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si, Korea
| | - Kyusik Kang
- Department of Neurology (Dr Kang), Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Soo Joo Lee
- Department of Neurology (Drs Lee, Kim), Eulji University Hospital, Eulji University, Daejeon, Korea
| | - Jae Guk Kim
- Department of Neurology (Drs Lee, Kim), Eulji University Hospital, Eulji University, Daejeon, Korea
| | - Jae-Kwan Cha
- Department of Neurology (Drs Cha, Kim), Dong-A University Hospital, Busan, Korea
| | - Dae-Hyun Kim
- Department of Neurology (Drs Cha, Kim), Dong-A University Hospital, Busan, Korea
| | - Tai Hwan Park
- Department of Neurology (Dr Park), Seoul Medical Center, Seoul, Korea
| | - Kyungbok Lee
- Department of Neurology (Dr Lee), Soonchunhyang University Hospital, Seoul, Korea
| | - Jun Lee
- Department of Neurology (Dr Lee), Yeungnam University Hospital, Daegu, Korea
| | - Keun-Sik Hong
- Department of Neurology (Drs Hong, Cho, Park), Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Yong-Jin Cho
- Department of Neurology (Drs Hong, Cho, Park), Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Hong-Kyun Park
- Department of Neurology (Drs Hong, Cho, Park), Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Byung-Chul Lee
- Department of Neurology (Drs Lee, Yu, Oh), Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kyung-Ho Yu
- Department of Neurology (Drs Lee, Yu, Oh), Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Mi Sun Oh
- Department of Neurology (Drs Lee, Yu, Oh), Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Dong-Eog Kim
- Department of Neurology (Drs Kim, Ryu), Dongguk University Ilsan Hospital, Goyang, Korea
| | - Wi-Sun Ryu
- Department of Neurology (Drs Kim, Ryu), Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jay Chol Choi
- Department of Neurology (Dr Choi), Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Jee-Hyun Kwon
- Department of Neurology (Drs Kwon, Kim), Ulsan University College of Medicine, Ulsan, Korea
| | - Wook-Joo Kim
- Department of Neurology (Drs Kwon, Kim), Ulsan University College of Medicine, Ulsan, Korea
| | - Dong-Ick Shin
- Department of Neurology (Drs Shin, Yum), Chungbuk National University Hospital, Cheongju, Korea
| | - Kyu Sun Yum
- Department of Neurology (Drs Shin, Yum), Chungbuk National University Hospital, Cheongju, Korea
| | - Sung Il Sohn
- Department of Neurology (Drs Sohn, Hong), Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jeong-Ho Hong
- Department of Neurology (Drs Sohn, Hong), Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Sang-Hwa Lee
- Department of Neurology (Dr Lee), Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Man-Seok Park
- Department of Neurology (Drs Kim, Park, Choi), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kang-Ho Choi
- Department of Neurology (Drs Kim, Park, Choi), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Juneyoung Lee
- Department of Biostatistics (Dr Lee), Korea University College of Medicine, Seoul, Korea
| | - Kwang-Yeol Park
- Department of Neurology (Dr Park), Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology (Drs Kim, Kang, Lee, Bae), Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
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Yang BSK, Jang M, Lee KJ, Kim BJ, Han MK, Kim JT, Choi KH, Cha JK, Kim DH, Kim DE, Ryu WS, Park JM, Kang K, Lee SJ, Kim JG, Oh MS, Yu KH, Lee BC, Hong KS, Cho YJ, Choi JC, Park TH, Lee KB, Kwon JH, Kim WJ, Sohn SI, Hong JH, Lee J, Lee SH, Lee JS, Lee J, Gorelick PB, Bae HJ. Comparison of Hospital Performance in Acute Ischemic Stroke Based on Mortality and Functional Outcome in South Korea. Circ Cardiovasc Qual Outcomes 2023; 16:554-565. [PMID: 37465993 DOI: 10.1161/circoutcomes.122.009653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 06/14/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Recent evidence suggests a correlation between modified Rankin Scale-based measures, an outcome measure commonly used in acute stroke trials, and mortality-based measures used by health agencies in the evaluation of hospital performance. We aimed to examine whether the 2 types of measures are interchangeable in relation to evaluation of hospital performance in acute ischemic stroke. METHODS Five outcome measures, unfavorable functional outcome (3-month modified Rankin Scale score ≥2), death or dependency (3-month modified Rankin Scale score ≥3), 1-month mortality, 3-month mortality, and 1-year mortality, were collected for 8292 individuals who were hospitalized for acute ischemic stroke between January 2014 and May 2015 in 14 hospitals participating in the Clinical Research Collaboration for Stroke in Korea - National Institute of Health registry. Hierarchical regression models were used to calculate per-hospital risk-adjusted outcome rates for each measure. Hospitals were ranked and grouped based on the risk-adjusted outcome rates, and the correlations between the modified Rankin Scale-based and mortality-based ranking and their intermeasure reliability in categorizing hospital performance were analyzed. RESULTS The comparison between the ranking based on the unfavorable functional outcome and that based on 1-year mortality resulted in a Spearman correlation coefficient of -0.29 and Kendall rank coefficient of -0.23, and the comparison of grouping based on these 2 types of ranks resulted in a weighted kappa of 0.123 for the grouping in the top 33%/middle 33%/bottom 33% and 0.25 for the grouping in the top 20%/middle 60%/bottom 20%, respectively. No significant correlation or similarity in grouping capacities were found between the rankings based on the functional outcome measures and those based on the mortality measures. CONCLUSIONS This study shows that regardless of clinical correlation at an individual patient level, functional outcome-based measures and mortality-based measures are not interchangeable in the evaluation of hospital performance in acute ischemic stroke.
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Affiliation(s)
- Bosco Seong Kyu Yang
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (B.S.K.Y., K.-J.L., B.J.K., M.-K.H., H.-J.B.)
| | - Minuk Jang
- Department of Neurology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea (M.-J.)
| | - Keon-Joo Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (B.S.K.Y., K.-J.L., B.J.K., M.-K.H., H.-J.B.)
- Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea (K.-J.L.)
| | - Beom Joon Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (B.S.K.Y., K.-J.L., B.J.K., M.-K.H., H.-J.B.)
| | - Moon-Ku Han
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (B.S.K.Y., K.-J.L., B.J.K., M.-K.H., H.-J.B.)
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea (J.-T.K., K.-H.C.)
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea (J.-T.K., K.-H.C.)
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea (J.-K.C., D.-H.K.)
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea (J.-K.C., D.-H.K.)
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea (D.-E.K., W.-S.R.)
| | - Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea (D.-E.K., W.-S.R.)
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Seoul, Republic of Korea (J.-M.P.)
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea (K.K.)
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Daejeon, Republic of Korea (S.J.L.)
| | - Jae Guk Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.G.K., M.-S.O., K.-H.Y., B.-C.L.)
| | - Mi-Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.G.K., M.-S.O., K.-H.Y., B.-C.L.)
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.G.K., M.-S.O., K.-H.Y., B.-C.L.)
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.G.K., M.-S.O., K.-H.Y., B.-C.L.)
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (K.-S.H., Y.-J.C.)
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (K.-S.H., Y.-J.C.)
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Republic of Korea (J.C.C.)
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Republic of Korea (T.H.P.)
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, College of Medicine, Seoul, Republic of Korea (K.B.L.)
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Republic of Korea (J.-H.K., W.-J.K.)
| | - Wook-Joo Kim
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Republic of Korea (J.-H.K., W.-J.K.)
| | - Sung Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea (S.I.S., J.-H.H.)
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea (S.I.S., J.-H.H.)
| | - Jun Lee
- Department of Neurology, Yeungnam University Medical Center, Daegu, Republic of Korea (J.L.)
| | - Sang-Hwa Lee
- Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, South Korea (S.-H.L.)
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.)
| | - Juneyoung Lee
- Department of Biostatistics, Korea University, Seoul (J.L.)
| | - Philip B Gorelick
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.B.G.)
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (B.S.K.Y., K.-J.L., B.J.K., M.-K.H., H.-J.B.)
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11
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Ryu WS, Chung J, Schellingerhout D, Jeong SW, Kim HR, Park JE, Kim BJ, Kim JT, Hong KS, Lee KB, Park TH, Park SS, Park JM, Kang K, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Lee SJ, Kim JG, Cha JK, Kim DH, Lee J, Han MK, Park MS, Choi KH, Lee J, Bae HJ, Kim DE. Biological mechanism of sex difference in stroke manifestation and outcomes. Neurology 2023:WNL.0000000000207346. [PMID: 37094993 DOI: 10.1212/wnl.0000000000207346] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/10/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Female patients tend to have greater disability and worse long-term outcomes after stroke than male patients. To date, the biological basis of sex difference in ischemic stroke remains unclear. We aimed to 1) assess sex differences in clinical manifestation and outcomes of acute ischemic stroke and 2) investigate whether the sex disparity is due to different infarct locations or different impacts of infarct in the same location. METHODS This MRI-based multicenter study included 6,464 consecutive patients with acute ischemic stroke (<7-days) from 11-centers in South-Korea (May-2011∼January-2013). Multivariable statistical and brain mapping methods were used to analyze clinical and imaging data collected prospectively: admission National Institutes of Health Stroke Scale (NIHSS)-score, early neurological deterioration within 3-weeks, modified Rankin Scale (mRS)-score at 3-months, and culprit cerebrovascular lesion (symptomatic large artery steno-occlusion and cerebral infarction) locations. RESULTS Mean (SD) age was 67.5 (12.6) years, and 2,641 (40.9%) were female patients. Percentage infarct volumes on diffusion-weighted MRI did not differ between female patients and male patients (median 0.14% vs. 0.14%, P=0.35). However, female patients showed higher stroke severity (NIHSS-score, median 4 vs. 3, P<0.001) and had more frequent early neurological deterioration (adjusted-difference 3.5%; P=0.002) than male patients. Female patients had more frequent striatocapsular lesions (43.6% vs. 39.8%, P=0.001) and less frequent cerebrocortical and cerebellar lesions than male patients, which aligned with angiographic findings: female patients had more prevalent symptomatic steno-occlusion of the middle cerebral artery (31.1% vs. 25.3%; P<0.001) compared to male patients, who had more frequent symptomatic steno-occlusion of the extracranial internal carotid artery (14.2% vs. 9.3%; P<0.001) and vertebral artery (6.5% vs. 4.7%; P=0.001). Cortical infarcts in female patients, specifically left-sided parieto-occipital regions, were associated with higher NIHSS-scores than expected for similar infarct volumes in male patients. Consequently, female patients had a higher likelihood of unfavorable functional outcome (mRS-score>2) than male patients (adjusted-absolute-difference 4.5%; 95%-CI 2.0-7.0; P<0.001). DISCUSSION Female patients have more frequent middle cerebral artery disease and striatocapsular motor-pathway involvement with acute ischemic stroke, along with left parieto-occipital cortical infarcts showing greater severity for equivalent infarct volumes than in male patients. This leads to more severe initial neurological symptoms, higher susceptibility to neurological worsening, and less 3-month functional independence, when compared with male patients.
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Affiliation(s)
- Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea
- National Priority Research Center for Stroke, Goyang, South Korea
| | - Jinyong Chung
- National Priority Research Center for Stroke, Goyang, South Korea
| | - Dawid Schellingerhout
- Departments of Radiology and Cancer Systems Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sang-Wuk Jeong
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Hang-Rai Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Jung E Park
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, South Kore
| | - Sang-Soon Park
- Department of Neurology, Seoul Medical Center, Seoul, South Kore
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Uijeongbu, Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Daejeon, South Korea
| | - Jae Guk Kim
- Department of Neurology, Eulji University Hospital, Daejeon, South Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, South Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, South Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, South Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Man Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University, Seoul, South Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea
- National Priority Research Center for Stroke, Goyang, South Korea
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12
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Park HK, Lee KJ, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Han MK, Kang J, Kim BJ, Park TH, Park MS, Lee KB, Lee J, Hong KS, Cho YJ, Lee BC, Yu KH, Oh MS, Kim JT, Choi KH, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DI, Sohn SI, Hong JH, Lee J, Lee K, Song J, Bae JS, Cheong HS, Debette S, Bae HJ. Prevalence of Mutations in Mendelian Stroke Genes in Early Onset Stroke Patients. Ann Neurol 2023; 93:768-782. [PMID: 36541592 DOI: 10.1002/ana.26575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Heritability of stroke is assumed not to be low, especially in the young stroke population. However, most genetic studies have been performed in highly selected patients with typical clinical or neuroimaging characteristics. We investigated the prevalence of 15 Mendelian stroke genes and explored the relationships between variants and the clinical and neuroimaging characteristics in a large, unselected, young stroke population. METHODS We enrolled patients aged ≤55 years with stroke or transient ischemic attack from a prospective, nationwide, multicenter stroke registry. We identified clinically relevant genetic variants (CRGVs) in 15 Mendelian stroke genes (GLA, NOTCH3, HTRA1, RNF213, ACVRL1, ENG, CBS, TREX1, ABCC6, COL4A1, FBN1, NF1, COL3A1, MT-TL1, and APP) using a customized, targeted next generation sequencing panel. RESULTS Among 1,033 patients, 131 (12.7%) had 28 CRGVs, most frequently in RNF213 (n = 59), followed by ABCC6 (n = 53) and NOTCH3 (n = 15). The frequency of CRGVs differed by ischemic stroke subtypes (p < 0.01): the highest in other determined etiology (20.1%), followed by large artery atherosclerosis (13.6%). It also differed between patients aged ≤35 years and those aged 51 to 55 years (17.1% vs 9.3%, p = 0.02). Only 27.1% and 26.7% of patients with RNF213 and NOTCH3 variants had typical neuroimaging features of the corresponding disorders, respectively. Variants of uncertain significance (VUSs) were found in 15.4% patients. INTERPRETATION CRGVs in 15 Mendelian stroke genes may not be uncommon in the young stroke population. The majority of patients with CRGVs did not have typical features of the corresponding monogenic disorders. Clinical implications of having CRGVs or VUSs should be explored. ANN NEUROL 2023;93:768-782.
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Affiliation(s)
- Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Keon-Joo Lee
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, South Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, South Korea
| | - Jae Guk Kim
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, South Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, South Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, South Korea
| | - Moon-Ku Han
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jihoon Kang
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Beom Joon Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, South Korea
| | - Moo-Seok Park
- Department of Neurology, Seoul Hospital, Ewha Woman's University College of Medicine, Seoul, South Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, South Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea
- Research Center for Artificial Intelligence, JLK Corporation, Seoul, South Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, South Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University College of Medicine, Ulsan, South Korea
| | - Wook-Joo Kim
- Department of Neurology, Ulsan University College of Medicine, Ulsan, South Korea
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk University Hospital, Cheongju, South Korea
| | - Sung Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Kyunghoon Lee
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Junghan Song
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Joon Seol Bae
- Research Institute of Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Hyun Sub Cheong
- Research Institute for Life Science, GW Vitek, Seoul, South Korea
| | - Stéphanie Debette
- University of Bordeaux, Bordeaux Population Health Research Center, Bordeaux, France
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
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13
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Guk HS, Kim DY, Hong KS, Kim JY, Kang J, Kim BJ, Han MK, Choi KH, Kim JT, Park MS, Yum KS, Shin DI, Gwak DS, Kim DE, Kim YS, Kang K, Kim JG, Lee SJ, Lee M, Oh MS, Yu KH, Lee BC, Park HK, Cho YJ, Kang CH, Kim JG, Choi JC, Jang SH, Park H, Hong JH, Sohn SI, Park TH, Kim WJ, Kwon JH, Lee KB, Kwon DH, Lee J, Lee KJ, Lee SH, Chul Ho K, Lee JS, Lee J, Bae HJ. Abstract WMP97: Symptomatic Steno-occlusion Of Major Cerebral Arteries And Stroke Recurrence In Acute Ischemic Stroke Patients With Atrial Fibrillation. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wmp97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
There is lack of knowledge on whether symptomatic steno-occlusion (SYSO), common in acute ischemic stroke (AIS) patients with atrial fibrillation (AF), could increase the long-term risk of stroke recurrence in these patients.
Methods:
From a prospective cohort of patients with AIS and AF enrolled in 14 centers between Oct 2017 and Dec 2018, we identified patients who underwent MR angiography during hospitalization and completed 3-year follow-up including death during follow-up. SYSO was defined as (1)
≥
50% stenosis or occlusion of cerebral arteries relevant to acute infarction or (2) any residual stenosis after endovascular treatment. Using cause-specific hazard models with non-stroke death as a competing risk, the risk of any recurrent stroke and recurrent ischemic stroke was estimated according to SYSO, respectively.
Results:
A total of 889 patients (mean age, 74.4 years; men, 54.6 %; median NIHSS, 6) were analyzed for this study. During the median 1096 days of follow-up, 152 any recurrent strokes, 142 recurrent ischemic strokes, and 208 deaths were observed. Patients with SYSO, compared to those without, were more likely to be older, be female, have hypertension, diabetes and history of stroke/TIA, and be on antiplatelets at discharge and were less likely to be on anticoagulants at discharge (
p
<.05). The cumulative incidence of recurrent stroke in patients with and without SYSO was 25.2% and 8.3% at 1 month, 33.1% and 9.9% at 1 year, and 41.8% and 13.1% at 3 years, respectively (
p
<.001). With adjusting age, sex, hypertension, diabetes, history of stroke/TIA, discharge antiplatelets, and discharge anticoagulants, SYSO increased the risk of any stroke recurrence (adjusted hazard ratio [95% confidence interval]; 3.02 [2.18-4.20];
p
<.001) and ischemic stroke recurrence (3.20 [2.28-4.51];
p
<.001).
Conclusions:
SYSO in AIS patients with AF substantially increased the risk of recurrent stroke by a 3-fold or more. Accordingly, SYSO should be considered in stratifying the risk of recurrence in AIS patients with AF.
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Affiliation(s)
- Hyung Seok Guk
- Gunsan Med Cntr, Gunsan-si, Jeollabuk-do, Korea, Republic of
| | - Do Yeon Kim
- Dept of Neurology and Cerebrovascular Cntr, Seoul National Univ Bundang Hosp, Seongnam-si, Gyeonggi-do, Korea, Republic of
| | - Keun-Sik Hong
- Dept of Neurology, Inje Univ Ilsan Paik Hosp, Goyang-si, Gyeonggi-do, Korea, Republic of
| | - Jun Yup Kim
- Dept of Neurology and Cerebrovascular Cntr, Seoul National Univ Bundang Hosp, Seongnam-si, Gyeonggi-do, Korea, Republic of
| | - Jihoon Kang
- Dept of Neurology and Cerebrovascular Cntr, Seoul National Univ Bundang Hosp, Seongnam-si, Gyeonggi-do,, Korea, Republic of
| | - Beom J Kim
- Dept of Neurology and Cerebrovascular Cntr, Seoul National Univ Bundang Hosp, Seongnam-si, Gyeonggi-do, Korea, Republic of
| | - Moon Ku Han
- Dept of Neurology and Cerebrovascular Cntr, Seoul National Univ Bundang Hosp, Seongnam-si, Gyeonggi-do, Korea, Republic of
| | - Kang-Ho Choi
- Dept of Neurology, Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | - Joon-Tae Kim
- Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | | | - Kyu Sun Yum
- Dept of Neurology, Chungbuk National Univ Hosp, Cheongju, Chungcheongbuk-do, Korea, Republic of
| | - Dong-Ick Shin
- Dept of Neurology, Chungbuk National Univ Hosp, Cheongju, Chungcheongbuk-do, Korea, Republic of
| | - Dong-Seok Gwak
- Dept of Neurology, Dongguk Univ Ilsan Hosp, Goyang-si, Gyeonggi-do, Korea, Republic of
| | - Dong-Eog Kim
- Dept of Neurology, Dongguk Univ Ilsan Hosp, Goyang-si, Gyeonggi-do, Korea, Republic of
| | - Yong Soo Kim
- Dept of Neurology, Nowon Eulji Med Cntr, Eulji Univ Sch of Medicine, Seoul, Korea, Republic of
| | - Kyusik Kang
- Dept of Neurology, Nowon Eulji Med Cntr, Eulji Univ Sch of Medicine, Seoul, Korea, Republic of
| | - Jae G Kim
- Eulji Univ Hosp, Eulji Univ, Daejeon, Korea, Republic of
| | - Soo Joo Lee
- Eulji Univ Hosp, Eulji Univ, Daejeon, Korea, Republic of
| | - Minwoo Lee
- Hallym Univ Sacred Heart Hosp, Anyang-si, Gyeonggi-do, Korea, Republic of
| | - Mi-Sun Oh
- Hallym Univ Sacred Heart Hosp, Anyang-si, Gyeonggi-do, Korea, Republic of
| | - Kyung-Ho Yu
- Hallym Univ Sacred Heart Hosp, Anyang-si, Gyeonggi-do, Korea, Republic of
| | - Byung-Chul Lee
- Dept of Neurology, Hallym Univ Sacred Heart Hosp, Anyang-si, Gyeonggi-do, Korea, Republic of
| | - Hong-Kyun Park
- Inje Univ Ilsan Paik Hosp, Goyang-si, Gyeonggi-do, Korea, Republic of
| | - Yong-Jin Cho
- Dept of Neurology, Inje Univ Ilsan Paik Hosp, Goyang-si, Gyeonggi-do, Korea, Republic of
| | - Chul-Hoo Kang
- Dept of Neurology, Jeju National Univ Hosp, Jeju, Korea, Republic of
| | - Joong-Goo Kim
- Dept of Neurology, Jeju National Univ Hosp, Jeju, Korea, Republic of
| | - Jay Chol Choi
- Dept of Neurology, Jeju National Univ Hosp, Jeju, Korea, Republic of
| | - Seong Hwa Jang
- Dept of Neurology, Keimyung Univ Dongsan Med Cntr, Daegu, Korea, Republic of
| | - Hyungjong Park
- Keimyung Univ Dongsan Med Cntr, Daegu, Korea, Republic of
| | - Jeong-Ho Hong
- Dept of Neurology, Keimyung Univ Dongsan Med Cntr, Daegu, Korea, Republic of
| | - Sung-il Sohn
- Dept of Neurology, Keimyung Univ Dongsan Med Cntr, Daegu, Korea, Republic of
| | - Tai H Park
- Dept of Neurology, Seoul Med Cntr, Seoul, Korea, Republic of
| | | | | | | | - Doo Hyuk Kwon
- Dept of Neurology, Yeungnam Univ Hosp, Daegu, Korea, Republic of
| | - Jun Lee
- Dept of Neurology, Yeungnam Univ Hosp, Daegu, Korea, Republic of
| | - Keon-Joo Lee
- Dept of Neurology, Korea Univ Guro Hosp, Seoul, Korea, Republic of
| | - Sang-Hwa Lee
- Dept of Neurology, Hallym Univ Chuncheon Sacred Heart Hosp, Chuncheon-si, Gangwon-do, Korea, Republic of
| | - Kim Chul Ho
- Dept of Neurology, Hallym Univ Chuncheon Sacred Heart Hosp, Chuncheon-si, Gangwon-do, Korea, Republic of
| | | | - Juneyoung Lee
- Dept of Biostatistics, Korea Univ College of Medicine, Seoul, Korea, Republic of
| | - Hee-Joon Bae
- Dept of Neurology, Seoul National Univ College of Medicine, Seongnam-si, Gyeonggi-do, Korea, Republic of
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14
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Kim JT, Lee JS, Kim BJ, Kang J, Lee KJ, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Park TH, Lee KB, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Choi JC, Kwon JH, Kim WJ, Shin DI, Yum KS, Sohn SI, Hong JH, Lee SH, Park MS, Choi KH, Ryu WS, Lee J, Saver JL, Bae HJ. Admission hyperglycemia, stroke subtypes, outcomes in acute ischemic stroke. Diabetes Res Clin Pract 2023; 196:110257. [PMID: 36642337 DOI: 10.1016/j.diabres.2023.110257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023]
Abstract
AIMS Whether admission hyperglycemia is differentially associated with early vascular outcomes in acute ischemic stroke (AIS) depending on stroke subtype has been incompletely delineated. METHODS In a multicenter, prospective stroke registry, patients with AIS were categorized based on admission glucose levels into normoglycemia, moderate hyperglycemia, and severe hyperglycemia (<140mg/dl, 140-179mg/dl, and ≥180mg/dl, respectively) groups. Multivariate analysis assessed the interaction between the hyperglycemia and ischemic stroke subtypes of large artery atherothrombosis (LAA), cardioembolism (CE), and small vessel occlusion (SVO) and early vascular outcomes (3-month stroke, all-cause mortality, and composite of stroke, MI, and all-cause mortality). RESULTS Among the 32,772 patients (age:69.0±12.6yrs, male:58.4%) meeting eligibility criteria, 61.9% were in the normoglycemia group, 19.5% were in the moderate hyperglycemia group, and 18.7% were in the severe hyperglycemia group. Substantial interactions between hyperglycemia groups and stroke subtypes were observed for 3-month stroke (Pinteraction = 0.003) and composite of stroke, MI, and all-cause mortality (Pinteraction = 0.001), with differential recurrence strongest among CE, intermediate among LAA, and least among SVO. CONCLUSIONS Hyperglycemia was differently associated with the risk of 3-month stroke by ischemic stroke subtype. The associations of hyperglycemia with 3-month stroke were greatest in CE subtype but not in SVO subtype. These results suggest that the effect of glucose-lowering treatment after AIS may differ according to stroke subtype.
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Affiliation(s)
- Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea.
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Beom Joon Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jihoon Kang
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keon-Joo Lee
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si, Republic of Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Republic of Korea
| | - Jae Guk Kim
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Republic of Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Yong-Jin Cho
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Hong-Kyun Park
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University College of Medicine, Ulsan, Republic of Korea
| | - Wook-Joo Kim
- Department of Neurology, Ulsan University College of Medicine, Ulsan, Republic of Korea
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Kyu Sun Yum
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Sung Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Sang-Hwa Lee
- Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea; Artificial Intelligence Research Center, JLK Inc., Seoul, Republic of Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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15
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Kim JT, Lee JS, Kim BJ, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Park TH, Lee KB, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DI, Yum KS, Sohn SI, Hong JH, Lee SH, Park MS, Choi KH, Lee J, Saver JL, Bae HJ. Frequency, management, and outcomes of early neurologic deterioration due to stroke progression or recurrence. J Stroke Cerebrovasc Dis 2023; 32:106940. [PMID: 36529099 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106940] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/23/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The frequency, management, and outcomes of early neurologic deterioration (END) after ischemic stroke specifically due to stroke progression or stroke recurrence have not been well delineated. MATERIALS AND METHODS In a multicenter, nationwide registry, data on END due to stroke progression or recurrence confirmed by imaging were collected prospectively between January 2019 and July 2020. Patient characteristics, management strategies, and clinical outcomes were analyzed. RESULTS Among 14,828 consecutive ischemic stroke patients, 1717 (11.6%) experienced END, including 1221 (8.2%) with END due to stroke progression (SP) or stroke recurrence (SR). Active management after END was implemented in 64.2% of patients. Active management strategies included volume expansion (29.2%), change in antithrombotic regimen (26.1%), induced hypertension (8.6%), rescue reperfusion therapy (6.8%), intracranial pressure lowering with hyperosmolar agents (1.5%), bypass surgery (0.6%), and hypothermia (0.1%). Active management strategies that varied with patient features included volume expansion and induced hypertension, used more often in large artery atherosclerosis and small vessel occlusion, and rescue endovascular thrombectomy, more common in other (dissection), cardioembolism, and large artery atherosclerosis. Active management was associated with higher rates of freedom from disability (modified Rankin Scale, mRS, 0-1; 24.3% vs. 16.6%) and functional independence (mRS, 0-2; 41.6% vs. 27.7%) at 3 months. CONCLUSION END specifically due to stroke progression or recurrence occurs in 1 in 12 acute ischemic stroke patients. In this observational study, active management, undertaken in two-thirds of patients, was most often hemodynamic or antithrombotic and was associated with improved functional outcomes.
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Affiliation(s)
- Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-gu, Gwangju 61469, Korea.
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Cerebrovascular Disease Center, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si, Republic of Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Soo Joo Lee
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Jae Guk Kim
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Yong-Jin Cho
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Hong-Kyun Park
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Republic of Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea; Artificial Intelligence Research Center, JLK Inc., Seoul, Republic of Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University College of Medicine, Ulsan, Republic of Korea
| | - Wook-Joo Kim
- Department of Neurology, Ulsan University College of Medicine, Ulsan, Republic of Korea
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Kyu Sun Yum
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Sung Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Sang-Hwa Lee
- Department of Neurology, Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-gu, Gwangju 61469, Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebongro, Dong-gu, Gwangju 61469, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Jeffrey L Saver
- Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University College of Medicine, Cerebrovascular Disease Center, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea.
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16
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Kim DY, Choi KH, Kim JH, Hong J, Choi SM, Park MS, Cho KH. Deep learning-based personalised outcome prediction after acute ischaemic stroke. J Neurol Neurosurg Psychiatry 2023; 94:369-378. [PMID: 36650037 DOI: 10.1136/jnnp-2022-330230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/06/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Whether deep learning models using clinical data and brain imaging can predict the long-term risk of major adverse cerebro/cardiovascular events (MACE) after acute ischaemic stroke (AIS) at the individual level has not yet been studied. METHODS A total of 8590 patients with AIS admitted within 5 days of symptom onset were enrolled. The primary outcome was the occurrence of MACEs (a composite of stroke, acute myocardial infarction or death) over 12 months. The performance of deep learning models (DeepSurv and Deep-Survival-Machines (DeepSM)) and traditional survival models (Cox proportional hazards (CoxPH) and random survival forest (RSF)) were compared using the time-dependent concordance index ([Formula: see text] index). RESULTS Given the top 1 to all 60 clinical factors according to feature importance, CoxPH and RSF yielded [Formula: see text] index of 0.7236-0.8222 and 0.7279-0.8335, respectively. Adding image features improved the performance of deep learning models and traditional models assisted by deep learning models. DeepSurv and DeepSM yielded the best [Formula: see text] index of 0.8496 and 0.8531 when images were added to all 39 relevant clinical factors, respectively. In feature importance, brain image was consistently ranked highly. Deep learning models automatically extracted the image features directly from personalised brain images and predicted the risk and date of future MACEs at the individual level. CONCLUSIONS Deep learning models using clinical data and brain images could improve the prediction of MACEs and provide personalised outcome prediction for patients with AIS. Deep learning models will allow us to develop more accurate and tailored prognostic prediction systems that outperform traditional models.
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Affiliation(s)
- Doo-Young Kim
- Department of Artificial Intelligence Convergence, Chonnam National University, Gwangju, Korea (the Republic of)
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Korea (the Republic of) .,Department of Biomedical Sciences, Chonnam National University, Gwangju, Korea (the Republic of)
| | - Ja-Hae Kim
- Department of Artificial Intelligence Convergence, Chonnam National University, Gwangju, Korea (the Republic of) .,Department of Nuclear Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea (the Republic of)
| | - Jina Hong
- Department of Biomedical Sciences, Chonnam National University, Gwangju, Korea (the Republic of)
| | - Seong-Min Choi
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Korea (the Republic of)
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Korea (the Republic of)
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Korea (the Republic of)
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17
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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Kim DY, Han SG, Jeong HG, Lee KJ, Kim BJ, Han MK, Choi KH, Kim JT, Shin DI, Cha JK, Kim DH, Kim DE, Ryu WS, Park JM, Kang K, Kim JG, Lee SJ, Oh MS, Yu KH, Lee BC, Park HK, Hong KS, Cho YJ, Choi JC, Sohn SI, Hong JH, Park TH, Lee KB, Kwon JH, Kim WJ, Lee J, Lee JS, Lee J, Gorelick PB, Bae HJ. Covert Brain Infarction as a Risk Factor for Stroke Recurrence in Patients With Atrial Fibrillation. Stroke 2023; 54:87-95. [PMID: 36268719 DOI: 10.1161/strokeaha.122.038600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We aimed to evaluate covert brain infarction (CBI), frequently encountered during the diagnostic work-up of acute ischemic stroke, as a risk factor for stroke recurrence in patients with atrial fibrillation (AF). METHODS For this prospective cohort study, from patients with acute ischemic stroke hospitalized at 14 centers between 2017 and 2019, we enrolled AF patients without history of stroke or transient ischemic attack and divided them into the CBI (+) and CBI (-) groups. The 2 groups were compared regarding the 1-year cumulative incidence of recurrent ischemic stroke and all-cause mortality using the Fine and Gray subdistribution hazard model with nonstroke death as a competing risk and the Cox frailty model, respectively. Each CBI lesion was also categorized into either embolic-appearing (EA) or non-EA pattern CBI. Adjusted hazard ratios and 95% CIs of any CBI, EA pattern CBI only, non-EA pattern CBI only, and both CBIs were estimated. RESULTS Among 1383 first-ever stroke patients with AF, 578 patients (41.8%) had CBI. Of these 578 with CBI, EA pattern CBI only, non-EA pattern CBI only, and both CBIs were 61.8% (n=357), 21.8% (n=126), and 16.4% (n=95), respectively. The estimated 1-year cumulative incidence of recurrent ischemic stroke was 5.2% and 1.9% in the CBI (+) and CBI (-) groups, respectively (P=0.001 by Gray test). CBI increased the risk of recurrent ischemic stroke (adjusted hazard ratio [95% CI], 2.91 [1.44-5.88]) but did not the risk of all-cause mortality (1.32 [0.97-1.80]). The EA pattern CBI only and both CBIs elevated the risk of recurrent ischemic stroke (2.76 [1.32-5.77] and 5.39 [2.25-12.91], respectively), while the non-EA pattern only did not (1.44 [0.40-5.16]). CONCLUSIONS Our study suggests that AF patients with CBI might have increased risk of recurrent stroke. CBI could be considered when estimating the stroke risk in patients with AF.
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Affiliation(s)
- Do Yeon Kim
- Department of Neurology and Cerebrovascular Center (D.Y.K., S.-G.H., H.-G.J., K.-J.L., B.J.K., M.-K.H., H.-J.B.), Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Seok-Gil Han
- Department of Neurology and Cerebrovascular Center (D.Y.K., S.-G.H., H.-G.J., K.-J.L., B.J.K., M.-K.H., H.-J.B.), Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Han-Gil Jeong
- Department of Neurology and Cerebrovascular Center (D.Y.K., S.-G.H., H.-G.J., K.-J.L., B.J.K., M.-K.H., H.-J.B.), Seoul National University College of Medicine, Seongnam, Republic of Korea.,Department of Neurosurgery, Seoul National University Bundang Hospital (H.-G.J.), Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Keon-Joo Lee
- Department of Neurology and Cerebrovascular Center (D.Y.K., S.-G.H., H.-G.J., K.-J.L., B.J.K., M.-K.H., H.-J.B.), Seoul National University College of Medicine, Seongnam, Republic of Korea.,Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea (K.-J.L.)
| | - Beom Joon Kim
- Department of Neurology and Cerebrovascular Center (D.Y.K., S.-G.H., H.-G.J., K.-J.L., B.J.K., M.-K.H., H.-J.B.), Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Moon-Ku Han
- Department of Neurology and Cerebrovascular Center (D.Y.K., S.-G.H., H.-G.J., K.-J.L., B.J.K., M.-K.H., H.-J.B.), Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea (K.-H.C., J.-T.K.)
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea (K.-H.C., J.-T.K.)
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.-I.S.)
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea (J.K.C., D.H.K.)
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea (J.K.C., D.H.K.)
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea (D.-E.K., W.-S.R.)
| | - Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea (D.-E.K., W.-S.R.).,Artificial Intelligence R&D, JLK Corp, Seoul, Republic of Korea (W.-S.R.)
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea (J.-M.P.)
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea (K.K.)
| | - Jae Guk Kim
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea (J.G.K., S.J.L.)
| | - Soo Joo Lee
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea (J.G.K., S.J.L.)
| | - Mi-Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (M.-S.O., K.-H.Y., B.-C.L.)
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (M.-S.O., K.-H.Y., B.-C.L.)
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (M.-S.O., K.-H.Y., B.-C.L.)
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea (H.-K.P., K.-S.H., Y.-J.C.,)
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea (H.-K.P., K.-S.H., Y.-J.C.,)
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea (H.-K.P., K.-S.H., Y.-J.C.,)
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Republic of Korea (J.C.C.)
| | - Sung Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea (S.I.S., J.-H.H.)
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea (S.I.S., J.-H.H.)
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Republic of Korea (T.H.P.)
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, Republic of Korea (K.B.L.)
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, Ulsan University College of Medicine, Republic of Korea (J.-H.K., W.-J.K.)
| | - Wook-Joo Kim
- Department of Neurology, Ulsan University Hospital, Ulsan University College of Medicine, Republic of Korea (J.-H.K., W.-J.K.)
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, Republic of Korea (J.L.)
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.)
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea (J.L.)
| | - Philip B Gorelick
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.B.G.)
| | - Hee-Joon Bae
- Department of Neurology and Cerebrovascular Center (D.Y.K., S.-G.H., H.-G.J., K.-J.L., B.J.K., M.-K.H., H.-J.B.), Seoul National University College of Medicine, Seongnam, Republic of Korea
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19
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Kang YR, Nam TS, Kim BC, Kim JM, Cho SH, Kang KW, Choi KH, Kim JT, Choi SM, Lee SH, Park MS, Kim MK. Characteristics of patients with meningitis after lumbar epidural steroid injection. Medicine (Baltimore) 2022; 101:e32396. [PMID: 36595762 PMCID: PMC9794205 DOI: 10.1097/md.0000000000032396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
To investigate the clinical, laboratory, and radiological features of meningitis after lumbar epidural steroid injection (M-ESI) without accompanying spinal infection, data of patients with meningitis admitted between January 2014 and December 2021 in a single center were retrospectively reviewed. Among them, patients with a recent history of lumbar ESI were identified, and their medical records were collected. Patients with concomitant infections other than meningitis, including spinal epidural abscess, were excluded. Seven patients with M-ESI were identified. All patients presented with headache and fever without focal neurological deficits, and headache developed shortly after a procedure (median, 4 hours). Cerebrospinal fluid (CSF) analysis showed neutrophilic pleocytosis (median, 6729/μL), elevated protein level (median, 379.1 mg/dL), decreased ratio of CSF glucose to serum glucose (median, 0.29), and elevated lactate level (median, 8.64 mmol/L). Serum level of C-reactive protein was elevated in 6, but serum procalcitonin level was within normal range. No causative pathogen was identified in the microbiological studies. The most frequent radiologic feature was sulcal hyperintensity on fluid-attenuated inversion recovery images (57%), followed by pneumocephalus (43%). Symptoms subsided in a short period (median, 1 day) after initiating treatment with antibiotics and adjuvant intravenous corticosteroids. None of the patients experienced neurological sequelae. Though the cardinal symptoms and CSF findings of M-ESI were comparable to those of bacterial meningitis, M-ESI seems to have distinctive characteristics regarding the clinical course, laboratory parameters, and pneumocephalus.
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Affiliation(s)
- You-Ri Kang
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Tai-Seung Nam
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Neurology, Chonnam National University Medical School, Gwangju, South Korea
- * Correspondence: Tai-Seung Nam, Department of Neurology, Chonnam National University Medical School and Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 61469, South Korea (e-mail: )
| | - Byeong C. Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Neurology, Chonnam National University Medical School, Gwangju, South Korea
| | - Jae-Myung Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Soo Hyun Cho
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Neurology, Chonnam National University Medical School, Gwangju, South Korea
| | - Kyung Wook Kang
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Neurology, Chonnam National University Medical School, Gwangju, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Medical School, Gwangju, South Korea
- Department of Neurology, Chonnam National University Hwasun Hospital, Jeollanam-do, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Neurology, Chonnam National University Medical School, Gwangju, South Korea
| | - Seong-Min Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Neurology, Chonnam National University Medical School, Gwangju, South Korea
| | - Seung-Han Lee
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Neurology, Chonnam National University Medical School, Gwangju, South Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Neurology, Chonnam National University Medical School, Gwangju, South Korea
| | - Myeong-Kyu Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Neurology, Chonnam National University Medical School, Gwangju, South Korea
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20
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Guezzi N, Lee C, Le TD, Seong H, Choi KH, Min JJ, Yu J. Multistage adaptive noise reduction technique for optical resolution photoacoustic microscopy. J Biophotonics 2022; 15:e202200164. [PMID: 36053943 DOI: 10.1002/jbio.202200164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
Photoacoustic microscopy has received great attention due to the benefits of the optical resolution contrast as well as its superior spatial resolution and relatively deep depth. Like other imaging modalities, photoacoustic images suffer from noise, and filtering techniques are required to remove them. To overcome the noise, we proposed a combination of filters, including an adaptive median filter, an effective filter for impulsive noise, and a nonlocal means filter, an effective filter for background noise, for noise removal and image quality enhancement. Our proposed method enhanced the signal-to-noise ratio by 16 dB in an in vivo study compared to the traditional image reconstruction approach and preserved the image detail with minimal blurring, which usually occurs when filtering. These experimental results verified that the proposed adaptive multistage denoising techniques could effectively improve image quality under noisy data acquisition conditions, providing a strong foundation for photoacoustic microscopy with limited laser power.
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Affiliation(s)
- Nizar Guezzi
- Department of Robotics and Mechatronics Engineering, DGIST, Daegu, South Korea
- DGIST Robotics Research Center, DGIST, Daegu, South Korea
| | - Changho Lee
- Department of Nuclear Medicine, Chonnam National University Medical School & Hwasun Hospital, Hwasun, Jeollanamado, South Korea
- Department of Artificial Intelligence Convergence, Chonnam National University, Gwangju, South Korea
| | - Thanh Dat Le
- Department of Artificial Intelligence Convergence, Chonnam National University, Gwangju, South Korea
| | - Hyojin Seong
- Department of Robotics and Mechatronics Engineering, DGIST, Daegu, South Korea
- DGIST Robotics Research Center, DGIST, Daegu, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Jung-Joon Min
- Department of Nuclear Medicine, Chonnam National University Medical School & Hwasun Hospital, Hwasun, Jeollanamado, South Korea
| | - Jaesok Yu
- Department of Robotics and Mechatronics Engineering, DGIST, Daegu, South Korea
- DGIST Robotics Research Center, DGIST, Daegu, South Korea
- The Interdisciplinary Studies of Artificial Intelligence, DGIST, Daegu, South Korea
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21
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Kim DH, Moon SJ, Lee J, Cha JK, Kim MH, Park JS, Ban B, Kang J, Kim BJ, Kim WS, Yoon CH, Lee H, Kim S, Kang EK, Her AY, Yoon CW, Rha JH, Woo SI, Lee WK, Jung HY, Lee JH, Park HS, Hwang YH, Kim K, Kim RB, Choi NC, Hwang J, Park HW, Park KS, Yi S, Cho JY, Kim NH, Choi KH, Kim J, Han JY, Choi JC, Kim SY, Choi JH, Kim J, Sohn MK, Choi SW, Shin DI, Lee SY, Bae JW, Lee KS, Bae HJ. Comparison of Factors Associated With Direct Versus Transferred-in Admission to Government-Designated Regional Centers Between Acute Ischemic Stroke and Myocardial Infarction in Korea. J Korean Med Sci 2022; 37:e305. [PMID: 36325609 PMCID: PMC9623032 DOI: 10.3346/jkms.2022.37.e305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND There has been no comparison of the determinants of admission route between acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We examined whether factors associated with direct versus transferred-in admission to regional cardiocerebrovascular centers (RCVCs) differed between AIS and AMI. METHODS Using a nationwide RCVC registry, we identified consecutive patients presenting with AMI and AIS between July 2016 and December 2018. We explored factors associated with direct admission to RCVCs in patients with AIS and AMI and examined whether those associations differed between AIS and AMI, including interaction terms between each factor and disease type in multivariable models. To explore the influence of emergency medical service (EMS) paramedics on hospital selection, stratified analyses according to use of EMS were also performed. RESULTS Among the 17,897 and 8,927 AIS and AMI patients, 66.6% and 48.2% were directly admitted to RCVCs, respectively. Multivariable analysis showed that previous coronary heart disease, prehospital awareness, higher education level, and EMS use increased the odds of direct admission to RCVCs, but the odds ratio (OR) was different between AIS and AMI (for the first 3 factors, AMI > AIS; for EMS use, AMI < AIS). EMS use was the single most important factor for both AIS and AMI (OR, 4.72 vs. 3.90). Hypertension and hyperlipidemia increased, while living alone decreased the odds of direct admission only in AMI; additionally, age (65-74 years), previous stroke, and presentation during non-working hours increased the odds only in AIS. EMS use weakened the associations between direct admission and most factors in both AIS and AMI. CONCLUSIONS Various patient factors were differentially associated with direct admission to RCVCs between AIS and AMI. Public education for symptom awareness and use of EMS is essential in optimizing the transportation and hospitalization of patients with AMI and AIS.
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Affiliation(s)
- Dae-Hyun Kim
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Seok-Joo Moon
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Jae-Kwan Cha
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Moo Hyun Kim
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Jong-Sung Park
- Busan Regional Cardiocerebrovascular Disease Center, Dong-A University Hospital, Busan, Korea
| | - Byeolnim Ban
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jihoon Kang
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Beom Joon Kim
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Won-Seok Kim
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chang-Hwan Yoon
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Heeyoung Lee
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seongheon Kim
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Eun Kyoung Kang
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ae-Young Her
- Gangwon Regional Cardiocerebrovascular Disease Center, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Cindy W Yoon
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Joung-Ho Rha
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Seong-Ill Woo
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Won Kyung Lee
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Han-Young Jung
- Incheon Regional Cardiocerebrovascular Disease Center, Inha University College of Medicine, Incheon, Korea
| | - Jang Hoon Lee
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Hun Sik Park
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Yang-Ha Hwang
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Keonyeop Kim
- Daegu-Gyeongbuk Regional Cardiocerebrovascular Disease Center, Kyungpook National University Hospital, Daegu, Korea
| | - Rock Bum Kim
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Nack-Cheon Choi
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jinyong Hwang
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Hyun-Woong Park
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ki Soo Park
- Gyeongnam Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - SangHak Yi
- Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Jae Young Cho
- Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Nam-Ho Kim
- Jeonbuk Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Kang-Ho Choi
- Gwangju-Jeonnam Regional Cardiocerebrovascular Disease Center, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Juhan Kim
- Gwangju-Jeonnam Regional Cardiocerebrovascular Disease Center, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jae-Young Han
- Gwangju-Jeonnam Regional Cardiocerebrovascular Disease Center, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Jay Chol Choi
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, Korea
| | - Song-Yi Kim
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, Korea
| | - Joon-Hyouk Choi
- Jeju Regional Cardiocerebrovascular Disease Center, Jeju National University Hospital, Jeju, Korea
| | - Jei Kim
- Daejeon-Chungnam Regional Cardiocerebrovascular Disease Center, Hospital and College of Medicine, Chungnam National University, Daejeon, Korea
| | - Min Kyun Sohn
- Daejeon-Chungnam Regional Cardiocerebrovascular Disease Center, Hospital and College of Medicine, Chungnam National University, Daejeon, Korea
| | - Si Wan Choi
- Daejeon-Chungnam Regional Cardiocerebrovascular Disease Center, Hospital and College of Medicine, Chungnam National University, Daejeon, Korea
| | - Dong-Ick Shin
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University and Hospital, Cheongju, Korea
| | - Sang Yeub Lee
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University and Hospital, Cheongju, Korea
| | - Jang-Whan Bae
- Chungbuk Regional Cardiocerebrovascular Disease Center, Chungbuk National University and Hospital, Cheongju, Korea
| | - Kun Sei Lee
- Department of Preventive Medicine, School of Medicine, Konkuk University, Seoul, Korea
| | - Hee-Joon Bae
- Gyeonggi Regional Cardiocerebrovascular Disease Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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22
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Kwon W, Yang JH, Lee SH, Choi KH, Park TK, Lee JM, Song YB, Hahn JY, Choi SH, Ahn CM, Ko YG, Yu CW, Jang WJ, Kim HJ, Kwon SU. Impact of obesity paradox between genders on in-hospital mortality in cardiogenic shock: a retrospective cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In a few studies, obesity was associated with better outcomes in patients with cardiogenic shock (CS). Although this phenomenon, the “obesity paradox”, reportedly manifests differently based on sex in other disease entities, it has not yet been investigated in CS patients.
Methods and results
1,227 patients with CS from The REtrospective and prospective observational Study to investigate Clinical oUtcomes and Efficacy of left ventricular assist device for Korean patients with cardiogenic shock (RESCUE) registry in Korea were analyzed. The study population was classified into obese and non-obese groups according to Asian-Pacific criteria (BMI >25.0 kg/m2 for obese). Clinical impact of obesity on in-hospital mortality according to sex was analyzed using logistic regression analysis and restricted cubic spline curves. In-hospital mortality rate was significantly lower in obese men than non-obese men (34.2% vs. 24.1%, p=0.004) while the difference was not significant in women (37.3% vs. 35.8%, p=0.884). As a continuous variable, higher BMI showed a protective effect in men conversely, BMI was not associated with clinical outcomes in women. Comparing to normal-weight patients, obesity was associated with a decreased risk of in-hospital death in men (multivariable-adjusted OR 0.63, CI 0.43–0.92, p=0.016), not in women (multivariable-adjusted OR 0.94, 95% CI 0.55–1.61, p=0.828). Interaction P value for the association between BMI and sex was 0.023.
Conclusions
Obesity paradox exists and apparently occurs in men among CS patients. The differential effect of BMI on in-hospital mortality was observed according to sex.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- W Kwon
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - J H Yang
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - S H Lee
- Chonnam National University Hospital , Gwangju , Korea (Republic of)
| | - K H Choi
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - T K Park
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - J M Lee
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - Y B Song
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - J Y Hahn
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - S H Choi
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - C M Ahn
- Yonsei Cardiovascular Center , Seoul , Korea (Republic of)
| | - Y G Ko
- Yonsei Cardiovascular Center , Seoul , Korea (Republic of)
| | - C W Yu
- Korea University Anam Hospital , Seoul , Korea (Republic of)
| | - W J Jang
- Ewha Womans University Seoul Hospital , Seoul , Korea (Republic of)
| | - H J Kim
- Konkuk University Hospital , Seoul , Korea (Republic of)
| | - S U Kwon
- Inje University Sanggye Paik Hospital , Seoul , Korea (Republic of)
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23
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Bak M, Choi KH, Kim JH, Park TK, Kim EK, Kim SM, Choi SH, Park SJ. Risk factors and clinical effects of late leaflet thrombosis after transcatheter aortic valve replacement. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
As the indications for trans-catheter aortic valve replacement (TAVR) expand, it is expected that the number of TAVR patients would increase and the follow-up duration would be longer. It is known that the incidence of leaflet thrombosis is higher in TAVR than in surgical aortic valve replacement (SAVR), but not much is known about the risk factors of late leaflet thrombosis in TAVR.
Aim
Therefore, in this study, the incidence and risk factors of late leaflet thrombosis at late term after TAVR and the effect on clinical course of late leaflet thrombosis would be investigated.
Method
There were 176 patients undergone TAVR from January 2015 to October 2020 in one tertiary hospital of south korea. 94 patients had follow-up cardiovascular computed tomography (CT) between 3 months and 2 years after TAVR. Among 94 patients, late leaflet thrombosis was discovered at 20 patients, and risk factors were analyzed by comparing clinical factors, echocardiographic and cardiovascular CT information, and angiographic data between the group with and without late leaflet thrombosis. And the difference in aortic valve hemodynamics between the group with and without leaflet thrombosis was examined and clinical outcomes were compared. Clinical outcome was defined as the composite of all-cause death, stroke, heart failure (HF) admission, redo-aortic valve (AV) replacement and major bleeding after detection of late leaflet thrombosis.
Results
Indexed mean sinus of Valsalva diameter, AV calcium score and post procedure estimated orifice area (EOA) had predictability of late leaflet thrombosis with AUC value of 0.670 (95% CI [0.546–0.795], p value = 0.020), AUC value of 0.698 (95% CI [0.544–0.851], p value = 0.012) and AUC value of 0.665 (95 percent CI [0.548–0.782], p value = 0.031), respectively (Figure 1).
In echocardiography performed at the time of follow-up CT, AV max velocity and AV mean pressure gradient were higher in thrombosis group and EOA and Doppler velocity index were lower in thrombosis group than in no thrombosis group within normal range (Figure 2). Clinical outcome was not significant different between the two groups (log rank p value = 0.560).
Conclusion
Larger indexed sinus of Valsalva diameter, higher AV calcium score and smaller post procedure AV EOA were risk factors for late leaflet thrombosis after TAVR. Subclinical late leaflet thrombosis have a benign course when properly managed.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Bak
- Samsung Medical Center, Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute , Seoul , Korea (Republic of)
| | - K H Choi
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - J H Kim
- Samsung Medical Center, Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute , Seoul , Korea (Republic of)
| | - T K Park
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - E K Kim
- Samsung Medical Center, Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute , Seoul , Korea (Republic of)
| | - S M Kim
- Samsung Medical Center, Department of Radiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute , Seoul , Korea (Republic of)
| | - S H Choi
- Samsung Medical Center , Seoul , Korea (Republic of)
| | - S J Park
- Samsung Medical Center, Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute , Seoul , Korea (Republic of)
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24
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Kang YR, Kim JT, Lee JS, Kim BJ, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Park TH, Lee KB, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DI, Sohn SI, Hong JH, Park MS, Choi KH, Cho KH, Park JM, Lee SH, Lee J, Bae HJ. Differential influences of LDL cholesterol on functional outcomes after intravenous thrombolysis according to prestroke statin use. Sci Rep 2022; 12:15478. [PMID: 36104394 PMCID: PMC9474509 DOI: 10.1038/s41598-022-19852-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 09/06/2022] [Indexed: 11/09/2022] Open
Abstract
AbstractThis study aimed to elucidate whether low-density lipoprotein cholesterol (LDL-C) levels differentially affect functional outcomes after intravenous thrombolysis (IVT) depending on prestroke statin use. Patients with acute ischemic stroke treated with IVT were categorized into low, intermediate, and high LDL-C groups based on LDL-C levels at admission (< 100/100–130/ > 130 mg/dl, respectively). Multivariable logistic regression analyses were performed to explore the relationships between LDL-C and clinical outcomes (good outcomes at 3 months, modified Rankin Scale scores 0–2). The interaction between LDL-C levels and prestroke statin use regarding functional outcomes was investigated. Among the 4711 patients (age, 67 ± 12 years; males, 62.1%) who met the eligibility criteria, compared with the high LDL-C group, the low and intermediate LDL-C groups were not associated with good outcomes at 3 months according to the multivariable analysis. A potential interaction between the LDL-C group and prestroke statin use on good outcomes at 3 months was observed (Pinteraction = 0.07). Among patients with prestroke statin use, low (aOR 1.84 [1.04–3.26]) and intermediate (aOR 2.31 [1.20–4.47]) LDL-C groups were independently associated with a greater likelihood of having a 3-month good outcome. Our study showed that LDL-C was not associated with a 3-month good outcome, but prestroke statin use could modify the influence of LDL-C levels on functional outcomes after IVT.
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25
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kim BJ, Menon BK, Yoo J, Han JH, Kim BJ, Kim CK, Kim JG, Kim JT, Park H, Baik SH, Han MK, Kang J, Kim JY, Lee KJ, Park JM, Kang K, Lee SJ, Cha JK, Kim DH, Jeong JH, Park TH, Park SS, Lee KB, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi KH, Choi JC, Kim JG, Kwon JH, Kim WJ, Shin DI, Yum KS, Sohn SI, Hong JH, Kim C, Lee SH, Lee J, Almekhlafi MA, Demchuk A, Bae HJ. Effectiveness and safety of EVT in patients with acute LVO and low NIHSS. Front Neurol 2022; 13:955725. [PMID: 35989920 PMCID: PMC9389111 DOI: 10.3389/fneur.2022.955725] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background and purposeThere is much uncertainty in endovascular treatment (EVT) decisions in patients with acute large vessel occlusion (LVO) and mild neurological deficits.MethodsFrom a prospective, nationwide stroke registry, all patients with LVO and baseline NIHSS <6 presenting within 24 h from the time last known well (LKW) were included. Early neurological deterioration (END) developed before EVT was prospectively collected as an increasing total NIHSS score ≥2 or any worsening of the NIHSS consciousness or motor subscores during hospitalization not related to EVT. Significant hemorrhage was defined as PH2 hemorrhagic transformation or hemorrhage at a remote site. The modified Rankin Scale (mRS) was prospectively collected at 3 months.ResultsAmong 1,083 patients, 149 (14%) patients received EVT after a median of 5.9 [3.6–12.3] h after LKW. In propensity score-matched analyses, EVT was not associated with mRS 0-1 (matched OR 0.99 [0.63–1.54]) but increased the risk of a significant hemorrhage (matched OR, 4.51 [1.59–12.80]). Extraneous END occurred in 207 (19%) patients after a median of 24.5 h [IQR, 13.5–41.9 h] after LKW (incidence rate, 1.41 [95% CI, 1.23–1.62] per 100 person-hours). END unrelated to EVT showed a tendency to modify the effectiveness of EVT (P-for-interaction, 0.08), which decreased the odds of having mRS 0–1 in mild LVO patients without END (adjusted OR, 0.63 [0.40–0.99]).ConclusionsThe use of EVT in patients with acute LVO and low NIHSS scores may require the assessment of individual risks of early deterioration, hemorrhagic complications and expected benefit.
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Affiliation(s)
- Beom Joon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
- *Correspondence: Beom Joon Kim
| | - Bijoy K. Menon
- Calgary Stroke Program, Department of Clinical Neuroscience, Radiology and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Joonsang Yoo
- Department of Neurology, Yongin Severance Hospital, Yongin-si, South Korea
| | - Jung Hoon Han
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Jae Guk Kim
- Department of Neurology, Eulji University Hospital, Daejeon, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Hyungjong Park
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Sung Hyun Baik
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Moon-Ku Han
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jihoon Kang
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jun Yup Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Keon-Joo Lee
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si, South Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Daejeon, South Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, South Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, South Korea
| | - Jin-Heon Jeong
- Department of Neurology, Dong-A University Hospital, Busan, South Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, South Korea
| | - Sang-Soon Park
- Department of Neurology, Seoul Medical Center, Seoul, South Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Medical Center, Daegu, South Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang-si, South Korea
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang-si, South Korea
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang-si, South Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang-si, South Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang-si, South Korea
| | - Mi-Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang-si, South Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang-si, South Korea
| | - Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang-si, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju, South Korea
| | - Joong-Goo Kim
- Department of Neurology, Jeju National University Hospital, Jeju, South Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, Ulsan, South Korea
| | - Wook-Joo Kim
- Department of Neurology, Ulsan University Hospital, Ulsan, South Korea
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Cheongju-si, South Korea
| | - Kyu Sun Yum
- Department of Neurology, Chungbuk National University Hospital, Cheongju-si, South Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Chulho Kim
- Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si, South Korea
| | - Sang-Hwa Lee
- Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si, South Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University, Seoul, South Korea
| | - Mohammed A. Almekhlafi
- Calgary Stroke Program, Department of Clinical Neuroscience, Radiology and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Andrew Demchuk
- Calgary Stroke Program, Department of Clinical Neuroscience, Radiology and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Hee-Joon Bae
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
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27
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Kim H, Kim JT, Lee JS, Kim BJ, Kang J, Lee KJ, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Park TH, Lee KB, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DI, Yum KS, Sohn SI, Hong JH, Lee SH, Park MS, Choi KH, Lee J, Bae HJ. Stroke of Other Determined Etiology: Results From the Nationwide Multicenter Stroke Registry. Stroke 2022; 53:2597-2606. [DOI: 10.1161/strokeaha.121.037582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND:
Stroke of other determined etiology (OE) includes patients with an uncommon cause of stroke. We described the general characteristics, management, and outcomes of stroke in OE and its subgroups.
METHODS:
This study is a retrospective analysis of a prospective, multicenter, nationwide registry, the Clinical Research Center for Stroke-Korea-National Institutes of Health registry. We classified OE strokes into 10 subgroups according to the literature and their properties. Each OE subgroup was compared according to clinical characteristics, sex, age strata, lesion locations, and management. Moreover, 1-year composites of stroke and all-cause mortality were investigated according to the OE subgroups.
RESULTS:
In total, 2119 patients with ischemic stroke with OE types (mean age, 55.6±16.2 years; male, 58%) were analyzed. In the Clinical Research Center for Stroke-Korea-National Institutes of Health registry, patients with OE accounted for 2.8% of all patients with stroke. The most common subtypes were arterial dissection (39.1%), cancer-related coagulopathy (17.3%), and intrinsic diseases of the arterial wall (16.7%). Overall, strokes of OE were more common in men than in women (58% versus 42%). Arterial dissection, intrinsic diseases of the arterial wall and stroke associated with migraine and drugs were more likely to occur at a young age, while disorders of platelets and the hemostatic system, cancer-related coagulopathy, infectious diseases, and hypoperfusion syndromes were more frequent at an old age. The composite of stroke and all-cause mortality within 1 year most frequently occurred in cancer-related coagulopathy, with an event rate of 71.8%, but least frequently occurred in stroke associated with migraine and drugs and arterial dissection, with event rates of 0% and 7.2%, respectively.
CONCLUSIONS:
This study presents the different characteristics, demographic findings, lesion locations, and outcomes of OE and its subtypes. It is characterized by a high proportion of arterial dissection, high mortality risk in cancer-related coagulopathy and an increasing annual frequency of cancer-related coagulopathy in patients with stroke of OE.
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Affiliation(s)
- Hyunsoo Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea (H.K., J.-T.K., M.-S.P., K.-H.C.)
- Department of Neurology, Ulsan University College of Medicine, Korea (H.K., W.-J.K.)
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea (H.K., J.-T.K., M.-S.P., K.-H.C.)
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (J.S.L.)
| | - Beom Joon Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (B.J.K., J.K., K.-J.L., H.-J.B.)
| | - Jihoon Kang
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (B.J.K., J.K., K.-J.L., H.-J.B.)
| | - Keon-Joo Lee
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (B.J.K., J.K., K.-J.L., H.-J.B.)
- Department of Neurology, Korea University Guro Hospital, Seoul (K.-J.L.)
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si, Korea (J.-M.P.)
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea (K.K.)
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea (S.J.L., J.G.K.)
| | - Jae Guk Kim
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, Korea (S.J.L., J.G.K.)
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K.)
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K.)
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea (T.H.P.)
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea (K.B.L.)
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, Korea (J.L.)
| | - Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea (K.-S.H., Y.-J.C., H.-K.P.)
| | - Yong-Jin Cho
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea (K.-S.H., Y.-J.C., H.-K.P.)
| | - Hong-Kyun Park
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea (K.-S.H., Y.-J.C., H.-K.P.)
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.S.O.)
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.S.O.)
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (B.-C.L., K.-H.Y., M.S.O.)
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea (D.-E.K., W.-S.R.)
| | - Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea (D.-E.K., W.-S.R.)
- Artificial Intelligence Research Center, JLK, Inc., Seoul, Korea (W.-S.R.)
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea (J.C.C.)
| | | | - Wook-Joo Kim
- Department of Neurology, Ulsan University College of Medicine, Korea (H.K., W.-J.K.)
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea (D.-I.S., K.S.Y.)
| | - Kyu Sun Yum
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea (D.-I.S., K.S.Y.)
| | - Sung Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea (S.I.S., J.-H.H.)
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea (S.I.S., J.-H.H.)
| | - Sang-Hwa Lee
- Department of Neurology, Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, Republic of Korea (S.-H.L.)
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea (H.K., J.-T.K., M.-S.P., K.-H.C.)
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea (H.K., J.-T.K., M.-S.P., K.-H.C.)
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea (J.L.)
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea (B.J.K., J.K., K.-J.L., H.-J.B.)
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Nam KW, Kim CK, Yu S, Oh K, Chung JW, Bang OY, Kim GM, Jung JM, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Seo WK. Plasma Total Homocysteine Level Is Related to Unfavorable Outcomes in Ischemic Stroke With Atrial Fibrillation. J Am Heart Assoc 2022; 11:e022138. [PMID: 35470699 PMCID: PMC9238578 DOI: 10.1161/jaha.121.022138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Unlike patients with stroke caused by other mechanisms, the effect of elevated plasma total homocysteine (tHcy) on the prognosis of patients with both ischemic stroke and atrial fibrillation (AF) is unknown. This study aimed to evaluate the association between tHcy level and the functional outcome of patients with AF‐related stroke. Methods and Results We included consecutive patients with AF‐related stroke between 2013 and 2015 from the registry of a real‐world prospective cohort from 11 large centers in South Korea. A 3‐month modified Rankin Scale score ≥3 was considered an unfavorable outcome. Since tHcy is strongly affected by renal function, we performed a subgroup analysis according to the presence of renal dysfunction. A total of 910 patients with AF‐related stroke were evaluated (mean age, 73 years; male sex, 56.0%). The mean tHcy level was 11.98±8.81 μmol/L. In multivariable analysis, the tHcy level (adjusted odds ratio, 1.04; 95% CI, 1.01–1.07, per 1 μmol/L) remained significantly associated with unfavorable outcomes. In the subgroup analysis based on renal function, tHcy values above the cutoff point (≥14.60 μmol/L) showed a close association with the unfavorable outcome only in the normal renal function group (adjusted odds ratio, 3.10; 95% CI, 1.60–6.01). In patients with renal dysfunction, tHcy was not significantly associated with the prognosis of AF‐related stroke. Conclusions A higher plasma tHcy level was associated with unfavorable outcomes in patients with AF‐related stroke. This positive association may vary according to renal function but needs to be verified in further studies.
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Affiliation(s)
- Ki-Woong Nam
- Department of Neurology Seoul Metropolitan Government-Seoul National University Boramae Medical Center Seoul South Korea
| | - Chi Kyung Kim
- Department of Neurology Korea University Guro HospitalKorea University College of Medicine Seoul South Korea
| | - Sungwook Yu
- Department of Neurology Korea University Anam HospitalKorea University College of Medicine Seoul South Korea
| | - Kyungmi Oh
- Department of Neurology Korea University Guro HospitalKorea University College of Medicine Seoul South Korea
| | - Jong-Won Chung
- Department of Neurology Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
| | - Oh Young Bang
- Department of Neurology Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
| | - Gyeong-Moon Kim
- Department of Neurology Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
| | - Jin-Man Jung
- Department of Neurology Korea University Ansan HospitalKorea University College of Medicine Ansan South Korea
| | - Tae-Jin Song
- Department of Neurology Ewha Womans UniversitySchool of Medicine Seoul South Korea
| | - Yong-Jae Kim
- Department of Neurology The Catholic University of Korea Seoul South Korea
| | - Bum Joon Kim
- Department of Neurology Asan Medical Center Seoul South Korea
| | - Sung Hyuk Heo
- Department of Neurology Kyung Hee University College of Medicine Seoul South Korea
| | - Kwang-Yeol Park
- Department of Neurology Chung-Ang University College of MedicineChung-Ang University Hospital Seoul South Korea
| | - Jeong-Min Kim
- Department of Neurology Seoul National University Hospital Seoul South Korea
| | - Jong-Ho Park
- Department of Neurology Myongji HospitalHanyang University College of medicine Seoul South Korea
| | - Jay Chol Choi
- Department of Neurology Jeju National University Jeju South Korea
| | - Man-Seok Park
- Department of Neurology Chonnam National University Hospital Chonnam South Korea
| | - Joon-Tae Kim
- Department of Neurology Chonnam National University Hospital Chonnam South Korea
| | - Kang-Ho Choi
- Department of Neurology Chonnam National University Hospital Chonnam South Korea
| | - Yang Ha Hwang
- Department of Neurology Kyungpook National University Hospital Dae-gu South Korea
| | - Woo-Keun Seo
- Department of Neurology Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea.,Departement of Digital Health SHAISTSungkyunkwan University Seoul South Korea
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PARK HK, Lee KJ, Park JM, Kang K, Lee SJJ, Kim J, Cha JK, Kim BJ, Park TH, Lee KB, Lee J, Hong KS, Cho YJ, Lee BC, Oh MS, Kim JT, Choi KH, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Sohn SI, Hong JH, LEE JUNEYOUNG, Bae JS, Bae HJ. Abstract WMP102: Prevalence Of Genetic Mutations In 15 Mendelian Stroke Genes In Young Stroke Patients. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wmp102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Although the heritability of stroke might be higher in young-age stroke population, it is even uncertain how many of them has monogenic causes of stroke. We aimed to estimate the prevalence and clinical characteristics of 15 monogenic disorders associated with stroke in a large, unselected young-age stroke population
Methods:
From a prospective, nationwide, multicenter, acute stroke registry of consecutive patients admitted to 15 academic or regional stroke centers in Korea, we enrolled all patients aged 55 years or younger except those who refuse to participate in this study. We performed genetic analysis using a customized targeted next-generation sequencing panel (
GLA, NOTCH3, HTRA1, RNF213, ACVRL1, ENG, CBS, TREX1, ABCC6, COL4A1, FBN1, NF1, COL3A1, MT-TL1, and APP
) to find clinically relevant genetic variants, and reviewed clinical information of the patients.
Results:
Genetic analysis was performed in 1,033 patients (male 70.7%, mean age 45.8±7.9). Twenty-eight clinically relevant genetic variants were identified in 131 (12.7%) patients, and were found most frequently in RNF213 (59, 5.7%) followed by ABCC6 (53, 5.1%) and NOTCH3 (15, 1.5%). Genetic variants were more commonly observed in younger group than older group (17.1% vs. 9.3%, p=0.021), but were not different according to vascular risk factor burden. Patients with premature (<60y) family history of stroke had genetic variants more frequently than those with family history at ≥60y (23.7% vs. 11.4%, p=0.047). Typical neuroimaging abnormalities were observed in only 25% of patients with RNF213 variants and 27% of those with NOTCH3 variants. Variants of uncertain significance were found in 15.4%.
Conclusion:
Clinically relevant genetic variants were not uncommon than expected. We might have opportunities to improve our daily practice by genetic counseling patients and their families to reduce the future stroke.
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Affiliation(s)
| | | | | | | | | | - Jae Kim
- EULJI UNIVERSITY HOSPITAL, Daejeon-si
| | | | - Beom J Kim
- SNU BUNDANG HOSPITAL, Seongnam-si Gyeonggi-do
| | | | | | - Jun Lee
- YEUNGNAM UNIV MEDICAL CTR, Daegu, Korea, Republic of
| | | | | | | | - Mi Sun Oh
- Hallym Sacred Heart Hosptial, Anyang
| | | | - Kang-Ho Choi
- Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | | | | | | | | | | | | | | | | | | | - Hee-joon Bae
- SEOUL NATL UNIV BUNDANG HOSPITAL, Seongnam-si Gyeonggi-do
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30
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Kim J, Lee KJ, Kim JY, Kang J, Kim BJ, Han MK, Choi KH, Kim JT, Shin DI, Cha JK, Kim DH, Kim DE, Ryu WS, Park JM, Kang K, Kim J, Lee SJ, Oh MS, Cho YJ, Choi JC, Sohn SI, Hong JH, Park TH, Lee KB, Kwon JH, Kim WJ, Lee J, Lee JS, Lee J, BAE HJ. Abstract TP180: Secular Trends For Demographics, Characteristics, Management, And Clinical Outcome Of Young Adults With Acute Ischemic Stroke. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The incidence of stroke in young adults is increasing with the growing prevalence of stroke risk factors among young adults over the last decades. However, studies on secular trends in the young-age stroke population are scarce.
Methods:
We extracted data of acute ischemic stroke (AIS) patients aged 18-50 (n=7053; age, 43±6; male, 72%) from the multicenter stroke registry in South Korea. Demographics, risk factors, stroke characteristics, management, and clinical outcomes in young adults with AIS were summarized according to calendar year (2008-2019). Trends analysis was conducted using a linear regression model for continuous variables and the Mann-Kendall trend test for categorical variables.
Results:
There was no significant change between 2008 and 2019 in the proportions of young adults among female patients (7.1% to 7.0%, p=0.44). However, the proportions of young adults within male patients tended to decrease (12.4% to 10.7%; p=0.001) The prevalence, and awareness of risk factors were unchanged during the study period. Regarding stroke subtypes, there was a significant increase in other determined etiology (8% to 20%; p<0.001) and a tendency to decrease in large artery atherosclerosis (26% in 2008; 34% in 2009 to 26% in 2019; p=0.28). The endovascular thrombectomy (EVT) rate increased (2% to 8%; p<0.001), but the intravenous thrombolysis rate (8.8% to 10.6%) and door-to-needle time (38 to 36 min) did not change. Use of dual antiplatelet (DAPT; 29% to 55%; p=<0.001) increased and direct oral anticoagulants (DOACs) in patients with atrial fibrillation tended to increase (11.7% in 2013 to 44.8% in 2019; p=0.07; DOAC began to be used in 2013 in Korea). However, the use of anticoagulants among young adult patients having atrial fibrillation tended to decrease (80% to 66%; p=0.054). Clinical outcomes, including a 3-month modified ranking scale 0-2 (84.6% to 85.2%), 1-year mortality (2.8% to 2.4%), and stroke recurrence rate (4.5 to 5.6%), did not improve during the study period.
Conclusions:
Among young adults with ischemic stroke, the EVT rate and use of DAPT or DOACs increased. Still, awareness of risk factors, door-to-needle time, and anticoagulation for atrial fibrillation required more attention to improve clinical outcomes.
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Affiliation(s)
- Jonguk Kim
- Neurology, Seoul Nat' Univ' Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Keon-joo Lee
- Neurology, Seoul Nat' Univ' Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Jun Yup Kim
- Neurology, Seoul Nat' Univ' Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Jihoon Kang
- Neurology, Seoul Nat' Univ' Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Beom Joon Kim
- Neurology, Seoul Nat' Univ' Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Moon-Ku Han
- Neurology, Seoul Nat' Univ' Bundang Hosp, Seongnam-si, Korea, Republic of
| | - Kang-Ho Choi
- Neurology, Chonnam National Univ Hosp, Gwangju-si, Korea, Republic of
| | - Joon-Tae Kim
- Neurology, Chonnam National Univ Hosp, Gwangju-si, Korea, Republic of
| | - Dong-Ick Shin
- Neurology, Chungbuk National Univ Hosp, Cheongju-si, Korea, Republic of
| | - Jae-kwan Cha
- Neurology, Dong-A Univ Hosp, Busan-si, Korea, Republic of
| | - Dae-Hyun Kim
- Neurology, Dong-A Univ Hosp, Busan-si, Korea, Republic of
| | - Dong-Eog Kim
- Neurology, Dongguk Univ Ilsan Hosp, Goyang-si, Korea, Republic of
| | - Wi-Sun Ryu
- Neurology, Dongguk Univ Ilsan Hosp, Goyang-si, Korea, Republic of
| | - Jong-moo Park
- Neurology, Uijeongbu Eulji Med Cntr, Eulji Univ., Uijeongbu-si, Korea, Republic of
| | - Kyusik Kang
- Neurology, Nowon Eulji Med Cntr, Eulji Univ., Seoul-si, Korea, Republic of
| | - Jae Kim
- Neurology, Daejeon Eulji Med Cntr, Eulji Univ., Daejeon -si, Korea, Republic of
| | - Soo Joo Lee
- Neurology, Daejeon Eulji Med Cntr, Eulji Univ., Daejeon-si, Korea, Republic of
| | - Mi-Sun Oh
- Neurology, Hallym Univ Sacred Heart Hosp, Anyang-si, Korea, Republic of
| | - Yong-Jin Cho
- Neurology, Ilsan Paik Hosp, Inje Univ., Goyang-si, Korea, Republic of
| | - Jay Chol Choi
- Neurology, Jeju National Univ Hosp, Jeju-si, Korea, Republic of
| | - Sung Il Sohn
- Neurology, Keimyung Univ Dongsan Hosp, Daegu-si, Korea, Republic of
| | - Jeong-ho Hong
- Neurology, Keimyung Univ Dongsan Hosp, Daegu-si, Korea, Republic of
| | - Tai Hwan Park
- Neurology, Seoul Med Cntr, Seoul-si, Korea, Republic of
| | - Kyung Bok Lee
- Neurology, Soonchunhyang Univ Hosp, Seoul-si, Korea, Republic of
| | - Jee-hyun Kwon
- Neurology, Ulsan Univ Hosp, Ulsan-si, Korea, Republic of
| | - Wook-Jo Kim
- Neurology, Ulsan Univ Hosp, Ulsan-si, Korea, Republic of
| | - Jun Lee
- Neurology, Yeungnam Univ Med Cntr, Daegu-si, Korea, Republic of
| | - Ji Sung Lee
- Clinical Rsch Cntr, Asan Med Cntr, Seoul-si, Korea, Republic of
| | - Juneyoung Lee
- Dept of Biostatistics, Korea Univ College of Medicine, Seoul-si, Korea, Republic of
| | - Hee-joon BAE
- Seoul Nat' Univ' Bundang Hosp, Seongnam-si, Korea, Republic of
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Ryu WS, Hong KS, Jeong SW, Park JE, Kim BJ, Kim JT, Lee KB, Park TH, Park SS, Park JM, Kang K, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Lee SJ, Kim JG, Cha JK, Kim DH, Lee J, Han MK, Park MS, Choi KH, Lee J, Saver JL, Lo EH, Bae HJ, Kim DE. Association of ischemic stroke onset time with presenting severity, acute progression, and long-term outcome: A cohort study. PLoS Med 2022; 19:e1003910. [PMID: 35120123 PMCID: PMC8815976 DOI: 10.1371/journal.pmed.1003910] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Preclinical data suggest circadian variation in ischemic stroke progression, with more active cell death and infarct growth in rodent models with inactive phase (daytime) than active phase (nighttime) stroke onset. We aimed to examine the association of stroke onset time with presenting severity, early neurological deterioration (END), and long-term functional outcome in human ischemic stroke. METHODS AND FINDINGS In a Korean nationwide multicenter observational cohort study from May 2011 to July 2020, we assessed circadian effects on initial stroke severity (National Institutes of Health Stroke Scale [NIHSS] score at admission), END, and favorable functional outcome (3-month modified Rankin Scale [mRS] score 0 to 2 versus 3 to 6). We included 17,461 consecutive patients with witnessed ischemic stroke within 6 hours of onset. Stroke onset time was divided into 2 groups (day-onset [06:00 to 18:00] versus night-onset [18:00 to 06:00]) and into 6 groups by 4-hour intervals. We used mixed-effects ordered or logistic regression models while accounting for clustering by hospitals. Mean age was 66.9 (SD 13.4) years, and 6,900 (39.5%) were women. END occurred in 2,219 (12.7%) patients. After adjusting for covariates including age, sex, previous stroke, prestroke mRS score, admission NIHSS score, hypertension, diabetes, hyperlipidemia, smoking, atrial fibrillation, prestroke antiplatelet use, prestroke statin use, revascularization, season of stroke onset, and time from onset to hospital arrival, night-onset stroke was more prone to END (adjusted incidence 14.4% versus 12.8%, p = 0.006) and had a lower likelihood of favorable outcome (adjusted odds ratio, 0.88 [95% CI, 0.79 to 0.98]; p = 0.03) compared with day-onset stroke. When stroke onset times were grouped by 4-hour intervals, a monotonic gradient in presenting NIHSS score was noted, rising from a nadir in 06:00 to 10:00 to a peak in 02:00 to 06:00. The 18:00 to 22:00 and 22:00 to 02:00 onset stroke patients were more likely to experience END than the 06:00 to 10:00 onset stroke patients. At 3 months, there was a monotonic gradient in the rate of favorable functional outcome, falling from a peak at 06:00 to 10:00 to a nadir at 22:00 to 02:00. Study limitations include the lack of information on sleep disorders and patient work/activity schedules. CONCLUSIONS Night-onset strokes, compared with day-onset strokes, are associated with higher presenting neurologic severity, more frequent END, and worse 3-month functional outcome. These findings suggest that circadian time of onset is an important additional variable for inclusion in epidemiologic natural history studies and in treatment trials of neuroprotective and reperfusion agents for acute ischemic stroke.
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Affiliation(s)
- Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
- National Priority Research Center for Stroke, Goyang, Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sang-Wuk Jeong
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jung E. Park
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Sang-Soon Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Uijeongbu, Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, 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
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Daejeon, Korea
| | - Jae Guk Kim
- Department of Neurology, Eulji University Hospital, 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
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Man Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University, Seoul, Korea
| | - Jeffrey L. Saver
- Comprehensive Stroke Center, Department of Neurology, University of California, Los Angeles, California, United States of America
- Consortium International pour la Recherche Circadienne sur l’AVC (CIRCA)
| | - Eng H. Lo
- Consortium International pour la Recherche Circadienne sur l’AVC (CIRCA)
- Neuroprotection Research Laboratory, Departments of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
- Consortium International pour la Recherche Circadienne sur l’AVC (CIRCA)
- * E-mail: (H-JB); (D-EK)
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
- National Priority Research Center for Stroke, Goyang, Korea
- Consortium International pour la Recherche Circadienne sur l’AVC (CIRCA)
- * E-mail: (H-JB); (D-EK)
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Kim DY, Han SG, Jeong HG, Lee KJ, Kim BJ, Han MK, Choi KH, Kim JT, Shin DI, Cha JK, Kim DH, Kim DE, Ryu WS, Park JM, Kang K, Kim J, Lee SJ, Oh MS, Yu KH, Lee BC, PARK HK, Hong KS, Cho YJ, Choi JC, Sohn SI, Hong JH, Park TH, Lee KB, Kwon JH, Kim WJ, Lee J, Lee JS, LEE JUNEYOUNG, BAE HJ. Abstract WP184: The Risk Of Stroke Recurrence According To Neuroimaging Parameters In Patients With Acute Ischemic Stroke And Atrial Fibrillation. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wp184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose:
The usefulness of the existing risk stratification tools for atrial fibrillation (AF) is limited in predicting stroke recurrence in patients with acute ischemic stroke (AIS). Neuroimaging parameters obtained from diagnostic work-up of AIS could offer more elaborate prediction.
Methods:
A multicenter prospective cohort of AIS patients with AF recruited from 14 university hospitals or regional stroke centers were followed up for recurrent ischemic stroke (RIS) and a composite of all stroke and TIA. Neuroimaging features were derived from acute and chronic infarction patterns, and SVD markers such as lacunes, CMBs, and WMH. Cumulative incidences according to each neuroimaging parameter were estimated and compared using the Kaplan-Meier method with log-rank test and multivariable cause-specific hazard models with death as a competing risk.
Results:
A total of 2,270 patients were followed up for 431 days (IQR, 365-735), during which 111 RISs and 130 composite outcomes occurred. In unadjusted analysis, lesion multiplicity among acute infarction patterns, the presence of chronic non-lacunar infarction, and the presence of lacunes among SVD markers increased the risk of RIS significantly (Table). Other neuroimaging features such as territory multiplicity and location, confluency, topography, and size of acute lesions, lesion multiplicity, territory multiplicity, confluency, topography, and size of chronic infarction, number of lacunes, presence of CMBs, and WMH did not affect the incidence of RIS. The adjusted hazard ratios of lesion multiplicity of acute infarction, chronic infarction and lacunes were 1.45 (95% CI, 0.99-2.11), 1.57 (1.06-2.34) and 1.97 (1.30-2.98) for RIS, respectively. Similar findings were obtained for the composite outcome.
Conclusions:
Several neuroimaging markers were associated with recurrent ischemic stroke in AIS with AF. This could pave the way to a new stratification scheme for AF including neuroimaging parameters.
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Affiliation(s)
- Do Yeon Kim
- Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
| | - Seok-Gil Han
- Neurology and Cerebrovascular Cntr, Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
| | - Han-gil Jeong
- Neurology and Neurosurgery, Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
| | - Keon-joo Lee
- Neurology and Cerebrovascular Cntr, Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
| | - Beom J Kim
- Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
| | - Moon-Ku Han
- Neurology and Cerebrovascular Cntr, Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
| | - Kang-Ho Choi
- Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | - Joon-tae Kim
- Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | - Dong-Ick Shin
- Chungbuk National Univ Hosp, Cheongju, Korea, Republic of
| | - Jae-kwan Cha
- Dong-A Univ Hosp, Dong-A Univ College of Medicine, Busan, Korea, Republic of
| | - Dae Hyun Kim
- Dong-A Univ Hosp, Dong-A Univ College of Medicine, Busan, Korea, Republic of
| | - Dong E Kim
- Dongguk Univ Ilsan Hosp, Goyang, Korea, Republic of
| | - Wi-Sun Ryu
- Dongguk Univ Ilsan Hosp, Goyang, Korea, Republic of
| | - Jong-moo Park
- ngbu Eulji Med Cntr, Eulji Univ Sch of Medicine, Uijeongbu, Korea, Republic of
| | - Kyusik Kang
- Nowon Eulji Med Cntr, Eulji Univ Sch of Medicine, Seoul, Korea, Republic of
| | - Jae Kim
- Daejeon Eulji Med Cntr, Eulji Univ Sch of Medicine, Daejeon, Korea, Republic of
| | - Soo Joo Lee
- Daejeon Eulji Med Cntr, Eulji Univ Sch of Medicine, Daejeon, Korea, Republic of
| | - Mi Sun Oh
- Hallym Univ Sacred Heart Hosp, Anyang, Korea, Republic of
| | - Kyung-Ho Yu
- Hallym Univ Sacred Heart Hosp, Anyang, Korea, Republic of
| | - Byung-chul Lee
- Hallym Univ Sacred Heart Hosp, Anyang, Korea, Republic of
| | - Hong-kyun PARK
- Inje Univ Ilsan Paik Hosp, Inje Univ College of Medicine, Goyang, Korea, Republic of
| | - Keun-sik Hong
- Inje Univ Ilsan Paik Hosp, Inje Univ College of Medicine, Goyang, Korea, Republic of
| | - Yong-Jin Cho
- Inje Univ Ilsan Paik Hosp, Inje Univ College of Medicine, Goyang, Korea, Republic of
| | - Jay Chol Choi
- ju National Univ Hosp, Jeju National Univ Sch of Medicine, Jeju, Korea, Republic of
| | - Sung-il Sohn
- Keimyung Univ Dongsan Med Cntr, Daegu, Korea, Republic of
| | - Jeong-ho Hong
- Keimyung Univ Dongsan Med Cntr, Daegu, Korea, Republic of
| | | | | | - Jee-Hyun Kwon
- Ulsan Univ Hosp, Ulsan Univ College of Medicine, Ulsan, Korea, Republic of
| | - Wook-joo Kim
- Ulsan Univ Hosp, Ulsan Univ College of Medicine, Ulsan, Korea, Republic of
| | - Jun Lee
- Yeungnam Univ Hosp, Daegu, Korea, Republic of
| | | | | | - Hee-joon BAE
- Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
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Kim J, Lee KJ, Kim B, Kang J, Han MK, Kim SE, Park JM, Kang K, Lee SJ, Kim J, Cha JK, Kim DH, Park TH, Lee KB, PARK HK, Cho YJ, Hong KS, Choi KH, Kim JT, Kim DE, Ryu WS, Choi JC, Oh MS, Yu KH, Lee BC, Park KY, Lee JS, LEE JUNEYOUNG, BAE HJ. Abstract WP186: Long-term Incidence Of Gastrointestinal Bleeding After Ischemic Stroke. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.wp186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Incidence of gastrointestinal (GI) bleeding after acute ischemic stroke (AIS) was reported as 1.5% during hospitalization, one-thirds of which required blood transfusion. However, it is not known about the long-term incidence and the incidence rates by period after AIS.
Methods:
AIS patients who were admitted to the 14 participating hospitals between 2011 and 2013 were identified using a nationwide multicenter prospective stroke registry database. GI bleeding was captured with related diagnosis codes by International Classification of Diseases-10th Revision through the linkage between the registry database and the claims data. Bleeding requiring at least 2 packs of blood transfusion was defined as major GI bleeding. Incidence rates were calculated for each period as follow; 0-30 days, 31-90 days, 91-180 days, 181-365 days, 1-2 years, 2-3years, after 3 years.
Results:
Of 10,818 AIS patients, 59.0% were male and mean age was 67.5 ± 12.9 years. The median follow-up duration was 3.1 (interquartile range 2.3 to 4.0) years. During 31,208 person-years, 947 patients (8.8%) had 1,224 episodes of major GI bleeding. Annual incidence rate was 3.92 per 100 person-years. The incidence rates by periods were the highest at 19.21 per 100 person-years in the first month of AIS, gradually decreased to 9.02 in one to three months, 6.18 in three to six months, and 3.48 in six to twelve months. After three years, it remained at about 2.62 events per 100 person-years. During the observation period, only one major GI bleeding occurred without recurrence in about 80% of patients, about 13% recurred twice, and about 6% of patients had three or more recurrences. In the multivariable recurrent event analysis, anemia at admission, lower eGFR below 60, and mRS at 3 months ≥4 were independently associated with higher risk of major GI bleeding during the most of the observation period above 3 years.
Conclusions:
Major GI bleeding, requiring transfusion, seems to occur frequently after AIS, and the risk was gradually decreased after stroke. The efforts are needed to prevent it, especially in stroke patients with anemia and decreased renal function.
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Affiliation(s)
- Jun Kim
- Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam-si, Korea, Republic of
| | - Keon-joo Lee
- Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam-si, Korea, Republic of
| | - Beom Kim
- Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam-si, Korea, Republic of
| | - Jihoon Kang
- Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam-si, Korea, Republic of
| | - Moon-Ku Han
- Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam-si, Korea, Republic of
| | - Seong-Eun Kim
- Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam-si, Korea, Republic of
| | - Jong-moo Park
- Uijeonbu Eulji Med Cntr, Eulji Univ, Uijeongbu-si, Korea, Republic of
| | - Kyusik Kang
- Nowon Eulji Med Cntr, Eulji Univ, Jinju, Korea, Republic of
| | - Soo Joo Lee
- Eulji Univ Hosp, Eulji Univ, Daejon, Korea, Republic of
| | - Jae Kim
- Eulji Univ Hosp, Eulji Univ, Daejeon, Korea, Republic of
| | - Jae-kwan Cha
- Dong-A Univ Hosp, Dong-A Univ College of Medicine, Busan, Korea, Republic of
| | - Dae-Hyun Kim
- Dong-A Univ Hosp, Dong-A Univ College of Medicine, Busan, Korea, Republic of
| | | | - Kyung Bok Lee
- Soonchunhyang Univ Hosp, Soonchunhyang Univ College of Medicine, Seoul, Korea, Republic of
| | | | - Yong-jin Cho
- Inje Univ Ilsan Paik Hosp, Goyang, Korea, Republic of
| | - Keun-sik Hong
- Inje Univ Ilsan Paik Hosp, Goyang, Korea, Republic of
| | - Kang-Ho Choi
- Chonnam National Univ Hosp, Chonnam National Univ College of Medicine, Gwangju, Korea, Republic of
| | - Joon-tae Kim
- Chonnam National Univ Hosp, Chonnam National Univ College of Medicine, Gwangju, Korea, Republic of
| | - Dong-Eog Kim
- Dongguk Univ Ilsan Hosp, Goyang, Korea, Republic of
| | - Wi-Sun Ryu
- Dongguk Univ Ilsan Hosp, Goyang, Korea, Republic of
| | - Jay Chol Choi
- Jeju National Univ Hosp, Jeju National Univ Sch of Medicine, Jeju, Korea, Republic of
| | - Mi-Sun Oh
- Hallym Univ Sacred Heart Hosp, Hallym Univ College of Medicine, Anyang, Korea, Republic of
| | - Kyung-Ho Yu
- Hallym Univ Sacred Heart Hosp, Hallym Univ College of Medicine, Anyang, Korea, Republic of
| | - Byung-chul Lee
- Hallym Univ Sacred Heart Hosp, Hallym Univ College of Medicine, Anyang, Korea, Republic of
| | - Kwang-yeol Park
- Chung-Ang Univ Hosp, Chung-Ang Univ College of Medicine, Seoul, Korea, Republic of
| | - Ji Sung Lee
- Clinical Rsch Cntr, Asan Institute for Life Sciences, Asan Med Cntr, Seoul, Korea, Republic of
| | - JUNEYOUNG LEE
- Dept of Biostatistics, Korea Univ College of Medicine, Seoul, Korea, Republic of
| | - Hee-joon BAE
- Seoul National Univ Bundang Hosp, Seoul National Univ College of Medicine, Seongnam, Korea, Republic of
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Kim BJ, Hwang YH, Park MS, Kim JT, Choi KH, Jung JM, Yu S, Kim CK, Oh K, Song TJ, Kim YJ, Park KY, Kim JM, Park JH, Choi JC, Chung JW, Bang OY, Kim GM, Heo SH, Seo WK. Atrial Fibrillation Related and Unrelated Stroke Recurrence Among Ischemic Stroke Patients With Atrial Fibrillation. Front Neurol 2021; 12:744607. [PMID: 34744981 PMCID: PMC8566747 DOI: 10.3389/fneur.2021.744607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Ischemic stroke with atrial fibrillation (AF) may recur despite appropriate treatment. It may be AF-related or AF-unrelated. We compared the factors associated with AF-related and AF-unrelated recurrences among ischemic stroke patients with AF. Methods: Patients with ischemic stroke and AF were enrolled from 11 centers in Korea. Ischemic stroke recurrence was classified as AF-related if the lesion pattern was compatible with cardioembolism without significant stenosis or as AF-unrelated if the lesion was more likely due to small vessel disease or arterial stenosis. Factors associated with stroke recurrence (AF-related and AF-unrelated) were investigated. Results: Among the 2,239 patients, 115 (5.1%) experienced recurrence (75 AF-related and 40 AF-unrelated). Factors independently associated with any stroke recurrence included AF diagnosed before stroke, small subcortical infarctions, and small scattered lesions in a single vascular territory. Type of AF was associated with the type of stroke recurrence, with persistent AF being associated with AF-related stroke [hazard ratio (HR) = 2.94, 95% confidence interval (CI) 1.69-5.26; p < 0.001]. By contrast, paroxysmal AF (HR = 3.76, 95% CI 1.56-9.04; p = 0.003), AF diagnosed before stroke (HR = 2.38, 95% CI 1.19-4.55; p = 0.014), small scattered lesions in a single vascular territory (reference: corticosubcortical lesion, HR = 3.19, 95% CI 1.18-8.63; p = 0.022), and the use of antiplatelet agents (HR = 2.11, 95% CI 1.11-4.03; p = 0.024) were independently associated with AF-unrelated stroke. Conclusion: Persistent AF was more associated with AF-related stroke recurrence, whereas paroxysmal AF was more associated with AF-unrelated stroke recurrence. A scattered lesion in a single vascular territory may predict AF-unrelated stroke recurrence.
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Affiliation(s)
- Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, South Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Daegu, South Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju, South Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
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Kim SH, Jeon ET, Yu S, Kyungmi O, Kim CK, Song TJ, Kim YJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Kim BJ, Chung JW, Bang OY, Kim G, Seo WK, Jung JM. Interpretable machine learning for early neurological deterioration prediction in atrial fibrillation-related stroke. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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36
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Ryu WS, Schellingerhout D, Hong KS, Jeong SW, Kim BJ, Kim JT, Lee KB, Park TH, Park SS, Park JM, Kang K, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Lee SJ, Kim JG, Cha JK, Kim DH, Lee J, Han MK, Park MS, Choi KH, Nahrendorf M, Lee J, Bae HJ, Kim DE. Relation of Pre-Stroke Aspirin Use With Cerebral Infarct Volume and Functional Outcomes. Ann Neurol 2021; 90:763-776. [PMID: 34536234 PMCID: PMC9292882 DOI: 10.1002/ana.26219] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/13/2023]
Abstract
Objective We investigated (1) the associations of pre‐stroke aspirin use with thrombus burden, infarct volume, hemorrhagic transformation, early neurological deterioration (END), and functional outcome, and (2) whether stroke subtypes modify these associations in first‐ever ischemic stroke. Methods This multicenter magnetic resonance imaging (MRI)‐based study included 5,700 consecutive patients with acute first‐ever ischemic stroke, who did not undergo intravenous thrombolysis or endovascular thrombectomy, from May 2011 through February 2014. Propensity score‐based augmented inverse probability weighting was performed to estimate adjusted effects of pre‐stroke aspirin use. Results The mean age was 67 years (41% women), and 15.9% (n = 907) were taking aspirin before stroke. Pre‐stroke aspirin use (vs nonuse) was significantly related to a reduced infarct volume (by 30%), particularly in large artery atherosclerosis stroke (by 45%). In cardioembolic stroke, pre‐stroke aspirin use was associated with a ~50% lower incidence of END (adjusted difference = −5.4%, 95% confidence interval [CI] = −8.9 to −1.9). Thus, pre‐stroke aspirin use was associated with ~30% higher likelihood of favorable outcome (3‐month modified Rankin Scale score < 3), particularly in large artery atherosclerosis stroke and cardioembolic stroke (adjusted difference = 7.2%, 95% CI = 1.8 to 12.5 and adjusted difference = 6.4%, 95% CI = 1.7 to 11.1, respectively). Pre‐stroke aspirin use (vs nonuse) was associated with 85% less frequent cerebral thrombus‐related susceptibility vessel sign (SVS) in large artery atherosclerosis stroke (adjusted difference = −1.4%, 95% CI = −2.1 to −0.8, p < 0.001) and was associated with ~40% lower SVS volumes, particularly in cardioembolic stroke (adjusted difference = −0.16 cm3, 95% CI = −0.29 to −0.02, p = 0.03). Moreover, pre‐stroke aspirin use was not significantly associated with hemorrhagic transformation (adjusted difference = −1.1%, p = 0.09). Interpretation Pre‐stroke aspirin use associates with improved functional independence in patients with first‐ever ischemic large arterial stroke by reducing infarct volume and/or END, likely by decreasing thrombus burden, without increased risk of hemorrhagic transformation. ANN NEUROL 2021;90:763–776
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Affiliation(s)
- Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea.,National Priority Research Center for Stroke, Goyang, South Korea
| | - Dawid Schellingerhout
- Departments of Radiology and Cancer Systems Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang
| | - Sang-Wuk Jeong
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, South Korea
| | - Sang-Soon Park
- Department of Neurology, Seoul Medical Center, Seoul, South Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, South Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Daejeon, South Korea
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Soo Joo Lee
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, South Korea
| | - Jae Guk Kim
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, South Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, South Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, South Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, South Korea
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Man Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Matthias Nahrendorf
- Center for Systems Biology and Department of Radiology, Massachusetts General Hospital Research Institute, Harvard Medical School, Boston, MA
| | - Juneyoung Lee
- Department of Biostatistics, Korea University, Seoul, South Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea.,National Priority Research Center for Stroke, Goyang, South Korea
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Cho MJ, Kim YJ, Kim MJ, Kim YS, Park E, Choi KH, Kang JY, Kim HO, Koong MK, Kim YS, Yoon TK, Ko JJ, Lee JH. P–205 Epothilone D as an actin cytoskeleton stabilizer improved mitochondria bioenergenesis and blastocyst formation of mouse preimplantation embryo. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
What is primary factor of bioenergetics product activity between microtubule instability and the functional activity of mitochondria in embryo?
Summary answer
The actin cytoskeleton instability is presumably the primary cause for the bioenergenesis of mitochondrial function to the preimplantation embryo development.
What is known already
Mitochondria are cellular organelles dynamically moving and morphological changes. It provides for homeostatic energy to the cell. The dynamic property of the mitochondria is associated with the microtubule network in the cell. However, the stability of the microtubule was clearly identified for preimplantation embryo development.
Study design, size, duration
This study is designed to assess the ATP productivity of the mitochondria, and specifically to observe what its primary factor is in terms of providing microtubule stability in mammalian cells. Additionally, we investigated the relationship between blastocyst formation and actin cytoskeleton stabilization by EpD with 2-cell mice.
Participants/materials, setting, methods
We prepared the microtubule stability regulation model with the HEK293 cell line by using the microtubule stabilizer as an Epothilone D (EpD). Then we analyzed the metabolic activity of the cells through oxidative phosphorylation (OXP) ratios analysis. Also, we performed confocal live imaging to observe mitochondria morphology depending on the cells’ microtubule. Next, we treated EpD to 2-cell culture media for the analysis of blastocyst development ratios.
Main results and the role of chance
EpD significantly increased fusion form. Also, EpD enhance bioenergy ratios like OXP in the mitochondria and functional activity related marker, like mTOR compared with the control. These results suggest that microtubule stabilization enhances mitochondrial metabolism by increasing oxygen consumption. Also, EpD in 2-cell culture media led to a significant increase in the speed of development and 50% higher hatched out blastocyst formation ratios compared to the control group.
Limitations, reasons for caution
This study had limited animal experiments. For the next study, we are planning with an aim to improve the quality and development ratios of human embryos by EpD.
Wider implications of the findings: Microtubule stabilizer has a possibility to recover the mitochondria’s functional activity in the preimplantation embryo development. Mitochondrial functional activity along the actin cytoskeleton may play a pivotal role in determining the embryo quality and development ratios for archive pregnancy.
Trial registration number
non-clinical trials
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Affiliation(s)
- M J Cho
- CHA University, Biomedical Sciences, Seoul, Korea- South
| | - Y J Kim
- CHA Medical Group, Reproductive and Molecular Medicine, Seoul, Korea- South
| | - M J Kim
- CHA Fertility Center Seoul Station, Clinic, Seoul, Korea- South
| | - Y S Kim
- CHA Fertility Center Seoul Station, Clinic, Seoul, Korea- South
| | - E Park
- CHA Fertility Center Seoul Station, Embryology lab, Seoul, Korea- South
| | - K H Choi
- CHA Fertility Center Seoul Station, Embryology lab, Seoul, Korea- South
| | - J Y Kang
- CHA Fertility Center Seoul Station, Embryology lab, Seoul, Korea- South
| | - H O Kim
- CHA Fertility Center Seoul Station, Clinic, Seoul, Korea- South
| | - M K Koong
- CHA Fertility Center Seoul Station, Clinic, Seoul, Korea- South
| | - Y S Kim
- CHA Fertility Center Seoul Station, Clinic, Seoul, Korea- South
| | - T K Yoon
- CHA Fertility Center Seoul Station, Clinic, Seoul, Korea- South
| | - J J Ko
- CHA University, Biomedical Sciences, Seoul, Korea- South
| | - J H Lee
- CHA fertility seoul center seoul sequare 3floor, Reproductive and Molecular Medicine., Seoul, Korea- South
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Choi KH, Kim YJ, Kang KY, Park EA, Kim YS, Kim MJ, Kim HO, Koong MK, Kim YS, Yoon TK, Ko JJ, Lee JH. P–657 Prostaglandin D2 is correlated with follicles development and a reliable marker of ovarian reserve of poor ovarian responder patients. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is the prostaglandin D2 (PGD2) associated with growing follicles and ovarian reserve of poor ovarian responders?
Summary answer
PGD2 is correlated with ovarian stimulation activity and follicle growth. Especially, poor ovarian responders show a significant decrease in the level of follicular fluid.
What is known already
Prostaglandins (PGs) are involved in the female reproductive process, mainly ovulation, fertilization, and implantation.
Study design, size, duration
We investigated the PGD2 level in the follicular fluid of poor ovarian responders. The collection of human follicular fluid was approved by the Institutional Research and Ethical Committees of CHA University (approval number: 1044308–201611-BR–027–04) from January to December 2019. Follicular fluid was collected from patients with normal ovarian response and patients with POR.
Participants/materials, setting, methods
We studied whether prostaglandin has related to POR in the clinical key factor by measuring human follicular fluid. Follicular fluid was collected from patients with normal ovarian response and patients with POR. The concentration of PGD2 in follicular fluid was determined with ELISA kits following the manufacturer’s protocol.
Main results and the role of chance
We analyzed the level of PGD2 in the follicular fluid of patients with normal ovarian response and patients with POR using an ELISA. The PGD2 concentration was significantly lower in the follicular fluid of patients with POR than in the follicular fluid of young and old patients with normal ovarian response.
Limitations, reasons for caution
This study has an identification of biomarker of the clinical samples as POR criteria patients. Therefore, further investigations aimed at specific recovery of low PGD2 metabolic activity in the CCs during control ovarian stimulation.
Wider implications of the findings: Until now there is no specific biomarker of POR. AMH is just an ovary reserve marker for an indication of ovary function. PGD2 is one of the metabolites in steroid metabolism in the ovary. Therefore, we can find some cure through further study for improved PGD2 production to POR patients.
Trial registration number
none
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Affiliation(s)
- K H Choi
- CHA Fertility Center Seoul Station, Embryology Lab, Seoul, Korea- South
| | - Y J Kim
- CHA Medical Group, Advanced Research Division of Reproductive Medicine, Seoul, Korea- South
| | - K Y Kang
- CHA Fertility Center Seoul Station, Embryology Lab, Seoul, Korea- South
| | - E A Park
- CHA Fertility Center Seoul Station, Embryology Lab, Seoul, Korea- South
| | - Y S Kim
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - M J Kim
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - H O Kim
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - M K Koong
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - Y S Kim
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - T K Yoon
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - J J Ko
- CHA University, Biomedical Science, Pocheon-si, Korea- South
| | - J H Lee
- CHA Fertility Center Seoul Station, Embryology Lab, Seoul, Korea- South
- CHA University, Biomedical Science, Pocheon-si, Korea- South
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Kim YJ, Choi KH, Kang KY, Park EA, Kim YS, Kim MJ, Kim HO, Koong MK, Kim YS, Yoon TK, Ko JJ, Lee JH. P–658 Lovastatin promotes the expression of LDL receptor and enhances E2 production in the cumulus cells. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Study question
Lovastatin enhanced E2 productive ratios in the cumulus cells through promoted expression of Low-density lipoprotein receptor (LDLR).
Summary answer
Lovastatin up-regulated gene expression of LDLR in the CCs. And the high expression of LDLR promoted E2 productive ratios from CCs.
What is known already
We already reported that the up-regulation of LDLR correlated with clinical pregnancy. Therefore, we found lovastatin as an up-regulator of LDLR expression of clinical pregnancy.
Study design, size, duration
This is an expended study of LDLR to enhance steroidogenesis regarding the effect of lovastatin in the CCs. The collection of human cumulus cells was approved by the Institutional Research and Ethical Committees of CHA University (approval number: 1044308–201611-BR–027–04) from January to December 2019. The CCs were collected from 12 patients with normal ovarian response after oocyte denudation for ICSI.
Participants/materials, setting, methods
We studied whether lovastatin has up-regulated LDLR expression in human CCs. Cumulus cells were collected from patients with young (∼ 36) and old aged patients (37 ∼). After culturing human CCs, they were treated lovastatin for one day. The concentration of E2 in culture medium was measured using Chemiluminescence immunoassay. The mRNA isolated from CCs was analyzed gene expression level through real time-PCR.
Main results and the role of chance
The concentration of E2 was significantly increased in the culture medium treated with lovastatin. The CCs treated with lovastatin increased the expression of LDLR and StAR which are components of the steroidogenesis pathway.
Limitations, reasons for caution
We have found that the role of lovastatin promotes the E2 production by increasing the ldlr gene of CCs. Therefore, further investigations aimed at lovastatin effect on human oocytes embryo whether enhanced quality of oocytes or not.
Wider implications of the findings: Previous data show that high activation of LDLR and StAR was associated with embryo quality and clinical pregnancy in infertile women. Our data suggest that lovastatin is stimulated LDLR expression to enhanced pregnancy ratios of IVF patients.
Trial registration number
none
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Affiliation(s)
- Y J Kim
- CHA Medical Group, Advanced Research Division of Reproductive Medicine, Seoul, Korea- South
| | - K H Choi
- CHA Fertility Center Seoul Station, Embryology Lab, Seoul, Korea- South
| | - K Y Kang
- CHA Fertility Center Seoul Station, Embryology Lab, Seoul, Korea- South
| | - E A Park
- CHA Fertility Center Seoul Station, Embryology Lab, Seoul, Korea- South
| | - Y S Kim
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - M J Kim
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - H O Kim
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - M K Koong
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - Y S Kim
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - T K Yoon
- CHA Fertility Center Seoul Station, IVF clinic, Seoul, Korea- South
| | - J J Ko
- CHA University, Biomedical Science, Pocheon-si, Korea- South
| | - J H Lee
- CHA Fertility Center Seoul Station, Embryology Lab, Seoul, Korea- South
- CHA University, Biomedical Science, Pocheon-si, Korea- South
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40
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Kim S, Kim JT, Lee JS, Kim BJ, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Park TH, Park SS, Lee KB, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DI, Sohn SI, Hong JH, Park MS, Choi KH, Cho KH, Lee J, Bae HJ. Comparative effectiveness of combined antiplatelet treatments in acute minor ischaemic stroke. Stroke Vasc Neurol 2021; 7:13-21. [PMID: 34290076 PMCID: PMC8899677 DOI: 10.1136/svn-2020-000841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/27/2021] [Indexed: 12/05/2022] Open
Abstract
Background No study has thoroughly compared the effectiveness of combined antiplatelet treatments (other than clopidogrel–aspirin) versus clopidogrel–aspirin or aspirin alone for early secondary prevention in acute ischaemic stroke. Methods We identified patients with acute, minor, non-cardiogenic ischaemic stroke treated with aspirin alone, clopidogrel–aspirin or other combination treatment. Propensity scores considering the inverse probability of treatment weighting were used to adjust for baseline imbalances. The primary outcome was the composite of all strokes (ischaemic or haemorrhagic), myocardial infarction and all-cause mortality at 3 months. Results Among 12 234 patients (male: 61.9%; age: 65.5±13 years) who met the eligibility criteria, aspirin, clopidogrel–aspirin and other combination treatments were administered in 52.2%, 42.9% and 4.9% of patients, respectively. In the crude analysis, the primary outcome event at 3 months occurred in 14.5% of the other combination group, 14.4% of the aspirin group and 13.0% of the clopidogrel–aspirin group. In the weighted Cox proportional hazards analysis, the 3-month primary outcome event occurred less frequently in the clopidogrel–aspirin group than in the other combination group (weighted HR: 0.82 (0.59–1.13)), while no association was found between the aspirin group (weighted HR: 1.04 (0.76–1.44)) or other combination group and the 3-month primary outcome. Conclusion Other combined antiplatelet treatment, compared with aspirin alone or clopidogrel–aspirin, was not associated with reduced risks of primary composite vascular events or recurrent stroke during the first 3 months after stroke. Therefore, the results suggest that other combination treatments, particularly the cilostazol-based combination, may not be effective alternatives for clopidogrel–aspirin to prevent early vascular events in patients with acute minor stroke. Further exploration in clinical trials will be needed.
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Affiliation(s)
- Shina Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Joon Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, 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, 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, Busan, Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-a University, Busan, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Sang-Soon Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, 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
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Wi-Sun Ryu
- 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
| | - Jee-Hyun Kwon
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, Korea
| | - Wook-Joo Kim
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dong-Ick Shin
- 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
| | - 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
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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41
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Choi KH, Kim JH, Kim JM, Kang KW, Kim JT, Choi SM, Park MS, Cho KH. Troponin Levels and Outcomes in Patients with Embolic Stroke of Undetermined Source. J Stroke 2021; 23:285-288. [PMID: 34102765 PMCID: PMC8189862 DOI: 10.5853/jos.2021.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/03/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.,Department of Neurology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Ja-Hae Kim
- Molecular Imaging Center, Department of Nuclear Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jae-Myung Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.,Department of Neurology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Kyung-Wook Kang
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.,Department of Neurology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Seong-Min Choi
- 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
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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42
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Choi KH, Kim JH, Lee C, Kim JM, Kang KW, Kim JT, Choi SM, Park MS, Cho KH. Anticoagulation versus Antiplatelet Therapy after Ischemic Stroke in the Patients with Atrial Fibrillation and Cerebral Microbleeds. J Stroke 2021; 23:273-276. [PMID: 34102762 PMCID: PMC8189857 DOI: 10.5853/jos.2020.04588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/14/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.,Department of Neurology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Ja-Hae Kim
- Molecular Imaging Center, Department of Nuclear Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Changho Lee
- Molecular Imaging Center, Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jae-Myung Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.,Department of Neurology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Kyung-Wook Kang
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.,Department of Neurology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Seong-Min Choi
- 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
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Choi KH, Kim JH, Kim JM, Kang KW, Lee C, Kim JT, Choi SM, Park MS, Cho KH. d-dimer Level as a Predictor of Recurrent Stroke in Patients With Embolic Stroke of Undetermined Source. Stroke 2021; 52:2292-2301. [PMID: 33971744 DOI: 10.1161/strokeaha.120.033217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Kang-Ho Choi
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea (K.-H.C., J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H.C.).,Department of Neurology, Chonnam National University Hwasun Hospital, Republic of Korea (K.-H.C., J.-M.K., K.-W.K.)
| | - Ja-Hae Kim
- Molecular Imaging Center, Department of Nuclear Medicine, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea (J.-H.K.)
| | - Jae-Myung Kim
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea (K.-H.C., J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H.C.).,Department of Neurology, Chonnam National University Hwasun Hospital, Republic of Korea (K.-H.C., J.-M.K., K.-W.K.)
| | - Kyung-Wook Kang
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea (K.-H.C., J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H.C.).,Department of Neurology, Chonnam National University Hwasun Hospital, Republic of Korea (K.-H.C., J.-M.K., K.-W.K.)
| | - Changho Lee
- Molecular Imaging Center, Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea (C.L.)
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea (K.-H.C., J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H.C.)
| | - Seong-Min Choi
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea (K.-H.C., J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H.C.)
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea (K.-H.C., J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H.C.)
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea (K.-H.C., J.-M.K., K.-W.K., J.-T.K., S.-M.C., M.-S.P., K.-H.C.)
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Park JH, Chung JW, Bang OY, Kim GM, Choi KH, Park MS, Kim JT, Hwang YH, Song TJ, Kim YJ, Kim BJ, Heo SH, Jung JM, Oh K, Kim CK, Yu S, Park KY, Kim JM, Choi JC, Seo WK. Atherosclerotic Burden and Vascular Risk in Stroke Patients With Atrial Fibrillation. Stroke 2021; 52:1662-1672. [PMID: 33794654 DOI: 10.1161/strokeaha.120.032232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea (J.-H.P.)
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-W.C., O.Y.B., G.-M.K., W.-K.S.)
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-W.C., O.Y.B., G.-M.K., W.-K.S.)
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-W.C., O.Y.B., G.-M.K., W.-K.S.)
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (K.-H.C., M.-S.P., J.-T.K.)
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (K.-H.C., M.-S.P., J.-T.K.)
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (K.-H.C., M.-S.P., J.-T.K.)
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea (Y.-H.H.)
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea (T.-J.S.)
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul (Y.-J.K.)
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (B.J.K.)
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea (S.H.H.)
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital (J.-M.J.), Korea University College of Medicine
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital (K.O., C.K.K.), Korea University College of Medicine
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital (K.O., C.K.K.), Korea University College of Medicine
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital (S.Y.), Korea University College of Medicine
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea (K.Y.P.)
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Korea (J.-M.K.)
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Korea (J.C.C.)
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-W.C., O.Y.B., G.-M.K., W.-K.S.)
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Mai TT, Yoo SW, Park S, Kim JY, Choi KH, Kim C, Kwon SY, Min JJ, Lee C. In Vivo Quantitative Vasculature Segmentation and Assessment for Photodynamic Therapy Process Monitoring Using Photoacoustic Microscopy. Sensors (Basel) 2021; 21:s21051776. [PMID: 33806466 PMCID: PMC7961824 DOI: 10.3390/s21051776] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 11/16/2022]
Abstract
Vascular damage is one of the therapeutic mechanisms of photodynamic therapy (PDT). In particular, short-term PDT treatments can effectively destroy malignant lesions while minimizing damage to nonmalignant tissue. In this study, we investigate the feasibility of label-free quantitative photoacoustic microscopy (PAM) for monitoring the vasculature changes under the effect of PDT in mouse ear melanoma tumors. In particular, quantitative vasculature evaluation was conducted based on Hessian filter segmentation. Three-dimensional morphological PAM and depth-resolved images before and after PDT treatment were acquired. In addition, five quantitative vasculature parameters, including the PA signal, vessel diameter, vessel density, perfused vessel density, and vessel complexity, were analyzed to evaluate the influence of PDT on four different areas: Two melanoma tumors, and control and normal vessel areas. The quantitative and qualitative results successfully demonstrated the potential of the proposed PAM-based quantitative approach to evaluate the effectiveness of the PDT method.
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Affiliation(s)
- Thi Thao Mai
- Department of Artificial Intelligence Convergence, Chonnam National University, Gwangju 61186, Korea;
| | - Su Woong Yoo
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo 58128, Korea; (S.W.Y.); (S.Y.K.); (J.-J.M.)
| | - Suhyun Park
- Interdisciplinary Program of Molecular Medicine, Chonnam National University, Gwangju 61186, Korea;
| | - Jin Young Kim
- Department of Creative IT Engineering and Electrical Engineering, Pohang University of Science and Technology (POSTECH), 77 Cheongam-ro, Nam-gu, Pohang, Gyeongbuk-do 37673, Korea; (J.Y.K.); (C.K.)
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, 8 Hak-dong, Dong-gu, Gwangju 501-757, Korea;
| | - Chulhong Kim
- Department of Creative IT Engineering and Electrical Engineering, Pohang University of Science and Technology (POSTECH), 77 Cheongam-ro, Nam-gu, Pohang, Gyeongbuk-do 37673, Korea; (J.Y.K.); (C.K.)
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo 58128, Korea; (S.W.Y.); (S.Y.K.); (J.-J.M.)
- Interdisciplinary Program of Molecular Medicine, Chonnam National University, Gwangju 61186, Korea;
- Department of Nuclear Medicine, Chonnam National University Medical School, Jeollanamdo 58128, Korea
| | - Jung-Joon Min
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo 58128, Korea; (S.W.Y.); (S.Y.K.); (J.-J.M.)
- Interdisciplinary Program of Molecular Medicine, Chonnam National University, Gwangju 61186, Korea;
- Department of Nuclear Medicine, Chonnam National University Medical School, Jeollanamdo 58128, Korea
| | - Changho Lee
- Department of Artificial Intelligence Convergence, Chonnam National University, Gwangju 61186, Korea;
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Hwasun, Jeollanamdo 58128, Korea; (S.W.Y.); (S.Y.K.); (J.-J.M.)
- Interdisciplinary Program of Molecular Medicine, Chonnam National University, Gwangju 61186, Korea;
- Department of Nuclear Medicine, Chonnam National University Medical School, Jeollanamdo 58128, Korea
- Correspondence: ; Tel.: +82-61-379-2885
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Kim DY, Jeong HG, Lee JS, Lee KJ, Kim BJ, Han MK, Choi KH, Kim JT, Shin DII, Cha JK, Kim DH, Kim DE, Ryu WS, Park JM, Kang K, Kim JG, Lee SJ, Oh MS, Yu KH, Lee BC, Park HK, Hong KS, Cho YJ, Choi JC, Sohn SI, Hong JH, Park MS, Park TH, Park SS, Lee KB, Kwon JH, Kim WJ, LEE JUN, LEE JUNEYOUNG, BAE HJ. Abstract P648: The Presence and the Features of Silent Brain Infarction Are Associated With Stroke Recurrence in Acute Ischemic Stroke Patients With Atrial Fibrillation. Stroke 2021. [DOI: 10.1161/str.52.suppl_1.p648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The significance of silent brain infarction (SBI) for stroke recurrence in acute ischemic stroke (AIS) patients with atrial fibrillation (AF) has yet to be elucidated. This study aims to evaluate SBI as an independent predictor and which characteristics of SBI are associated with stroke recurrence in AIS patients with AF.
Methods:
A multicenter prospective cohort recruited AIS patients with non-valvular AF from 14 centers from Oct 2017 to Dec 2018, and followed for ischemic stroke recurrence, all types of stroke and TIA, and all-cause mortality. Three patient groups; stroke patients with prior stroke history (PS), first-ever stroke with SBI [F-SBI(+)] and first-ever stroke without SBI [F-SBI(-)] were compared with Cox frailty model according to predetermined covariates. SBI subtypes; embolic-appearing pattern (EAP) and non-EAP, and SBI characteristics; size, numbers, and vascular territory involvements were assessed.
Results:
A total of 978 AF-AIS patients [27.5% PS, 29.1% F-SBI(+), 43.4% F-SBI(-)] were followed for 365 [348-374] days (median). Incidence of ischemic stroke recurrence in F-SBI(+) was higher than F-SBI(-), however, there was no significant difference compared to PS (p=0.860). Adjusted hazards for ischemic stroke recurrence and all kinds of stroke and TIA in F-SBI(+) were shown to be elevated [HR 3.87 (95% CI 1.53-9.16) and 2.60 (1.21-5.56)], and similar to PS [4.20 (1.73-10.24) and 2.90 (1.36-6.18)] when compared to F-SBI(-), respectively. Despite irrelevance in non-EAP SBI, a 4-fold increase of hazards in EAP SBI was observed [4.07 (1.63-10.13)]. Other SBI characteristics were not associated with outcomes. SBI and SBI features did not increase all-cause mortality.
Conclusions:
SBI and specifically, EAP SBI elevated stroke recurrence in AF-AIS patients as much prior stroke has increased the risk. Considering SBI to predict recurrence is suggested likewise prior stroke history is scored in AF thromboembolic risk estimation tools.
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Affiliation(s)
- Do Yeon Kim
- Dept of Neurology and Cerebrovascular Cntr, Seoul National Univ Bundang Hosp, Seongnam, Korea, Republic of
| | | | | | | | | | - Moon-Ku Han
- Bundang Seoul Nati Univer Hosp, Seongnam si, Korea, Democratic People’s Republic of
| | - Kang-Ho Choi
- Dept of Neurology, Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | | | | | | | | | | | | | | | | | | | | | - Mi Sun Oh
- Hallym Sacred Heart Hosptial, Anyang
| | | | | | | | | | | | | | | | | | - Moo-Seok Park
- Dept of Neurology, Ewha Womans Univ Med Cntr, Seoul, Korea, Republic of
| | | | | | | | | | | | - JUN LEE
- Yeungnam Univ Med Cntr, Daegu, Korea, Republic of
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Nam KW, Kim CK, Yu S, Chung JW, Bang OY, Kim GM, Jung JM, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Oh K, Seo WK. Pre-Admission CHADS2 and CHA2DS2-VASc Scores on Early Neurological Worsening. Cerebrovasc Dis 2021; 50:288-295. [PMID: 33588410 DOI: 10.1159/000513396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stroke risk scores (CHADS2 and CHA2DS2-VASc) not only predict the risk of stroke in atrial fibrillation (AF) patients, but have also been associated with prognosis after stroke. OBJECTIVE The aim of this study was to evaluate the relationship between stroke risk scores and early neurological deterioration (END) in ischemic stroke patients with AF. METHODS We included consecutive ischemic stroke patients with AF admitted between January 2013 and December 2015. CHADS2 and CHA2DS2-VASc scores were calculated using the established scoring system. END was defined as an increase ≥2 on the total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 on the motor NIHSS score within the first 72 h of admission. RESULTS A total of 2,099 ischemic stroke patients with AF were included. In multivariable analysis, CHA2DS2-VASc score (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI] = 1.04-1.31) was significantly associated with END after adjusting for confounders. Initial NIHSS score, use of anticoagulants, and intracranial atherosclerosis (ICAS) were also found to be closely associated with END, independent of the CHA2DS2-VASc score. Multivariable analysis stratified by the presence of ICAS demonstrated that both CHA2DS2-VASc (aOR = 1.20, 95% CI = 1.04-1.38) and CHADS2 scores (aOR = 1.24, 95% CI = 1.01-1.52) were closely related to END in only patients with ICAS. In patients without ICAS, neither of the risk scores were associated with END. CONCLUSIONS High CHA2DS2-VASc score was associated with END in ischemic stroke patients with AF. This close relationship is more pronounced in patients with ICAS.
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Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University, School of Medicine, Seoul, Republic of Korea
| | - Yong-Jae Kim
- Department of Neurology, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju, Republic of Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam, Chonnam, Republic of Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam, Chonnam, Republic of Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Yang Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Dae-gu, Dae-gu, Republic of Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea, .,Department of Digital Health, SHAIST, Sungkyunkwan University, Seoul, Republic of Korea,
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48
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Kim H, Kim JT, Lee JS, Kim BJ, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Park TH, Park SS, Lee KB, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DI, Sohn SI, Hong JH, Park MS, Choi KH, Cho KH, Lee J, Bae HJ. Golden Hour Thrombolysis in Acute Ischemic Stroke: The Changing Pattern in South Korea. J Stroke 2021; 23:135-138. [PMID: 33600712 PMCID: PMC7900393 DOI: 10.5853/jos.2020.04658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/14/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hyunsoo Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Joon Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong-Moo Park
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, 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
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Sang-Soon Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Jee-Hyun Kwon
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, Korea
| | - Wook-Joo Kim
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sung Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, 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
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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49
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Eun MY, Kim JY, Hwang YH, Park MS, Kim JT, Choi KH, Jung JM, Yu S, Kim CK, Oh K, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Chung JW, Bang OY, Kim GM, Seo WK. Initiation of Guideline-Matched Oral Anticoagulant in Atrial Fibrillation-Related Stroke. J Stroke 2021; 23:113-123. [PMID: 33600708 PMCID: PMC7900398 DOI: 10.5853/jos.2020.03440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/19/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE To evaluate the outcome events and bleeding complications of the European Society of Cardiology (ESC) guideline-matched oral anticoagulant therapy for patients with acute ischemic stroke and atrial fibrillation (AF). METHODS Patients with acute ischemic stroke and AF from a nationwide multicenter registry (Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts [K-ATTENTION]) between January 2013 and December 2015 were included in the study. Patients were divided into the ESC guideline-matched and the non-matched groups. The primary outcome was recurrence of any stroke during the 90-day follow-up period. Secondary outcomes were major adverse cerebrovascular and cardiovascular events, ischemic stroke, intracranial hemorrhage, acute coronary syndrome, allcause mortality, and major hemorrhage. Propensity score matching and logistic regression analyses were performed to assess the effect of the treatments administered. RESULTS Among 2,321 eligible patients, 1,126 patients were 1:1 matched to the ESC guidelinematched and the non-matched groups. As compared with the non-matched group, the ESC guideline-matched group had a lower risk of any recurrent stroke (1.4% vs. 3.4%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.18 to 0.95). The risk of recurrent ischemic stroke was lower in the ESC guideline-matched group than in the non-matched group (0.9% vs. 2.7%; OR, 0.32; 95% CI, 0.11 to 0.88). There was no significant difference in the other secondary outcomes between the two groups. CONCLUSIONS ESC guideline-matched oral anticoagulant therapy was associated with reduced risks of any stroke and ischemic stroke as compared with the non-matched therapy.
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Affiliation(s)
- Mi-Yeon Eun
- Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae-Young Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Joon-Tae Kim
- 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
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Kore, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
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50
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Lee HL, Kim JT, Lee JS, Kim BJ, Park JM, Kang K, Lee SJ, Kim JG, Cha JK, Kim DH, Park TH, Park SS, Lee KB, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi JC, Kwon JH, Kim WJ, Shin DI, Sohn SI, Hong JH, Park MS, Choi KH, Cho KH, Lee J, Bae HJ. CHA2DS2-VASc score in acute ischemic stroke with atrial fibrillation: results from the Clinical Research Collaboration for Stroke in Korea. Sci Rep 2021; 11:793. [PMID: 33436977 PMCID: PMC7804950 DOI: 10.1038/s41598-020-80874-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/24/2020] [Indexed: 11/09/2022] Open
Abstract
We investigated a multicenter registry to identify estimated event rates according to CHA2DS2-VASc scores in patients with acute ischemic stroke (AIS) and atrial fibrillation (AF). The additional effectiveness of antiplatelets (APs) plus oral anticoagulants (OACs) compared with OACs alone considering the CHA2DS2-VASc scores was also explored. This study retrospectively analyzed a multicenter stroke registry between Jan 2011 and Nov 2017, identifying patients with acute ischemic stroke with AF. The primary outcome event was a composite of recurrent stroke, myocardial infarction, and all-cause mortality within 1 year. A total of 7395 patients (age, 73 ± 10 years; men, 54.2%) were analyzed. The primary outcome events at one year ranged from 5.99% (95% CI 3.21–8.77) for a CHA2DS2-VASc score of 0 points to 30.45% (95% CI 24.93–35.97) for 7 or more points. After adjustments for covariates, 1-point increases in the CHA2DS2-VASc score consistently increased the risk of primary outcome events (aHR 1.10 [1.06–1.15]) at 1-year. Among OAC-treated patients at discharge (n = 5500), those treated with OAC + AP (vs. OAC alone) were more likely to experience vascular events, though among patients with a CHA2DS2-VASc score of 5 or higher, the risk of primary outcome in the OAC + AP group was comparable to that in the OAC alone group (Pint = 0.01). Our study found that there were significant associations of increasing CHA2DS2-VASc scores with the increasing risk of vascular events at 1-year in AIS with AF. Further study would be warranted.
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Affiliation(s)
- Hak-Loh Lee
- Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea.
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Joon Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Jong-Moo Park
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, 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
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, Korea
| | - Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Yong-Jin Cho
- 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
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Wi-Sun Ryu
- 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
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University College of Medicine, Ulsan, Korea
| | - Wook-Joo Kim
- Department of Neurology, Ulsan University College of Medicine, Ulsan, Korea
| | - Dong-Ick Shin
- 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
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea.
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