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Lu WZ, Lin HA, Hou SK, Lin SF. ABCD2-I Score Predicts Unplanned Emergency Department Revisits within 72 Hours Due to Recurrent Acute Ischemic Stroke. Diagnostics (Basel) 2024; 14:1118. [PMID: 38893644 PMCID: PMC11172352 DOI: 10.3390/diagnostics14111118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/24/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND the ABCD2 score is valuable for predicting early stroke recurrence after a transient ischemic attack (TIA), and Doppler ultrasound can aid in expediting stroke triage. The study aimed to investigate whether combining the ABCD2 score with carotid duplex results can enhance the identification of early acute ischemic stroke after TIA. METHODS we employed a retrospective cohort design for this study, enrolling patients diagnosed with TIA who were discharged from the emergency department (ED). The modified ABCD2-I (c50) score, which incorporates a Doppler ultrasound assessment of internal carotid artery stenosis > 50%, was used to evaluate the risk of acute ischemic stroke within 72 h. Patients were categorized into three risk groups: low risk (with ABCD2 and ABCD2-I scores = 0-4), moderate risk (ABCD2 score = 4-5 and ABCD2-I score = 5-7), and high risk (ABCD2 score = 6-7 and ABCD2-I score = 8-9). RESULTS between 1 January 2014, and 31 December 2019, 1124 patients with new neurological deficits were screened, with 151 TIA patients discharged from the ED and included in the analysis. Cox proportional hazards analysis showed that patients in the high-risk group, as per the ABCD2-I (c50) score, were significantly associated with revisiting the ED within 72 h due to acute ischemic stroke (HR: 3.12, 95% CI: 1.31-7.41, p = 0.0102), while the ABCD2 alone did not show significant association (HR: 1.12, 95% CI: 0.57-2.22, p = 0.7427). CONCLUSION ABCD2-I (c50) scores effectively predict early acute ischemic stroke presentations to the ED within 72 h after TIA.
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Affiliation(s)
- Wei-Zhen Lu
- Department of Emergency Medicine, Taipei Medical University Shuang Ho Hospital, New Taipei 23561, Taiwan;
| | - Hui-An Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan; (H.-A.L.); (S.-K.H.)
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Sen-Kuang Hou
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan; (H.-A.L.); (S.-K.H.)
- Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Sheng-Feng Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan; (H.-A.L.); (S.-K.H.)
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, 250 Wu-Hsing Street, Taipei 11031, Taiwan
- Center of Evidenced-Based Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan
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Chen M, Qian D, Wang Y, An J, Meng K, Xu S, Liu S, Sun M, Li M, Pang C. Systematic Review of Machine Learning Applied to the Secondary Prevention of Ischemic Stroke. J Med Syst 2024; 48:8. [PMID: 38165495 DOI: 10.1007/s10916-023-02020-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/13/2023] [Indexed: 01/03/2024]
Abstract
Ischemic stroke is a serious disease posing significant threats to human health and life, with the highest absolute and relative risks of a poor prognosis following the first occurrence, and more than 90% of strokes are attributable to modifiable risk factors. Currently, machine learning (ML) is widely used for the prediction of ischemic stroke outcomes. By identifying risk factors, predicting the risk of poor prognosis and thus developing personalized treatment plans, it effectively reduces the probability of poor prognosis, leading to more effective secondary prevention. This review includes 41 studies since 2018 that used ML algorithms to build prognostic prediction models for ischemic stroke, transient ischemic attack (TIA), and acute ischemic stroke (AIS). We analyzed in detail the risk factors used in these studies, the sources and processing methods of the required data, the model building and validation, and their application in different prediction time windows. The results indicate that among the included studies, the top five risk factors in terms of frequency were cardiovascular diseases, age, sex, national institutes of health stroke scale (NIHSS) score, and diabetes. Furthermore, 64% of the studies used single-center data, 65% of studies using imbalanced data did not perform data balancing, 88% of the studies did not utilize external validation datasets for model validation, and 72% of the studies did not provide explanations for their models. Addressing these issues is crucial for enhancing the credibility and effectiveness of the research, consequently improving the development and implementation of secondary prevention measures.
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Affiliation(s)
- Meng Chen
- School of Life Science and Technology, Changchun University of Science and Technology, Jilin Province, Changchun, 130022, People's Republic of China
| | - Dongbao Qian
- School of Life Science and Technology, Changchun University of Science and Technology, Jilin Province, Changchun, 130022, People's Republic of China
| | - Yixuan Wang
- Union Hospital of Jilin University, Jilin Province, Neurosurgery, Changchun, 130033, People's Republic of China
| | - Junyan An
- Union Hospital of Jilin University, Jilin Province, Neurosurgery, Changchun, 130033, People's Republic of China
| | - Ke Meng
- Union Hospital of Jilin University, Jilin Province, Neurosurgery, Changchun, 130033, People's Republic of China
| | - Shuai Xu
- School of Life Science and Technology, Changchun University of Science and Technology, Jilin Province, Changchun, 130022, People's Republic of China
| | - Sheng Liu
- School of Life Science and Technology, Changchun University of Science and Technology, Jilin Province, Changchun, 130022, People's Republic of China
| | - Meiyan Sun
- Union Hospital of Jilin University, Jilin Province, Neurosurgery, Changchun, 130033, People's Republic of China
| | - Miao Li
- School of Life Science and Technology, Changchun University of Science and Technology, Jilin Province, Changchun, 130022, People's Republic of China.
- Union Hospital of Jilin University, Jilin Province, Neurosurgery, Changchun, 130033, People's Republic of China.
| | - Chunying Pang
- School of Life Science and Technology, Changchun University of Science and Technology, Jilin Province, Changchun, 130022, People's Republic of China.
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Nizar D, Amine MSM, Aissi M, Machraoui R, Adel S, Khaoula BHA, Blel S, Younes S, Boukef R, Henteti F, Nouira S, Hamdi B, Frih M. External validations of the ABCD2 score in prediction of stroke risk after transient ischemic attack. A Tunisian hospital-based cohort study. Int J Neurosci 2023; 133:1218-1223. [PMID: 33059508 DOI: 10.1080/00207454.2020.1835897] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 09/18/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE Identification of patients with high risk of stroke after transient ischemic attack (TIA) could be helpful to optimize stroke prevention. We aimed to externally validate the ABCD2 score for the prediction of stroke after TIA in a Tunisian population. METHODS We conducted a retrospective observational study of consecutive patients admitted for TIA in four university hospitals in Tunisia. Patients were screened for onset of stroke. Sensitivity, specificity, positive and negative predictive values with areas under the receiver operating characteristic (ROC) curves were calculated for risk of stroke at 2, 7, 30 and 90 days after the index event. RESULTS Of 415 patients screened in this study, the total cumulative subsequent stroke rates after TIA at 2, 7, 30 and 90 days were respectively, 4.8%, 10.6%, 13.5% and 20.2%. Using a cut-off value of 4, the ABCD2 showed an overall good sensitivity (95%, 97.7%, 96.4% and 97.6% respectively at 2, 7, 30 and 90 days). Areas under ROC cure of the ABCD2 score in patients with TIA for stroke onset at 2, 7, 30 and 90 days were respectively 0.67 (95% CI, 0.55-0.79), 0.79 (95% CI, 0.71-0.85), 0.79 (95% CI, 0.72-0.85), and 0.76 (95% CI, 0.70-0.81). CONCLUSION Our findings suggest that the ABCD2 score could be used in our population to discriminate patient with TIA at low and high risk of developing recurrent stroke.
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Affiliation(s)
- Daoussi Nizar
- Department of Neurology, University Hospital of Monastir, Monastir, Tunisia
| | - MSolli M Amine
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, University Hospital of Monastir, Monastir, Tunisia
| | - Mouna Aissi
- Department of Neurology, University Hospital of Monastir, Monastir, Tunisia
| | - Rafik Machraoui
- Department of Endocrinology and Internal Medicine, Tahar Sfar Hospital of Mahdia, Mahdia, Tunisia
| | - Sekma Adel
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, University Hospital of Monastir, Monastir, Tunisia
| | - Bel Haj Ali Khaoula
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, University Hospital of Monastir, Monastir, Tunisia
| | - Semir Blel
- Neurology Department, Mongi Ben Hmida National Institute of Neurology, Tunis, Tunisia
| | - Samia Younes
- Department of Endocrinology and Internal Medicine, Tahar Sfar Hospital of Mahdia, Mahdia, Tunisia
| | - Riadh Boukef
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Fayçal Henteti
- Neurology Department, Mongi Ben Hmida National Institute of Neurology, Tunis, Tunisia
| | - Semir Nouira
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, University Hospital of Monastir, Monastir, Tunisia
| | - Boubaker Hamdi
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, University Hospital of Monastir, Monastir, Tunisia
| | - Mahbouba Frih
- Department of Neurology, University Hospital of Monastir, Monastir, Tunisia
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Li J, Han M, Chen Y, Wu B, Wu Y, Jia W, Liu J, Luo H, Yu P, Tu J, Kuang J, Yi Y. Prediction of recurrent ischaemic stroke using radiomics data and machine learning methods in patients with acute ischaemic stroke: protocol for a multicentre, large sample, prospective observational cohort study in China. BMJ Open 2023; 13:e076406. [PMID: 37816554 PMCID: PMC10565242 DOI: 10.1136/bmjopen-2023-076406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/20/2023] [Indexed: 10/12/2023] Open
Abstract
INTRODUCTION Stroke is a leading cause of mortality and disability worldwide. Recurrent strokes result in prolonged hospitalisation and worsened functional outcomes compared with the initial stroke. Thus, it is critical to identify patients who are at high risk of stroke recurrence. This study is positioned to develop and validate a prediction model using radiomics data and machine learning methods to identify the risk of stroke recurrence in patients with acute ischaemic stroke (AIS). METHODS AND ANALYSIS A total of 1957 patients with AIS will be needed. Enrolment at participating hospitals will continue until the required sample size is reached, and we will recruit as many participants as possible. Multiple indicators including basic clinical data, image data, laboratory data, CYP2C19 genotype and follow-up data will be assessed at various time points during the registry, including baseline, 24 hours, 7 days, 1 month, 3 months, 6 months, 9 months and 12 months. The primary outcome was stroke recurrence. The secondary outcomes were death events, prognosis scores and adverse events. Imaging images were processed using deep learning algorithms to construct a programme capable of automatically labelling the lesion area and extracting radiomics features. The machine learning algorithms will be applied to integrate cross-scale, multidimensional data for exploratory analysis. Then, an ischaemic stroke recurrence prediction model of the best performance for patients with AIS will be established. Calibration, receiver operating characteristic and decision curve analyses will be evaluated. ETHICS AND DISSEMINATION This study has received ethical approval from the Medical Ethics Committee of the Second Affiliated Hospital of Nanchang University (medical research review No.34/2021), and informed consent will be obtained voluntarily. The research findings will be disseminated through publication in journals and presented at conferences. TRIAL REGISTRATION NUMBER ChiCTR2200055209.
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Affiliation(s)
- Jingyi Li
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, Jiangxi, China
| | - Mengqi Han
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, Jiangxi, China
| | - Yongsen Chen
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, Jiangxi, China
| | - Bin Wu
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, Jiangxi, China
| | - Yifan Wu
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, Jiangxi, China
| | - Weijie Jia
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, Jiangxi, China
| | - JianMo Liu
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Haowen Luo
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Pengfei Yu
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jianglong Tu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jie Kuang
- Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, Jiangxi, China
| | - Yingping Yi
- Department of Medical Big Data Research Centre, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Liu S, Chen T, Wu W. Predictive value of whole-brain CT perfusion combined with ABCD3 score for short-term secondary cerebral infarction after TIA. Front Neurol 2023; 14:1244014. [PMID: 37745657 PMCID: PMC10513042 DOI: 10.3389/fneur.2023.1244014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
Objective To investigate the predictive value of Whole Brain CT Perfusion (WB-CTP) combined with the ABCD3 score in patients with transient ischemic attack (TIA). Methods A total of 336 TIA patients with TIA underwent WB-CTP and ABCD3 score assessment within 48 h of admission. Spearman correlation test was performed to analyze the relationship between the degree of vascular stenosis, relative perfusion values, and ABCD3 score. Logistic regression analysis was used to identify independent risk factors for secondary cerebral infarction. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive value of relative cerebral blood flow (rCBF), degree of vascular stenosis, ABCD3 score, and the WB-CTP-ABCD3 combined model for secondary cerebral infarction after TIA. Calibration curves and H-L tests were used to evaluate the predictive efficacy of the model. Results Among the 336 TIA patients, 143 showed abnormal perfusion areas and 146 had responsible vessel stenosis. The degree of vascular stenosis, relative time-to-maximum (rTmax), and relative mean transit time (rMTT) were positively correlated with the ABCD3 score, while rCBF and relative cerebral blood volume (rCBV) were negatively correlated with the ABCD3 score. ROC curve analysis identified a cutoff value of 0.8205 for rCBF, with a sensitivity of 84.10% and specificity of 58.10% for distinguishing the cerebral infarction group from the non-cerebral infarction group. Furthermore, rCBF ≤ 0.8205, degree of vascular stenosis, and ABCD3 score > 6 were identified as independent risk factors for secondary cerebral infarction in TIA patients within 90 days in TIA patients. The AUC of the WB-CTP-ABCD3 combined model for predicting secondary cerebral infarction within 90 days was 0.836. The model risk was assessed by plotting calibration curves. The value of p for the H-L goodness of fit test was 0.366 (p > 0.05), which indicated that the difference between the obtained model and the perfect model were statistically insignificant. Conclusion The combined model of WB-CTP-ABCD3 shows promise as a valuable method for predicting secondary cerebral infarction within 90 days following TIA.
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Affiliation(s)
- Shushu Liu
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Medical Imaging, People’s Hospital of Fengjie, Chongqing, China
| | - Ting Chen
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Wu
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Shao K, Zhang F, Li Y, Cai H, Paul Maswikiti E, Li M, Shen X, Wang L, Ge Z. A Nomogram for Predicting the Recurrence of Acute Non-Cardioembolic Ischemic Stroke: A Retrospective Hospital-Based Cohort Analysis. Brain Sci 2023; 13:1051. [PMID: 37508983 PMCID: PMC10377670 DOI: 10.3390/brainsci13071051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/26/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Non-cardioembolic ischemic stroke (IS) is the predominant subtype of IS. This study aimed to construct a nomogram for recurrence risks in patients with non-cardioembolic IS in order to maximize clinical benefits. From April 2015 to December 2019, data from consecutive patients who were diagnosed with non-cardioembolic IS were collected from Lanzhou University Second Hospital. The least absolute shrinkage and selection operator (LASSO) regression analysis was used to optimize variable selection. Multivariable Cox regression analyses were used to identify the independent risk factors. A nomogram model was constructed using the "rms" package in R software via multifactor Cox regression. The accuracy of the model was evaluated using the receiver operating characteristic (ROC), calibration curve, and decision curve analyses (DCA). A total of 729 non-cardioembolic IS patients were enrolled, including 498 (68.3%) male patients and 231 (31.7%) female patients. Among them, there were 137 patients (18.8%) with recurrence. The patients were randomly divided into training and testing sets. The Kaplan-Meier survival analysis of the training and testing sets consistently revealed that the recurrence rates in the high-risk group were significantly higher than those in the low-risk group (p < 0.01). Moreover, the receiver operating characteristic curve analysis of the risk score demonstrated that the area under the curve was 0.778 and 0.760 in the training and testing sets, respectively. The nomogram comprised independent risk factors, including age, diabetes, platelet-lymphocyte ratio, leukoencephalopathy, neutrophil, monocytes, total protein, platelet, albumin, indirect bilirubin, and high-density lipoprotein. The C-index of the nomogram was 0.752 (95% CI: 0.705~0.799) in the training set and 0.749 (95% CI: 0.663~0.835) in the testing set. The nomogram model can be used as an effective tool for carrying out individualized recurrence predictions for non-cardioembolic IS.
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Affiliation(s)
- Kangmei Shao
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Provincial Neurology Clinical Medical Research Center, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Fan Zhang
- Department of Oncology Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Yongnan Li
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Hongbin Cai
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Provincial Neurology Clinical Medical Research Center, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Ewetse Paul Maswikiti
- Department of Oncology Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Mingming Li
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Provincial Neurology Clinical Medical Research Center, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Xueyang Shen
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Provincial Neurology Clinical Medical Research Center, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Longde Wang
- Expert Workstation of Academician Wang Longde, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Zhaoming Ge
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Provincial Neurology Clinical Medical Research Center, Lanzhou University Second Hospital, Lanzhou 730030, China
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Lv J, Zhang M, Fu Y, Chen M, Chen B, Xu Z, Yan X, Hu S, Zhao N. An interpretable machine learning approach for predicting 30-day readmission after stroke. Int J Med Inform 2023; 174:105050. [PMID: 36965404 DOI: 10.1016/j.ijmedinf.2023.105050] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Stroke is the second leading cause of death worldwide and has a significantly high recurrence rate. We aimed to identify risk factors for stroke recurrence and develop an interpretable machine learning model to predict 30-day readmissions after stroke. METHODS Stroke patients deposited in electronic health records (EHRs) in Xuzhou Medical University Hospital between February 1, 2021, and November 30, 2021, were included in the study, and deceased patients were excluded. We extracted 74 features from EHRs, and the top 20 features (chi-2 value) were used to build machine learning models. 80% of the patients were used for pre-training. Subsequently, a 20% holdout dataset was used for verification. The Shapley Additive exPlanations (SHAP) method was used to explore the interpretability of the model. RESULTS The cohort included 6,558 patients, of whom the mean (SD) age was 65 (11) years, 3,926 were males (59.86 %), and 132 (2.01 %) were readmitted within 30 days. The area under the receiver operating characteristic curve (AUROC) for the optimized model was 0.80 (95 % CI 0.68-0.80). We used the SHAP method to identify the top 10 risk factors (i.e., severe carotid artery stenosis, weak, homocysteine, glycosylated hemoglobin, sex, lymphocyte percentage, neutrophilic granulocyte percentage, urine glucose, fresh cerebral infarction, and red blood cell count). The AUROC of a model with the 10 features was 0.80 (95 % CI 0.69-0.80) and was not significantly different from that of the model with 20 risk factors. CONCLUSIONS Our methods not only showed good performance in predicting 30-day readmissions after stroke but also revealed risk factors that provided valuable insights for treatments.
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Affiliation(s)
- Ji Lv
- Emergency Medicine Department of the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, China; College of Computer Science and Technology, Jilin University, Changchun, Jilin Province 130000, China
| | - Mengmeng Zhang
- Emergency Medicine Department of the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, China; Laboratory of Emergency Medicine, Second Clinical Medical College of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, China
| | - Yujie Fu
- Emergency Medicine Department of the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, China; Laboratory of Emergency Medicine, Second Clinical Medical College of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, China
| | - Mengshuang Chen
- Emergency Medicine Department of the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, China; Laboratory of Emergency Medicine, Second Clinical Medical College of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, China
| | - Binjie Chen
- Emergency Medicine Department of the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, China; Laboratory of Emergency Medicine, Second Clinical Medical College of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, China
| | - Zhiyuan Xu
- Emergency Medicine Department of the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, China; Laboratory of Emergency Medicine, Second Clinical Medical College of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, China
| | - Xianliang Yan
- Emergency Medicine Department of the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, China; Laboratory of Emergency Medicine, Second Clinical Medical College of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, China.
| | - Shuqun Hu
- Emergency Medicine Department of the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, China; Laboratory of Emergency Medicine, Second Clinical Medical College of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, China.
| | - Ningjun Zhao
- Emergency Medicine Department of the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, China; Laboratory of Emergency Medicine, Second Clinical Medical College of Xuzhou Medical University, Xuzhou, Jiangsu Province 221002, China.
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Amin HP, Madsen TE, Bravata DM, Wira CR, Johnston SC, Ashcraft S, Burrus TM, Panagos PD, Wintermark M, Esenwa C. Diagnosis, Workup, Risk Reduction of Transient Ischemic Attack in the Emergency Department Setting: A Scientific Statement From the American Heart Association. Stroke 2023; 54:e109-e121. [PMID: 36655570 DOI: 10.1161/str.0000000000000418] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
At least 240 000 individuals experience a transient ischemic attack each year in the United States. Transient ischemic attack is a strong predictor of subsequent stroke. The 90-day stroke risk after transient ischemic attack can be as high as 17.8%, with almost half occurring within 2 days of the index event. Diagnosing transient ischemic attack can also be challenging given the transitory nature of symptoms, often reassuring neurological examination at the time of evaluation, and lack of confirmatory testing. Limited resources, such as imaging availability and access to specialists, can further exacerbate this challenge. This scientific statement focuses on the correct clinical diagnosis, risk assessment, and management decisions of patients with suspected transient ischemic attack. Identification of high-risk patients can be achieved through use of comprehensive protocols incorporating acute phase imaging of both the brain and cerebral vasculature, thoughtful use of risk stratification scales, and ancillary testing with the ultimate goal of determining who can be safely discharged home from the emergency department versus admitted to the hospital. We discuss various methods for rapid yet comprehensive evaluations, keeping resource-limited sites in mind. In addition, we discuss strategies for secondary prevention of future cerebrovascular events using maximal medical therapy and patient education.
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Yang Y, He K, Liu L, Li F, Zhang G, Xie B, Liang F. Risk Factors for Cerebral Infarction After Microsurgical Clipping of Hunt-Hess Grade 0-2 Single Intracranial Aneurysm: A Retrospective Study. World Neurosurg 2023; 171:e186-e194. [PMID: 36503119 DOI: 10.1016/j.wneu.2022.11.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/26/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The study aimed to explore risk factors for cerebral infarction after microsurgical clipping in patients with Hunt-Hess grade 0-2 single intracranial aneurysms. METHODS A total of 137 patients with Hunt-Hess grade 0-2 single intracranial aneurysms treated with microsurgical clipping between March 2017 and December 2020 were retrospectively enrolled. Patients were divided into 2 groups on the basis of the occurrence of cerebral infarction after surgery. RESULTS Of 137 enrolled patients, 14 (10.22%) showed cerebral infarction symptoms after surgery. Univariate analysis indicated that ruptured aneurysm status, aneurysm rupture during surgery, history of transient ischemic attack (TIA)/stroke, aneurysm size ≥7 mm, temporary clipping, intraoperative systolic hypotension (IOH), and occurrences of intraoperative motor-evoked potentials change were significantly related to postoperative cerebral infarction (PCI). However, using multivariate regression, only history of TIA/stroke (odds ratio = 0.124; 95% confidence interval [CI] = 0.021-0.748, P = 0.023) and IOH (odds ratio = 0.032; 95% CI = 0.005-0.210, P < 0.001) were independent predictors for PCI. Receiver operating characteristic curve analysis showed that the critical duration of temporary clipping and IOH that minimized the risk of PCI was 5.5 minutes and 7.5 minutes, respectively. CONCLUSIONS Our study identified history of TIA/stroke and IOH as independent risk factors for cerebral infarction after microsurgical clipping.
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Affiliation(s)
- Yibing Yang
- Neurosurgery Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Kejun He
- Neurosurgery Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Linfeng Liu
- Neurosurgery Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fanying Li
- Neurosurgery Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guofeng Zhang
- Neurosurgery Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Baoshu Xie
- Neurosurgery Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Feng Liang
- Neurosurgery Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Lyu J, Hu J, Wang X, Bian X, Wei M, Wang L, Duan Q, Lan Y, Zhang D, Wang X, Zhang T, Tian C, Lou X. Association of fluid-attenuated inversion recovery vascular hyperintensity with ischaemic events in internal carotid artery or middle cerebral artery occlusion. Stroke Vasc Neurol 2023; 8:69-76. [PMID: 36219570 PMCID: PMC9985801 DOI: 10.1136/svn-2022-001589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/18/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND PURPOSE Individuals with intracranial artery occlusion have high rates of ischaemic events and recurrence. It has been challenging to identify patients who had high-risk stroke using a simple, valid and non-invasive screening approach. This study aimed to investigate whether fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH), a specific imaging sign on the FLAIR sequence, could be a predictor of ischaemic events in a population with internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion. METHODS We retrospectively analysed 147 patients (mean 60.43±12.83 years) with 149 lesions, including 37 asymptomatic and 112 symptomatic cases of ICA or MCA occlusion. Symptomatic occlusion was considered if ischaemic events were present in the relevant territory within 90 days. FVH Alberta Stroke Program Early Computed Tomography Score (FVH-ASPECTS: 0-7, with 0 indicating absence of FVH and 7 suggesting prominent FVH) and collateral circulation grade were assessed for each participant. Multivariable logistic regression analysis was performed to detect independent markers associated with symptomatic status. RESULTS A lower FVH-ASPECTS was associated with a more favourable collateral circulation grade (rho=-0.464, p<0.0001). The FVH-ASPECTS was significantly lower in the asymptomatic occlusion group than in the symptomatic occlusion group (p<0.0001). FVH-ASPECTS (Odd ratio, 2.973; 95% confidence interval, 1.849 to 4.781; p<0.0001) was independently associated with symptomatic status after adjustment for age, sex, lesion location and collateral circulation grade in the multivariate logistic regression. The area under the curve was 0.861 for the use of FVH-ASPECTS to identify symptomatic occlusion. CONCLUSIONS The ability to discriminate symptomatic from asymptomatic occlusion suggests that FVH may be a predictor of stroke. As a simple imaging sign, FVH may serve as a surrogate for haemodynamic impairments and can be used to identify high-risk stroke cases early in ICA or MCA occlusion.
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Affiliation(s)
- Jinhao Lyu
- Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Jianxing Hu
- Radiology, Chinese PLA General Hospital, Beijing, China
| | - Xinrui Wang
- Radiology, Chinese PLA General Hospital, Beijing, China
| | | | - Mengting Wei
- Radiology, Chinese PLA General Hospital, Beijing, China
| | - Liuxian Wang
- Radiology, Chinese PLA General Hospital, Beijing, China
| | - Qi Duan
- Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Yina Lan
- Radiology, Chinese PLA General Hospital, Beijing, China
| | - Dekang Zhang
- Radiology, Chinese PLA General Hospital, Beijing, China
| | - Xueyang Wang
- Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Tingyang Zhang
- Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
| | - Chenglin Tian
- Neurology, Chinese PLA General Hospital, Beijing, China
| | - Xin Lou
- Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing, China
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Lip GYH, Genaidy A, Estes C, McKay D, Falks T. Transient ischemic attack events and incident cardiovascular and non-cardiovascular complications: Observations from a large diversified multimorbid cohort. Eur Stroke J 2022; 8:334-343. [PMID: 37021195 PMCID: PMC10069223 DOI: 10.1177/23969873221146044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Transient ischemic attack (TIA) is a strong signal prompting the incidence of future cardiovascular and non-cardiovascular complications, in light of recent debate on the so-called “stroke-heart syndrome.” We aimed to investigate the relation of TIAs to incident clinical events. Methods: Patients were drawn from three health plans with a wide spectrum of age groups and a wide mix of socio-economic/disability status. Two TIA cohorts in a retrospective design were used to achieve the study specific aims: (i) to investigate the incidence of TIA and associated cardiovascular and non-cardiovascular complications within 30 and 90 days from the onset of incident TIA events; and (ii) to examine the potential risk factors for developing incident TIA events in the general population with/without a history of prior stroke. Results: The incident TIA cohort consisted of 53,716 patients with an average age of 64.2 years (SD 15.2) and 46.1% male. Following TIA, the incidence proportions of ischemic stroke within 30 and 90 days were 2.7% and 3.8%, respectively, and for incident acute coronary syndrome being 0.94 and 1.84, respectively. Ventricular arrhythmia had proportions of 1.2 and 2.14, respectively within 30 and 90 days, with acute heart failure having values of 0.49 and 0.923. About 45% or more of the cardiovascular and non-cardiovascular complications occurred in the first 30 days following the incident TIA cases. About one-third of the recurrent TIA cases followed the incident TIA cases within a span of 30 days. Amongst comorbidities with stroke in the comorbid history, prior stroke provided the strongest risk factor in terms of odds ratio (OR = 8.34, 95% CI 7.21–9.66) for incident TIA events. Age was strongly associated with incident TIA events. Without a prior history of stroke (ischemic stroke/transient ischemic attack/thrombo-embolic events), valvular disease was the strongest risk factor from among the comorbidities (OR-1.87, 95% CI 1.51–2.32). Age also provided strong associations with incident TIA events. Conclusions: Following a TIA, there was a high risk of stroke, acute coronary syndrome, ventricular arrhythmia, acute heart failure, and non-cardiovascular complications.
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Affiliation(s)
- Gregory YH Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
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12
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Zhou J, He R, Xu X, Wei X, Li M, Wang F, Li Y. Diffusion kurtosis imaging in patients with tissue-negative transient ischemic attack. Front Neurol 2022; 13:1052310. [DOI: 10.3389/fneur.2022.1052310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
Approximately 50–60% of patients with a clinical transient ischemic attack (TIA) do not have diffusion-weighted imaging (DWI) evidence of cerebral ischemia. The purpose of this study was to assess the added diagnostic value of diffusion kurtosis imaging (DKI) in the evaluation of patients with TIA who have normal DWI findings. From September 2014 to May 2017, a total of 179 consecutive patients with suspected TIA were eligible for enrollment in our study. The inclusion criteria were a confirmed diagnosis of TIA confirmed by a stroke neurologist, MRI (including DWI and DKI) within 24 h after symptom onset, no stroke history, and no DWI lesion. A follow-up DWI was performed to establish stroke recurrence within a period of 90 days. A total of 98 patients who had no lesions on the baseline DWI were included for data analysis. Of these 98 patients, 31 (31.6%) had positive findings on the initial DKI. In 29 of the 31 (93.5%) patients, the location of the abnormality observed on DKI was consistent with the clinical symptoms. During the 90-day follow-up period, 14 (14.3%) patients developed recurrent stroke. The prevalence of recurrent stroke was higher in the DKI-positive group than in the DKI-negative group (29.0% vs. 7.5%, p = 0.01). A comparison between the patients with and without recurrent stroke showed that an abnormality on the baseline DKI was associated with stroke recurrence. Furthermore, 8 of the 9 stroke patients in the DKI-positive group developed a new ischemic lesion in the artery territory corresponding to the initial DKI abnormality. The new findings suggest the predictive value of DKI on the recurrence of stroke in the patients with TIA who have negative findings on conventional DWI.
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When Can an Emergency CTA Be Dispensed with for TIA Patients? J Clin Med 2022; 11:jcm11195686. [PMID: 36233554 PMCID: PMC9573404 DOI: 10.3390/jcm11195686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/31/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Transient ischemic attacks (TIAs) and minor strokes are often precursors of a major stroke. Therefore, diagnostic work-up of the TIA is essential to reduce the patient’s risk of further ischemic events. Purpose: With the help of this retrospective study, we aim to determine for which TIA patients a CT angiography (CTA) is not immediately necessary in order to reduce radiation exposure and nephrotoxicity. Material and Methods: Clinical and imaging data from patients who presented as an emergency case with a suspected diagnosis of TIA at a teaching hospital between January 2016 and December 2021 were evaluated. The included 1526 patients were divided into two groups—group 1, with major pathologic vascular findings in the CTA, and group 2, with minor vascular pathologies. Results: Out of 1821 patients with suspected TIA on admission, 1526 met the inclusion criteria. In total, 336 (22%) had major vascular pathologies on CTA, and 1190 (78%) were unremarkable. The majority of patients with major vascular pathologies were male and had a history of arterial hypertension, coronary heart disease, myocardial infarction, ischemic stroke, TIA, atherosclerotic peripheral vascular disease, smoking, antiplatelet medication, had a lower duration of TIA symptoms, and had lower ABCD2 scores. Conclusions: We were able to demonstrate a direct correlation between major CTA pathologies and a history of smoking, age, hyperlipidemia, history of peripheral arterial disease, and a history of stroke and TIA. We were able to prove that the ABCD2 score is even reciprocal to CTA pathology. This means that TIA patients without described risk factors do not immediately require a CTA and could be clarified in the course of treatment with ultrasound or MRI.
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Jalilianhasanpour R, Huntley JH, Alvin MD, Hause S, Ali N, Urrutia V, Ghazi Sherbaf F, Johnson PT, Yousem DM, Yedavalli V. Value of acute neurovascular imaging in patients with suspected transient ischemic attack. Eur J Radiol 2022; 154:110427. [DOI: 10.1016/j.ejrad.2022.110427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022]
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Shah K, McCabe B, Mathews C, Nehamkin A, Desai SM, Jadhav AP. Expedited management of low-risk transient ischemic attack patients: The “Fast-Track” TIA protocol. J Stroke Cerebrovasc Dis 2022; 31:106522. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/13/2022] [Accepted: 04/17/2022] [Indexed: 10/18/2022] Open
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Weng JX, Gu HQ, Wang S, Yang KX, Yang X, Wang CJ, Meng X, Zhao XQ, Wang YJ, Li ZX. External validation of ABCD series scores for predicting early stroke events following transient ischemic attack in a large nationwide registry. Eur Stroke J 2022; 7:439-446. [DOI: 10.1177/23969873221113145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/23/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: In the context of modern guideline-based strategies, new validations of prognostic scores for predicting early stroke risk are needed. We aimed to compare the validity of the ABCD series scores and assess the incremental values of risk components for predicting in-hospital stroke events in patients with transient ischemic attack (TIA). Patients and methods: We abstracted data from the Chinese Stroke Center Alliance (CSCA), a nationwide registry with 68,433 TIA patients admitted within 7 days of symptom onset from 1476 hospitals. TIA was defined by time-based criteria according to the World Health Organization (WHO). The discrimination of ABCD, ABCD2, ABCD2-I, and ABCD3 scores for predicting in-hospital stroke events was assessed by the area under the receiver-operating characteristics curves (AUC). The incremental predictive values of added risk predictor were determined by net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results: A total of 29,286 TIA patients were included, of whom 1466 (5.0%) had in-hospital stroke events. Compared with ABCD2-I score (AUC 0.79, 95% confidence interval [CI] 0.77–0.80), ABCD (AUC 0.58, 95% CI 0.57–0.60), ABCD2 (AUC 0.58, 95% CI 0.56–0.59), and ABCD3 (AUC 0.58, 95% CI 0.56–0.60) had lower predictive utility. An incremental value was observed when adding infarction on DWI (IDI = 0.0597, NRI = 1.1036) into ABCD2 score to be ABCD2-I. Conclusion: The traditional scales utilizing medical history (ABCD, ABCD2, and ABCD3 scores) show fair ability for predicting in-hospital stroke events after TIA, but the ABCD2-I score, which adds infarction on DWI, improves the predictive ability.
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Affiliation(s)
- Jia-Xu Weng
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shang Wang
- Neurocardiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kai-Xuan Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center for Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Yong-Jun Wang
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center for Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Zi-Xiao Li
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Center for Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
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Essen score in the prediction of cerebrovascular events compared with cardiovascular events after ischaemic stroke or transient ischaemic attack: a nationwide registry analysis. J Geriatr Cardiol 2022; 19:265-275. [PMID: 35572218 PMCID: PMC9068593 DOI: 10.11909/j.issn.1671-5411.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Essen risk score improves stratification of patients with acute ischemic stroke by early stroke recurrence. Recent study showed it could also predict myocardial infarction (MI). This study aimed to compare the Essen score's ability to predict cerebrovascular events with compared cardiovascular events. METHODS We included patients with acute ischaemic stroke or transient ischaemic attack within seven days from the Third China National Stroke Registry. One-year cumulative event rates of combined vascular events (a composite of MI, stroke recurrence or vascular death) and cardiac events (a composite of MI, heart failure or cardiac death) was estimated using the Kaplan-Meier method. The predictive value of the Essen score was assessed with C-statistics. In multivariate Cox regression analyses, we assessed whether Essen score, etiological subtype and imaging parameters were associated with outcomes. RESULTS Of 13,012 patients were included, the cumulative one-year event rates were 10.03% for combined vascular events and 0.77% for cardiac events, respectively. Compared with those with an Essen score < 3, patients with an Essen score ≥ 3 were more likely to have a subsequent combined vascular event [hazard ratio (HR) = 1.39, 95% CI: 1.24-1.55] and cardiac events (HR = 2.30, 95% CI: 1.53-3.44). The score tended to be more predictive of the risk of MI (C-statistic = 0.63, 95% CI: 0.55-0.71) and cardiac events (C-statistic = 0.62, 95% CI: 0.56-0.67) than stroke recurrence (C-statistic = 0.55, 95% CI: 0.54-0.57) and combined vascular events (C-statistic = 0.56, 95% CI: 0.54-0.57). In multivariable analysis after adjusted Essen score, patients with multiple acute infarctions or single acute infarctions and large artery atherosclerosis subtype were independently associated with an increased risk of combined vascular events. While the cardioembolism subtype was associated with an increased risk of cardiac events. CONCLUSIONS The Essen score is potentially more suitable for risk stratification of cardiovascular events than cerebrovascular events. Moreover, future predictive tools should take brain imaging findings and cause of stroke into consideration.
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Rostanski SK, Kvernland A, Liberman AL, de Havenon A, Henninger N, Mac Grory B, Kim AS, Easton JD, Johnston SC, Yaghi S. Infarct on Brain Imaging, Subsequent Ischemic Stroke, and Clopidogrel-Aspirin Efficacy: A Post Hoc Analysis of a Randomized Clinical Trial. JAMA Neurol 2022; 79:244-250. [PMID: 35040913 PMCID: PMC8767484 DOI: 10.1001/jamaneurol.2021.4905] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE In the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial, acute treatment with clopidogrel-aspirin was associated with significantly reduced risk of recurrent stroke. There may be specific patient groups who are more likely to benefit from this treatment. OBJECTIVE To investigate whether the association of clopidogrel-aspirin with stroke recurrence in patients with minor stroke or high-risk transient ischemic attack (TIA) is modified by the presence of infarct on imaging attributed to the index event (index imaging) among patients enrolled in the POINT Trial. DESIGN, SETTING, AND PARTICIPANTS In the POINT randomized clinical trial, patients with high-risk TIA and minor ischemic stroke were enrolled at 269 sites in 10 countries in North America, Europe, Australia, and New Zealand from May 28, 2010, to December 19, 2017. In this post hoc analysis, patients were divided into 2 groups according to whether they had an acute infarct on index imaging. All POINT trial participants with information available on the presence or absence of acute infarct on index imaging were eligible for this study. Univariable Cox regression models evaluated associations between the presence of an infarct on index imaging and subsequent ischemic stroke and evaluated whether the presence of infarct on index imaging modified the association of clopidogrel-aspirin with subsequent ischemic stroke risk. Data were analyzed from July 2020 to May 2021. EXPOSURES Presence or absence of acute infarct on index imaging. MAIN OUTCOMES AND MEASURES The primary outcome is whether the presence of infarct on index imaging modified the association of clopidogrel-aspirin with subsequent ischemic stroke risk. RESULTS Of the 4881 patients enrolled in POINT, 4876 (99.9%) met the inclusion criteria (mean [SD] age, 65 [13] years; 2685 men [55.0%]). A total of 1793 patients (36.8%) had an acute infarct on index imaging. Infarct on index imaging was associated with ischemic stroke during follow-up (hazard ratio [HR], 3.68; 95% CI, 2.73-4.95; P < .001). Clopidogrel-aspirin vs aspirin alone was associated with decreased ischemic stroke risk in patients with an infarct on index imaging (HR, 0.56; 95% CI, 0.41-0.77; P < .001) compared with those without an infarct on index imaging (HR, 1.11; 95% CI, 0.74-1.65; P = .62), with a significant interaction association (P for interaction = .008). CONCLUSIONS AND RELEVANCE In this study, the presence of an acute infarct on index imaging was associated with increased risk of recurrent stroke and a more pronounced benefit from clopidogrel-aspirin. Future work should focus on validating these findings before targeting specific patient populations for acute clopidogrel-aspirin treatment.
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Affiliation(s)
- Sara K. Rostanski
- Department of Neurology, NYU Grossman School of Medicine, New York, New York
| | - Alexandra Kvernland
- Department of Neurology, NYU Grossman School of Medicine, New York, New York
| | - Ava L. Liberman
- Department of Neurology, Weill Cornell Medical College, New York, New York
| | - Adam de Havenon
- Department of Neurology, Yale University, New Haven, Connecticut
| | - Nils Henninger
- Department of Psychiatry, University of Massachusetts Medical Center, Worcester,Department of Neurology, University of Massachusetts Medical Center, Worcester
| | - Brian Mac Grory
- Department of Neurology, Duke University, Durham, North Carolina
| | - Anthony S. Kim
- Department of Neurology, University of California, San Francisco, San Francisco
| | - J. Donald Easton
- Department of Neurology, University of California, San Francisco, San Francisco
| | | | - Shadi Yaghi
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Zhao L, Cao S, Pei L, Fang H, Liu H, Wu J, Sun S, Gao Y, Song B, Xu Y. Validation of CSR model to predict stroke risk after transient ischemic attack. Sci Rep 2022; 12:604. [PMID: 35022460 PMCID: PMC8755815 DOI: 10.1038/s41598-021-04405-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022] Open
Abstract
It is essential to identify high risk transient ischemic attack (TIA) patients. The previous study reported that the CSR (comprehensive stroke recurrence) model, a neuroimaging model, had a high predictive ability of recurrent stroke. The aims of this study were to validate the predictive value of CSR model in TIA patients and compare the predictive ability with ABCD3-I score. Data were analyzed from the prospective hospital-based database of patients with TIA which defined by the World Health Organization time-based criteria. The predictive outcome was stroke occurrence at 90 days. The receiver-operating characteristic (ROC) curves were plotted and the C statistics were calculated as a measure of predictive ability. Among 1186 eligible patients, the mean age was 57.28 ± 12.17 years, and 474 (40.0%) patients had positive diffusion-weighted imaging (DWI). There were 118 (9.9%) patients who had stroke within 90 days. In 1186 TIA patients, The C statistic of CSR model (0.754; 95% confidence interval [CI] 0.729–0.778) was similar with that of ABCD3-I score (0.717; 95% CI 0.691–0.743; Z = 1.400; P = 0.1616). In 474 TIA patients with positive DWI, C statistic of CSR model (0.725; 95% CI 0.683–0.765) was statistically higher than that of ABCD3-I score (0.626; 95% CI 0.581–0.670; Z = 2.294; P = 0.0245). The CSR model had good predictive value for assessing stroke risk after TIA, and it had a higher predictive value than ABCD3-I score for assessing stroke risk for TIA patients with positive DWI.
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Affiliation(s)
- Lu Zhao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shuang Cao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Lulu Pei
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hui Fang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hao Liu
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Jun Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shilei Sun
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yuan Gao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Bo Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China.
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Shahjouei S, Li J, Koza E, Abedi V, Sadr AV, Chen Q, Mowla A, Griffin P, Ranta A, Zand R. Risk of Subsequent Stroke Among Patients Receiving Outpatient vs Inpatient Care for Transient Ischemic Attack: A Systematic Review and Meta-analysis. JAMA Netw Open 2022; 5:e2136644. [PMID: 34985520 PMCID: PMC8733831 DOI: 10.1001/jamanetworkopen.2021.36644] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Transient ischemic attack (TIA) often indicates a high risk of subsequent cerebral ischemic events. Timely preventive measures improve the outcome. OBJECTIVE To estimate and compare the risk of subsequent ischemic stroke among patients with TIA or minor ischemic stroke (mIS) by care setting. DATA SOURCES MEDLINE, Web of Science, Scopus, Embase, International Clinical Trials Registry Platform, ClinicalTrials.gov, Trip Medical Database, CINAHL, and all Evidence-Based Medicine review series were searched from the inception of each database until October 1, 2020. STUDY SELECTION Studies evaluating the occurrence of ischemic stroke after TIA or mIS were included. Cohorts without data on evaluation time for reporting subsequent stroke, with retrospective diagnosis of the index event after stroke occurrence, and with a report of outcomes that were not limited to patients with TIA or mIS were excluded. Two authors independently screened the titles and abstracts and provided the list of candidate studies for full-text review; discrepancies and disagreements in all steps of the review were addressed by input from a third reviewer. DATA EXTRACTION AND SYNTHESIS The study was prepared and reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses, Meta-analysis of Observational Studies in Epidemiology, Methodological Expectations of Cochrane Intervention Reviews, and Enhancing the Quality and Transparency of Health Research guidelines. The Risk of Bias in Nonrandomized Studies-of Exposures (ROBINS-E) tool was used for critical appraisal of cohorts, and funnel plots, Begg-Mazumdar rank correlation, Kendall τ2, and the Egger bias test were used for evaluating the publication bias. All meta-analyses were conducted under random-effects models. MAIN OUTCOMES AND MEASURES Risk of subsequent ischemic stroke among patients with TIA or mIS who received care at rapid-access TIA or neurology clinics, inpatient units, emergency departments (EDs), and unspecified or multiple settings within 4 evaluation intervals (ie, 2, 7, 30, and 90 days). RESULTS The analysis included 226 683 patients from 71 articles recruited between 1981 and 2018; 5636 patients received care at TIA clinics (mean [SD] age, 65.7 [3.9] years; 2291 of 4513 [50.8%] men), 130 139 as inpatients (mean [SD] age, 78.3 [4.0] years; 49 458 of 128 745 [38.4%] men), 3605 at EDs (mean [SD] age, 68.9 [3.9] years; 1596 of 3046 [52.4%] men), and 87 303 patients received care in an unspecified setting (mean [SD] age, 70.8 [3.8] years, 43 495 of 87 303 [49.8%] men). Among the patients who were treated at a TIA clinic, the risk of subsequent stroke following a TIA or mIS was 0.3% (95% CI, 0.0%-1.2%) within 2 days, 1.0% (95% CI, 0.3%-2.0%) within 7 days, 1.3% (95% CI, 0.4%-2.6%) within 30 days, and 2.1% (95% CI, 1.4%-2.8%) within 90 days. Among the patients who were treated as inpatients, the risk of subsequent stroke was to 0.5% (95% CI, 0.1%-1.1%) within 2 days, 1.2% (95% CI, 0.4%-2.2%) within 7 days, 1.6% (95% CI, 0.6%-3.1%) within 30 days, and 2.8% (95% CI, 2.1%-3.5%) within 90 days. The risk of stroke among patients treated at TIA clinics was not significantly different from those hospitalized. Compared with the inpatient cohort, TIA clinic patients were younger and had had lower ABCD2 (age, blood pressure, clinical features, duration of TIA, diabetes) scores (inpatients with ABCD2 score >3, 1101 of 1806 [61.0%]; TIA clinic patients with ABCD2 score >3, 1933 of 3703 [52.2%]). CONCLUSIONS AND RELEVANCE In this systematic review and meta-analysis, the risk of subsequent stroke among patients who were evaluated in a TIA clinic was not higher than those hospitalized. Patients who received treatment in EDs without further follow-up had a higher risk of subsequent stroke. These findings suggest that TIA clinics can be an effective component of the TIA care component pathway.
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Affiliation(s)
- Shima Shahjouei
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania
| | - Jiang Li
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, Pennsylvania
| | - Eric Koza
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Geisinger Health System, Danville, Pennsylvania
- Biocomplexity Institute, Virginia Tech, Blacksburg, Virginia
| | - Alireza Vafaei Sadr
- Department de Physique Theorique and Center for Astroparticle Physics, University Geneva, Geneva, Switzerland
| | - Qiushi Chen
- Department of Industrial and Manufacturing Engineering, Pennsylvania State University, University Park
| | - Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Paul Griffin
- Department of Industrial and Manufacturing Engineering, Pennsylvania State University, University Park
| | - Annemarei Ranta
- Department of Neurology, Wellington Hospital, Wellington, New Zealand
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Ramin Zand
- Neurology Department, Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania
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21
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Maier IL, Herpertz GU, Bähr M, Psychogios MN, Liman J. What is the added value of CT-angiography in patients with transient ischemic attack? BMC Neurol 2022; 22:7. [PMID: 34980008 PMCID: PMC8722154 DOI: 10.1186/s12883-021-02523-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 12/13/2021] [Indexed: 12/03/2022] Open
Abstract
Background Transient ischemic attack (TIA) is an important predictor for a pending stroke. Guidelines recommend a workup for TIA-patients similar to that of stroke patients, including an assessment of the extra- and intracranial arteries for vascular pathologies with direct therapeutic implications via computed tomography angiography (CTA). Aim of our study was a systematic analysis of TIA-patients receiving early CTA-imaging and to evaluate the predictive value of TIA-scores and clinical characteristics for ipsilateral vascular pathologies and the need of an invasive treatment. Methods We analysed clinical and imaging data from TIA patients being admitted to a tertiary university hospital between September 2015 and March 2018. Following subgroups were identified: 1) no- or low-grade vascular pathology 2) ipsilateral high-risk vascular pathology and 3) high-risk findings that needed invasive, surgical or interventional treatment. We investigated established TIA-scores (ABCD2-, the ABCD3- and the SPI-II score) and various clinical characteristics as predictive factors for ipsilateral vascular pathologies and the need for invasive treatment. Results Of 812 patients, 531 (65.4%) underwent initial CTA in the emergency department. In 121 (22.8%) patients, ipsilateral vascular pathologies were identified, of which 36 (6.7%) needed invasive treatment. The ABCD2-, ABCD3- and SPI-II-scores were not predictive for ipsilateral vascular pathologies or the need for invasive treatment. We identified male sex (OR 1.579, 95%CI 1.049–2.377, p = 0.029), a short duration of symptoms (OR 0.692, 95% CI 0.542–0.884, p = 0.003), arterial hypertension (OR 1.718, 95%CI 0.951–3.104, p = 0.073) and coronary heart disease (OR 1.916, 95%CI 1.184–3.101, p = 0.008) as predictors for ipsilateral vascular pathologies. As predictors for the need of invasive treatment, a short duration of symptoms (OR 0.565, 95%CI 0.378–0.846, p = 0.006), arterial hypertension (OR 2.612, 95%OR 0.895–7.621, p = 0.079) and hyperlipidaemia (OR 5.681, 95%CI 0.766–42.117, p = 0.089) as well as the absence of atrial fibrillation (OR 0.274, OR 0.082–0.917, p = 0.036) were identified. Conclusion More than every fifth TIA-patient had relevant vascular findings revealed by acute CTA. TIA-scores were not predictive for these findings. Patients with a short duration of symptoms and a vascular risk profile including coronary heart disease, arterial hypertension and hyperlipidaemia most likely might benefit from early CTA to streamline further diagnostics and therapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02523-y.
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Affiliation(s)
- Ilko L Maier
- Department of Neurology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Gerrit U Herpertz
- Department of Anesthesiology, Klinikum Bremerhaven-Reinkenheide, Bremerhaven, Germany
| | - Mathias Bähr
- Department of Neurology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Marios-Nikos Psychogios
- Department of diagnostic and interventional Neuroradiology, University Clinic Basel, Basel, Switzerland
| | - Jan Liman
- Department of Neurology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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22
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Wechsler PM, Parikh NS, Heier LA, Ruiz E, Fink ME, Navi BB, White H. Evaluation of Transient Ischemic Attack and Minor Stroke: A Rapid Outpatient Model for the COVID-19 Pandemic and Beyond. Neurohospitalist 2022; 12:38-47. [PMID: 34950385 PMCID: PMC8689541 DOI: 10.1177/19418744211000508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The grim circumstances of the COVID-19 pandemic have highlighted the need to refine and adapt stroke systems of care. Patients' care-seeking behaviors have changed due to perceived risks of in-hospital treatment during the pandemic. In response to these challenges, we optimized a recently implemented, novel outpatient approach for the evaluation and management of minor stroke and transient ischemic attack, entitled RESCUE-TIA. This modified approach incorporated telemedicine visits and remote testing, and proved valuable during the pandemic. In this review article, we provide the evidence-based rationale for our approach, describe its operationalization, and provide data from our initial experience.
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Affiliation(s)
- Paul M. Wechsler
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Neal S. Parikh
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Linda A. Heier
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Evelyn Ruiz
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Matthew E. Fink
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Babak B. Navi
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Halina White
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA,Halina White, Department of Neurology, Weill Cornell Medicine, 520 E 70th St, Starr 607, New York, NY 10021, USA.
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23
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Xie X, Jing J, Meng X, Li Z, Chen P, Zhao X, Wang Y, Liu L, Jiang Y, Pan Y, Jin A, Li H, Wang Y. Predictive Value of the ABCD3-I for Short- and Long-Term Stroke after TIA with or without sICAS. J Atheroscler Thromb 2021; 29:1372-1382. [PMID: 34744099 PMCID: PMC9444691 DOI: 10.5551/jat.63050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aims: We aimed to validate the predictive value of the ABCD3-I score for short-term and long-term stroke risk after transient ischemic attack (TIA) and to evaluate the influence of symptomatic intracranial artery stenosis (sICAS) on the performance of ABCD3-I.
Methods: We recruited TIA patients from the Third China National Stroke Registry study. Outcome parameters were stroke events during the 14-day, 3-month, 6-month, and 12-month points. The area under the curve (AUC) was calculated as a measure of predictive ability. A multivariable-adjusted Cox proportional hazards model was used to assess the hazard ratio of risk factors for stroke.
Results: Among 986 patients, 3.9%, 5.1%, 6.5 %, and 8.2% of participants experienced a stroke event during the 14-day, 3-month, 6-month, and 12-month points post TIA, respectively. The AUCs of ABCD3-I score for the prediction of stroke were 0.786, 0.732, 0.715, and 0.699 at the 14-day, 3-month, 6-month, and 12-month points, respectively. The AUCs were 0.774, 0.690, 0.617, and 0.611 in patients with sICAS, 0.789, 0.748, and 0.758 and 0.734 in those without sICAS. P values of the interaction between ABCD3-I categories and sICAS were 0.0618 for 14-day, 0.0098 for 3-month, 0.0318 for 6-month, and 0.0294 for 12-month.
Conclusions: ABCD3-I score performed well in predicting short-term risk of a stroke after an index TIA in patients with or without sICAS. However, the predictive power decayed with the prolonged period, and the decayed extent was more pronounced among those with sICAS. The assessment of sICAS is a non-ignorable item when using the ABCD3-I score for long-term stroke risk prediction in patients with TIA.
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Affiliation(s)
- Xuewei Xie
- China National Clinical Research Center for Neurological Diseases.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease.,Center of Stroke, Beijing Institute for Brain Disorders
| | - Jing Jing
- China National Clinical Research Center for Neurological Diseases.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease.,Center of Stroke, Beijing Institute for Brain Disorders.,Tiantan Neuroimaging Center of Excellence
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease.,Center of Stroke, Beijing Institute for Brain Disorders
| | - Zixiao Li
- China National Clinical Research Center for Neurological Diseases.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease.,Center of Stroke, Beijing Institute for Brain Disorders
| | - Pan Chen
- China National Clinical Research Center for Neurological Diseases.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease.,Center of Stroke, Beijing Institute for Brain Disorders
| | - Xingquan Zhao
- China National Clinical Research Center for Neurological Diseases.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease.,Center of Stroke, Beijing Institute for Brain Disorders
| | - Yilong Wang
- China National Clinical Research Center for Neurological Diseases.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease.,Center of Stroke, Beijing Institute for Brain Disorders
| | - Liping Liu
- China National Clinical Research Center for Neurological Diseases.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease.,Center of Stroke, Beijing Institute for Brain Disorders
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease.,Center of Stroke, Beijing Institute for Brain Disorders
| | - Yuesong Pan
- China National Clinical Research Center for Neurological Diseases.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease.,Center of Stroke, Beijing Institute for Brain Disorders
| | - Aoming Jin
- China National Clinical Research Center for Neurological Diseases.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease.,Center of Stroke, Beijing Institute for Brain Disorders
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease.,Center of Stroke, Beijing Institute for Brain Disorders
| | - Yongjun Wang
- China National Clinical Research Center for Neurological Diseases.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease.,Center of Stroke, Beijing Institute for Brain Disorders.,Tiantan Neuroimaging Center of Excellence
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24
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Hellwig S, Ihl T, Ganeshan R, Laumeier I, Ahmadi M, Steinicke M, Weber JE, Endres M, Audebert HJ, Scheitz JF. Cardiac Troponin and Recurrent Major Vascular Events after Minor Stroke or Transient Ischemic Attack. Ann Neurol 2021; 90:901-912. [PMID: 34561890 DOI: 10.1002/ana.26225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/08/2021] [Accepted: 09/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study was undertaken to investigate whether high-sensitivity cardiac troponin T (hs-cTnT) is associated with major adverse cardiovascular events (MACE) in patients with minor stroke or transient ischemic attack (TIA), and whether this association differs after risk stratification based on the Age, Blood Pressure, Clinical Features, Duration of Symptoms, Diabetes (ABCD2 ) score. METHODS INSPiRE-TMS was a randomized controlled trial allocating patients with minor stroke or TIA to an intensified support program or conventional care. In this post hoc analysis, participants were categorized using hs-cTnT levels (5th generation; Roche Diagnostics, Manheim, Germany; 99th percentile upper reference limit [URL] = 14ng/l). Vascular risk was stratified using the ABCD2 score (lower risk = 0-5 vs higher risk = 6-7). Cox proportional hazard regression was performed using covariate adjustment and propensity score matching (PSM) for the association between hs-cTnT and MACE (stroke/nonfatal coronary event/vascular death). RESULTS Among 889 patients (mean age = 70 years, 37% female), MACE occurred in 153 patients (17.2%) during a mean follow-up of 3.2 years. hs-cTnT was associated with MACE (9.3%/yr, >URL vs 4.4%/yr, ≤URL, adjusted hazard ratio [HR] = 1.63 [95% confidence interval (CI) = 1.13-2.35], adjusted HR [Q4 vs Q1 ] = 2.57 [95% CI = 1.35-4.97], adjusted HR [log-transformed] = 2.31 [95% CI = 1.37-3.89]). This association remained after PSM (adjusted HR = 1.76 [95% CI = 1.14-2.72]). There was a significant interaction between hs-cTnT and ABCD2 category for MACE occurrence (pinteraction = 0.04). In the lower risk category, MACE rate was 9.5%/yr in patients with hs-cTnT > URL, which was higher than in those ≤URL (3.8%/yr) and similar to the overall rate in the higher risk category. INTERPRETATION hs-cTnT levels are associated with incident MACE within 3 years after minor stroke or TIA and may help to identify high-risk individuals otherwise deemed at lower risk based on the ABCD2 score. If confirmed in independent validation studies, this might warrant intensified secondary prevention measures and cardiac diagnostics in stroke patients with elevated hs-cTnT. ANN NEUROL 2021;90:901-912.
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Affiliation(s)
- Simon Hellwig
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Ihl
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ramanan Ganeshan
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Inga Laumeier
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Ahmadi
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Maureen Steinicke
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim E Weber
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Matthias Endres
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Excellence Cluster NeuroCure, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases, partner site Berlin, Berlin, Germany.,German Center for Cardiovascular Research, partner site Berlin, Berlin, Germany
| | - Heinrich J Audebert
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan F Scheitz
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Center for Cardiovascular Research, partner site Berlin, Berlin, Germany
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25
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Burrello J, Bianco G, Burrello A, Manno C, Maulucci F, Pileggi M, Nannoni S, Michel P, Bolis S, Melli G, Vassalli G, Albers GW, Cianfoni A, Barile L, Cereda CW. Extracellular Vesicle Surface Markers as a Diagnostic Tool in Transient Ischemic Attacks. Stroke 2021; 52:3335-3347. [PMID: 34344167 DOI: 10.1161/strokeaha.120.033170] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Extracellular vesicles (EVs) are promising biomarkers for cerebral ischemic diseases, but not systematically tested in patients with transient ischemic attacks (TIAs). We aimed at (1) investigating the profile of EV-surface antigens in patients with symptoms suspicious for TIA; (2) developing and validating a predictive model for TIA diagnosis based on a specific EV-surface antigen profile. METHODS We analyzed 40 subjects with symptoms suspicious for TIA and 20 healthy controls from a training cohort. An independent cohort of 28 subjects served as external validation. Patients were stratified according to likelihood of having a real ischemic event using the Precise Diagnostic Score, defined as: unlikely (score 0-1), possible-probable (score 2-3), or very likely (score 4-8). Serum vesicles were quantified by nanoparticle tracking analysis and EV-surface antigen profile characterized by multiplex flow cytometry. RESULTS EV concentration increased in patients with very likely or possible-probable TIA (P<0.05) compared with controls. Nanoparticle concentration was directly correlated with the Precise Diagnostic score (R=0.712; P<0.001). After EV immuno-capturing, CD8, CD2, CD62P, melanoma-associated chondroitin sulfate proteoglycan, CD42a, CD44, CD326, CD142, CD31, and CD14 were identified as discriminants between groups. Receiver operating characteristic curve analysis confirmed a reliable diagnostic performance for each of these markers taken individually and for a compound marker derived from their linear combinations (area under the curve, 0.851). Finally, a random forest model combining the expression levels of selected markers achieved an accuracy of 96% and 78.9% for discriminating patients with a very likely TIA, in the training and external validation cohort, respectively. CONCLUSIONS The EV-surface antigen profile appears to be different in patients with transient symptoms adjudicated to be very likely caused by brain ischemia compared with patients whose symptoms were less likely to due to brain ischemia. We propose an algorithm based on an EV-surface-antigen specific signature that might aid in the recognition of TIA.
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Affiliation(s)
- Jacopo Burrello
- Cellular and Molecular Cardiology Laboratory, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland (J.B., G.V.)
| | - Giovanni Bianco
- Neurology Clinic, Stroke Center, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano (G.B., C.M., F.M., G.M., C.W.C.)
| | - Alessio Burrello
- Department of Electrical, Electronic and Information Engineering (DEI), University of Bologna, Italy (A.B.)
| | - Concetta Manno
- Neurology Clinic, Stroke Center, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano (G.B., C.M., F.M., G.M., C.W.C.)
| | - Francesco Maulucci
- Neurology Clinic, Stroke Center, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano (G.B., C.M., F.M., G.M., C.W.C.)
| | - Marco Pileggi
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano (M.P., A.C.)
| | - Stefania Nannoni
- Stroke Center, Neurology Service, Lausanne University Hospital, Switzerland (S.N., P.M., C.W.C.)
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital, Switzerland (S.N., P.M., C.W.C.)
| | - Sara Bolis
- Laboratory for Cardiovascular Theranostics, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland (S.B., L.B.)
| | - Giorgia Melli
- Neurology Clinic, Stroke Center, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano (G.B., C.M., F.M., G.M., C.W.C.).,Faculty of Biomedical Sciences, Università Svizzera italiana, Lugano, Switzerland (G.M., G.V., L.B., C.W.C)
| | - Giuseppe Vassalli
- Cellular and Molecular Cardiology Laboratory, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland (J.B., G.V.).,Faculty of Biomedical Sciences, Università Svizzera italiana, Lugano, Switzerland (G.M., G.V., L.B., C.W.C)
| | - Gregory W Albers
- Department of Neurology & Neurologic Sciences, Stanford University, Stanford Stroke Center (G.W.A.)
| | - Alessandro Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano (M.P., A.C.)
| | - Lucio Barile
- Laboratory for Cardiovascular Theranostics, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland (S.B., L.B.).,Faculty of Biomedical Sciences, Università Svizzera italiana, Lugano, Switzerland (G.M., G.V., L.B., C.W.C)
| | - Carlo W Cereda
- Neurology Clinic, Stroke Center, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano (G.B., C.M., F.M., G.M., C.W.C.).,Stroke Center, Neurology Service, Lausanne University Hospital, Switzerland (S.N., P.M., C.W.C.).,Faculty of Biomedical Sciences, Università Svizzera italiana, Lugano, Switzerland (G.M., G.V., L.B., C.W.C)
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26
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Fonseca AC, Merwick Á, Dennis M, Ferrari J, Ferro JM, Kelly P, Lal A, Ois A, Olivot JM, Purroy F. European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack. Eur Stroke J 2021; 6:CLXIII-CLXXXVI. [PMID: 34414299 PMCID: PMC8370080 DOI: 10.1177/2396987321992905] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/16/2021] [Indexed: 01/14/2023] Open
Abstract
The aim of the present European Stroke Organisation Transient Ischaemic Attack (TIA) management guideline document is to provide clinically useful evidence-based recommendations on approaches to triage, investigation and secondary prevention, particularly in the acute phase following TIA. The guidelines were prepared following the Standard Operational Procedure for a European Stroke Organisation guideline document and according to GRADE methodology. As a basic principle, we defined TIA clinically and pragmatically for generalisability as transient neurological symptoms, likely to be due to focal cerebral or ocular ischaemia, which last less than 24 hours. High risk TIA was defined based on clinical features in patients seen early after their event or having other features suggesting a high early risk of stroke (e.g. ABCD2 score of 4 or greater, or weakness or speech disturbance for greater than five minutes, or recurrent events, or significant ipsilateral large artery disease e.g. carotid stenosis, intracranial stenosis). Overall, we strongly recommend using dual antiplatelet treatment with clopidogrel and aspirin short term, in high-risk non-cardioembolic TIA patients, with an ABCD2 score of 4 or greater, as defined in randomised controlled trials (RCTs). We further recommend specialist review within 24 hours after the onset of TIA symptoms. We suggest review in a specialist TIA clinic rather than conventional outpatients, if managed in an outpatient setting. We make a recommendation to use either MRA or CTA in TIA patients for additional confirmation of large artery stenosis of 50% or greater, in order to guide further management, such as clarifying degree of carotid stenosis detected with carotid duplex ultrasound. We make a recommendation against using prediction tools (eg ABCD2 score) alone to identify high risk patients or to make triage and treatment decisions in suspected TIA patients as due to limited sensitivity of the scores, those with score value of 3 or less may include significant numbers of individual patients at risk of recurrent stroke, who require early assessment and treatment. These recommendations aim to emphasise the importance of prompt acute assessment and relevant secondary prevention. There are no data from randomised controlled trials on prediction tool use and optimal imaging strategies in suspected TIA.
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Affiliation(s)
- Ana Catarina Fonseca
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria-CHLN, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Áine Merwick
- Department of Neurology, Cork University Hospital & University College Cork, Cork, Ireland
| | - Martin Dennis
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Julia Ferrari
- Department of Neurology, St. John´s of God Hospital, Vienna, Austria
| | - José M Ferro
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria-CHLN, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Peter Kelly
- Stroke Service, Mater University Hospital and HRB Stroke Clinical Trials Network Ireland, University College Dublin, Ireland
| | - Avtar Lal
- Guidelines Methodologist, European Stroke Organisation, Basel, Switzerland
| | - Angel Ois
- Department of Neurology, Hospital del Mar, IMIM, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jean Marc Olivot
- Acute Stroke Unit, Clinical Investigation Center and Toulouse Neuro Imaging Center, Toulouse University Medical Center, Toulouse, France
| | - Francisco Purroy
- Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomedica de Lleida (IRBLleida), Universitat de Lleida (UdL), Lleida, Spain
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Li C, Meng X, Pan Y, Li Z, Wang M, Wang Y. The Association Between Heart Rate Variability and 90-Day Prognosis in Patients With Transient Ischemic Attack and Minor Stroke. Front Neurol 2021; 12:636474. [PMID: 34122296 PMCID: PMC8193569 DOI: 10.3389/fneur.2021.636474] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/04/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Low heart rate variability (HRV) is known to be associated with increased all-cause, cardiovascular, and cerebrovascular mortality but its association with clinical outcomes in patients with transient ischemic attack (TIA) or minor stroke is unclear. Methods: We selected TIA and minor stroke patients from a prospective registration study. From each continuous electrocardiograph (ECG) record, each QRS complex was detected and normal-to-normal (N-N) intervals were determined. The standard deviation of all N-N intervals (SDNN) and the square root of the mean squared differences of successive N-N intervals (RMSSD) were calculated. Logistic regression analysis and Cox regression analysis were performed to assess the outcomes of patients at 90 days, and the odds and risk ratios (OR/HR) of each index quartile were compared. Results: Compared with SDNN patients in the lowest quartile, neurological disability was significantly reduced in other quartile groups at 90 days, with significant differences [OR of group Q2 was 0.659; 95% confidence interval (CI), 0.482–0.900; p = 0.0088; OR of group Q3 was 0.662; 95% CI, 0.478–0.916; p = 0.0127; OR of group Q4 was 0.441; 95% CI, 0.305–0.639; p <0.0001]. Compared with the lowest quartile, the recurrence rate of TIA or minor stroke in patients of the two higher quartiles (Q3 and Q4) of SDNN was significantly reduced at 90 days (HR of Q3 group was 0.732; 95% CI, 0.539–0.995; p = 0.0461; HR of Q4 group was 0.528; 95% CI, 0.374–0.745; p = 0.0003). Conclusions: Based on our findings, autonomic dysfunction is an adverse indicator for neurological function prognosis and stroke recurrence 90 days after TIA or minor stroke.
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Affiliation(s)
- Changhong Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Haidian Hospital, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yuesong Pan
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Mengxing Wang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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28
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Jing J, Suo Y, Wang A, Zuo Y, Jiang Y, Liu L, Zhao X, Wang Y, Li Z, Li H, Meng X, Wang Y. Imaging Parameters Predict Recurrence After Transient Ischemic Attack or Minor Stroke Stratified by ABCD 2 Score. Stroke 2021; 52:2007-2015. [PMID: 33947206 DOI: 10.1161/strokeaha.120.032424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Whether imaging parameters would independently predict stroke recurrence in low-risk minor ischemic stroke (MIS) or transient ischemic attack (TIA) according to traditional score system (such as ABCD2 score, which was termed on the basis of the initials of the five factors: age, blood pressure, clinical features, duration, diabetes) remains unclear. We sought to evaluate the association between imaging parameters and 1-year stroke recurrence in patients with TIA or MIS in different risk stratum stratified by ABCD2 score. METHODS We included patients with TIA and MIS (National Institutes of Health Stroke Scale score ≤3) with complete baseline vessel and brain imaging data from the Third China National Stroke Registry III. Patients were categorized into different risk groups based on ABCD2 score (low risk, 0-3; moderate risk, 4-5; and high risk, 6-7). The primary outcome was stroke recurrence within 1 year. Multivariable Cox proportional-hazards regression models were used to assess whether imaging parameters (large artery stenosis, infarction number) were independently associated with stroke recurrence. RESULTS Of the 7140 patients included, 584 patients experienced stroke recurrence within 1 year. According to the ABCD2 score, large artery stenosis was associated with higher stroke recurrence in both low-risk (adjusted hazard ratio, 1.746 [95% CI, 1.200-2.540]) and moderate-risk group (adjusted hazard ratio, 1.326 [95% CI, 1.042-1.687]) but not in the high-risk group (P>0.05). Patients with multiple acute infarctions or single acute infarction had a higher risk of recurrent stroke than those with no infarction in both low- and moderate-risk groups, but not in the high-risk group. CONCLUSIONS Large artery stenosis and infarction number were independent predictors of 1-year stroke recurrence in low-moderate risk but not in high-risk patients with TIA or MIS stratified by ABCD2 score. This finding emphasizes the importance of early brain and vascular imaging evaluation for risk stratification in patients with TIA or MIS.
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Affiliation(s)
- Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang).,Tiantan Neuroimaging Center of Excellence, Beijing, China (J.J.)
| | - Yue Suo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang)
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang)
| | - Yingting Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang)
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang)
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang)
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang)
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang)
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang)
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang)
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang)
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang).,China National Clinical Research Center for Neurological Diseases, Beijing, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang)
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Chan KL, Feng X, Ip B, Huang S, Ma SH, Fan FSY, Ip HL, Huang L, Mok VCT, Soo YOY, Leung TW, Leng X. Elevated Neutrophil to Lymphocyte Ratio Associated With Increased Risk of Recurrent Vascular Events in Older Minor Stroke or TIA Patients. Front Aging Neurosci 2021; 13:646961. [PMID: 33958997 PMCID: PMC8093519 DOI: 10.3389/fnagi.2021.646961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/29/2021] [Indexed: 12/14/2022] Open
Abstract
Background The risk of recurrent stroke following a minor stroke or transient ischemic attack (TIA) is high, when inflammation might play an important role. We aimed to evaluate the value of neutrophil to lymphocyte ratio (NLR) in predicting composite cardiovascular events in patients with minor stroke and TIA. Methods Consecutive patients with acute minor stroke or TIA admitted within 24 h of symptoms onset during a 5-year period in a prospective stroke registry were analyzed. We calculated the NLR dividing absolute neutrophil count by absolute lymphocyte count tested within 24 h of admission. NLR ≥4th quartile was defined as high NLR. A composite outcome was defined as stroke, acute coronary syndrome or vascular death within 1 year. We investigated associations between NLR and the composite outcome in univariate and multivariate analyses, among all patients and in those aged over 60 years (i.e., older patients). Results Overall, 841 patients (median age 68 years; 60.4% males) were recruited. No significant independent association was found between NLR and the composite outcome in multivariate analysis in the overall cohort. Among the 612 older patients (median age 73 years; 59.2% males), the median NLR was 2.76 (interquartile range 1.96-4.00) and 148 (24.2%) patients had high NLR. The composite outcome occurred in 77 (12.6%) older patients, who were more likely to have a high NLR (39.0% versus 22.1%; p = 0.001) than those without a composite outcome. In multivariate logistic regression, high NLR (adjusted odds ratio 2.00; 95% confidence interval 1.07-3.75; p = 0.031) was independently associated with the composite outcome in older patients. Conclusion In older (aged ≥60 years) patients with acute minor stroke or TIA, a higher NLR, a marker of systemic inflammation that can be easily obtained in routine blood tests, is an independent predictor of subsequent cardiovascular events.
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Affiliation(s)
- Ka Lung Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Xueyan Feng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bonaventure Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Shangmeng Huang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Department of Geriatrics, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Sze Ho Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Florence S Y Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Hing Lung Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Li'an Huang
- Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Vincent C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yannie O Y Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Xinyi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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Ouyang N, Shi C, Guo X, Chen Y, Sun Y. Risk factor control after ischemic stroke or transient ischemic attack. Acta Neurol Scand 2021; 143:367-374. [PMID: 33528038 DOI: 10.1111/ane.13398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/05/2021] [Accepted: 01/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We aimed to estimate the status of risk factor control after ischemic stroke or transient ischemic attack (IS/TIA), and the influence on recurrent stroke in rural communities of northeastern China. METHODS This population-based, prospective cohort study enrolled adults aged ≥35 years residing in rural northeastern China. We conducted cardiovascular health examinations in 2012-2015 and followed up in 2018 to record any cardiovascular event. Control of risk factors after IS/TIA was determined through a baseline survey. The Cox proportional hazard model was used to evaluate the relationship between uncontrolled risk factors and stroke recurrence. RESULTS Of the 10,700 participants, 575 were diagnosed with IS/TIA and were included in the analysis. At baseline, the rates of control of risk factors were as follows: fasting plasma glucose (FPG), 81.6%; not currently smoking, 65.7%; and achieving physical activity targets, 61%. Blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), and body mass index (BMI) were poorly controlled (28.3%, 26.3%, and 37.4%, respectively). The rate of stroke recurrence was 12% during a median follow-up of 4.43 years. After adjusting for age, sex, ethnicity, family history of stroke, and current drinking, uncontrolled BP and not achieving physical exercise targets were associated with an increased risk of recurrence (hazard ratios: 2.081, 1.685, respectively; p < .05). Uncontrolled FPG, BMI, or LDL-C and current smoking did not significantly influence recurrent risk (p > .05). CONCLUSIONS Control of risk factors after IS/TIA needs to be improved in rural communities of northeastern China to prevent recurrence and thus alleviate the public health and economic burden of stroke.
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Affiliation(s)
- Nanxiang Ouyang
- Department of Cardiology The First Hospital of China Medical University Shenyang China
| | - Chuning Shi
- Department of Cardiology The First Hospital of China Medical University Shenyang China
| | - Xiaofan Guo
- Department of Cardiology The First Hospital of China Medical University Shenyang China
| | - Yihan Chen
- Department of Cardiology The First Hospital of China Medical University Shenyang China
| | - Yingxian Sun
- Department of Cardiology The First Hospital of China Medical University Shenyang China
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ABCD3-I and ABCD2 Scores in a TIA Population with Low Stroke Risk. Stroke Res Treat 2021; 2021:8845898. [PMID: 33708373 PMCID: PMC7932764 DOI: 10.1155/2021/8845898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/20/2021] [Accepted: 02/06/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives We aimed to evaluate the ABCD3-I score and compare it with the ABCD2 score in short- (1 week) and long-term (3 months; 1 year) stroke risk prediction in our post-TIA stroke risk study, MIDNOR TIA. Materials and Methods We performed a prospective, multicenter study in Central Norway from 2012 to 2015, enrolling 577 patients with TIA. In a subset of patients with complete data for both scores (n = 305), we calculated the AUC statistics of the ABCD3-I score and compared this with the ABCD2 score. A telephone follow-up and registry data were used for assessing stroke occurrence. Results Within 1 week, 3 months, and 1 year, 1.0% (n = 3), 3.3% (n = 10), and 5.2% (n = 16) experienced a stroke, respectively. The AUCs for the ABCD3-I score were 0.72 (95% CI, 0.54 to 0.89) at 1 week, 0.66 (95% CI, 0.53 to 0.80) at 3 months, and 0.68 (0.95% CI, 0.56 to 0.79) at 1 year. The corresponding AUCs for the ABCD2 score were 0.55 (95% CI, 0.24 to 0.86), 0.55 (95% CI, 0.42 to 0.68), and 0.63 (95% CI, 0.50 to 0.76). Conclusions The ABCD3-I score had limited value in a short-term prediction of subsequent stroke after TIA and did not reliably discriminate between low- and high-risk patients in a long-term follow-up. The ABCD2 score did not predict subsequent stroke accurately at any time point. Since there is a generally lower stroke risk after TIA during the last years, the benefit of these clinical risk scores and their role in TIA management seems limited. Clinical Trial Registration. This trial is registered with NCT02038725 (retrospectively registered, January 16, 2014).
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Sibon I. Accidente ischemico cerebrale e retinico transitorio. Neurologia 2021. [DOI: 10.1016/s1634-7072(21)44501-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Hastrup S, Johnsen SP, Jensen M, von Weitzel-Mudersbach P, Simonsen CZ, Hjort N, Møller AT, Harbo T, Poulsen MS, Iversen HK, Damgaard D, Andersen G. Specialized Outpatient Clinic vs Stroke Unit for TIA and Minor Stroke: A Cohort Study. Neurology 2021; 96:e1096-e1109. [PMID: 33472916 PMCID: PMC8055342 DOI: 10.1212/wnl.0000000000011453] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 10/21/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To evaluate the effects of an outpatient clinic setup for minor stroke/TIA using subsequent admission of patients at high risk of recurrent stroke. METHODS We performed a cohort study of all patients with suspected minor stroke/TIA seen in an outpatient clinic at Aarhus University Hospital, Denmark, between September 2013 and August 2014. Patients with stroke were compared to historic (same hospital) and contemporary (another comparable hospital) matched, hospitalized controls on nonprioritized outcomes: length of stay, readmissions, care quality (10 process-performance measures), and mortality. Patients with TIA were compared to contemporary matched, hospitalized controls. Following complete diagnostic workup, patients with stroke/TIA were classified into low/high risk of recurrent stroke ≤7 days. RESULTS We analyzed 1,076 consecutive patients, of whom 253 (23.5%) were subsequently admitted to the stroke ward. Stroke/TIA was diagnosed in 215/171 patients, respectively. Fifty-six percent (121/215) of the patients with stroke were subsequently admitted to the stroke ward. Comparison with the historic stroke cohort (n = 191) showed a shorter acute hospital stay for the strokes (median 1 vs 3 days; adjusted length of stay ratio 0.49; 95% confidence interval 0.33-0.71). Thirty-day readmission rate was 3.2% vs 11.6% (adjusted hazard ratio 0.23 [0.09-0.59]), and care quality was higher, with a risk ratio of 1.30 (1.15-1.47). The comparison of stroke and TIAs to contemporary controls showed similar results. Only one patient in the low risk category and not admitted experienced stroke within 7 days (0.6%). CONCLUSIONS An outpatient clinic setup for patients with minor stroke/TIA yields shorter acute hospital stay, lower readmission rates, and better quality than hospitalization in stroke units. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that a neurovascular specialist-driven outpatient clinic for patients with minor stroke/TIA with the ability of subsequent admission is safe and yields shorter acute hospital stay, lower readmission rates, and better quality than hospitalization in stroke units.
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Affiliation(s)
- Sidsel Hastrup
- From the Danish Stroke Centre, Neurology (S.H., P.v.W.-M., C.Z.S., N.H., A.T.M., T.H., M.S.P., D.D., G.A.), Aarhus University Hospital; Department of Clinical Medicine, Health (S.H., C.Z.S., N.H., G.A.), Aarhus University; Danish Center for Clinical Health Services Research, Department of Clinical Medicine (S.P.J., M.J.), Aalborg University; Stroke Centre Rigshospitalet, Department of Neurology (H.K.I.), Rigshospitalet; and Faculty of Health and Medical Sciences (H.K.I.), University of Copenhagen, Denmark.
| | - Soren P Johnsen
- From the Danish Stroke Centre, Neurology (S.H., P.v.W.-M., C.Z.S., N.H., A.T.M., T.H., M.S.P., D.D., G.A.), Aarhus University Hospital; Department of Clinical Medicine, Health (S.H., C.Z.S., N.H., G.A.), Aarhus University; Danish Center for Clinical Health Services Research, Department of Clinical Medicine (S.P.J., M.J.), Aalborg University; Stroke Centre Rigshospitalet, Department of Neurology (H.K.I.), Rigshospitalet; and Faculty of Health and Medical Sciences (H.K.I.), University of Copenhagen, Denmark
| | - Martin Jensen
- From the Danish Stroke Centre, Neurology (S.H., P.v.W.-M., C.Z.S., N.H., A.T.M., T.H., M.S.P., D.D., G.A.), Aarhus University Hospital; Department of Clinical Medicine, Health (S.H., C.Z.S., N.H., G.A.), Aarhus University; Danish Center for Clinical Health Services Research, Department of Clinical Medicine (S.P.J., M.J.), Aalborg University; Stroke Centre Rigshospitalet, Department of Neurology (H.K.I.), Rigshospitalet; and Faculty of Health and Medical Sciences (H.K.I.), University of Copenhagen, Denmark
| | - Paul von Weitzel-Mudersbach
- From the Danish Stroke Centre, Neurology (S.H., P.v.W.-M., C.Z.S., N.H., A.T.M., T.H., M.S.P., D.D., G.A.), Aarhus University Hospital; Department of Clinical Medicine, Health (S.H., C.Z.S., N.H., G.A.), Aarhus University; Danish Center for Clinical Health Services Research, Department of Clinical Medicine (S.P.J., M.J.), Aalborg University; Stroke Centre Rigshospitalet, Department of Neurology (H.K.I.), Rigshospitalet; and Faculty of Health and Medical Sciences (H.K.I.), University of Copenhagen, Denmark
| | - Claus Z Simonsen
- From the Danish Stroke Centre, Neurology (S.H., P.v.W.-M., C.Z.S., N.H., A.T.M., T.H., M.S.P., D.D., G.A.), Aarhus University Hospital; Department of Clinical Medicine, Health (S.H., C.Z.S., N.H., G.A.), Aarhus University; Danish Center for Clinical Health Services Research, Department of Clinical Medicine (S.P.J., M.J.), Aalborg University; Stroke Centre Rigshospitalet, Department of Neurology (H.K.I.), Rigshospitalet; and Faculty of Health and Medical Sciences (H.K.I.), University of Copenhagen, Denmark
| | - Niels Hjort
- From the Danish Stroke Centre, Neurology (S.H., P.v.W.-M., C.Z.S., N.H., A.T.M., T.H., M.S.P., D.D., G.A.), Aarhus University Hospital; Department of Clinical Medicine, Health (S.H., C.Z.S., N.H., G.A.), Aarhus University; Danish Center for Clinical Health Services Research, Department of Clinical Medicine (S.P.J., M.J.), Aalborg University; Stroke Centre Rigshospitalet, Department of Neurology (H.K.I.), Rigshospitalet; and Faculty of Health and Medical Sciences (H.K.I.), University of Copenhagen, Denmark
| | - Anette T Møller
- From the Danish Stroke Centre, Neurology (S.H., P.v.W.-M., C.Z.S., N.H., A.T.M., T.H., M.S.P., D.D., G.A.), Aarhus University Hospital; Department of Clinical Medicine, Health (S.H., C.Z.S., N.H., G.A.), Aarhus University; Danish Center for Clinical Health Services Research, Department of Clinical Medicine (S.P.J., M.J.), Aalborg University; Stroke Centre Rigshospitalet, Department of Neurology (H.K.I.), Rigshospitalet; and Faculty of Health and Medical Sciences (H.K.I.), University of Copenhagen, Denmark
| | - Thomas Harbo
- From the Danish Stroke Centre, Neurology (S.H., P.v.W.-M., C.Z.S., N.H., A.T.M., T.H., M.S.P., D.D., G.A.), Aarhus University Hospital; Department of Clinical Medicine, Health (S.H., C.Z.S., N.H., G.A.), Aarhus University; Danish Center for Clinical Health Services Research, Department of Clinical Medicine (S.P.J., M.J.), Aalborg University; Stroke Centre Rigshospitalet, Department of Neurology (H.K.I.), Rigshospitalet; and Faculty of Health and Medical Sciences (H.K.I.), University of Copenhagen, Denmark
| | - Marika S Poulsen
- From the Danish Stroke Centre, Neurology (S.H., P.v.W.-M., C.Z.S., N.H., A.T.M., T.H., M.S.P., D.D., G.A.), Aarhus University Hospital; Department of Clinical Medicine, Health (S.H., C.Z.S., N.H., G.A.), Aarhus University; Danish Center for Clinical Health Services Research, Department of Clinical Medicine (S.P.J., M.J.), Aalborg University; Stroke Centre Rigshospitalet, Department of Neurology (H.K.I.), Rigshospitalet; and Faculty of Health and Medical Sciences (H.K.I.), University of Copenhagen, Denmark
| | - Helle K Iversen
- From the Danish Stroke Centre, Neurology (S.H., P.v.W.-M., C.Z.S., N.H., A.T.M., T.H., M.S.P., D.D., G.A.), Aarhus University Hospital; Department of Clinical Medicine, Health (S.H., C.Z.S., N.H., G.A.), Aarhus University; Danish Center for Clinical Health Services Research, Department of Clinical Medicine (S.P.J., M.J.), Aalborg University; Stroke Centre Rigshospitalet, Department of Neurology (H.K.I.), Rigshospitalet; and Faculty of Health and Medical Sciences (H.K.I.), University of Copenhagen, Denmark
| | - Dorte Damgaard
- From the Danish Stroke Centre, Neurology (S.H., P.v.W.-M., C.Z.S., N.H., A.T.M., T.H., M.S.P., D.D., G.A.), Aarhus University Hospital; Department of Clinical Medicine, Health (S.H., C.Z.S., N.H., G.A.), Aarhus University; Danish Center for Clinical Health Services Research, Department of Clinical Medicine (S.P.J., M.J.), Aalborg University; Stroke Centre Rigshospitalet, Department of Neurology (H.K.I.), Rigshospitalet; and Faculty of Health and Medical Sciences (H.K.I.), University of Copenhagen, Denmark
| | - Grethe Andersen
- From the Danish Stroke Centre, Neurology (S.H., P.v.W.-M., C.Z.S., N.H., A.T.M., T.H., M.S.P., D.D., G.A.), Aarhus University Hospital; Department of Clinical Medicine, Health (S.H., C.Z.S., N.H., G.A.), Aarhus University; Danish Center for Clinical Health Services Research, Department of Clinical Medicine (S.P.J., M.J.), Aalborg University; Stroke Centre Rigshospitalet, Department of Neurology (H.K.I.), Rigshospitalet; and Faculty of Health and Medical Sciences (H.K.I.), University of Copenhagen, Denmark
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Purroy F, Vicente-Pascual M, Arque G, Baraldes-Rovira M, Begue R, Gallego Y, Gil MI, Gil-Villar MP, Mauri G, Quilez A, Sanahuja J, Vazquez-Justes D. Sex-Related Differences in Clinical Features, Neuroimaging, and Long-Term Prognosis After Transient Ischemic Attack. Stroke 2021; 52:424-433. [PMID: 33493055 PMCID: PMC7834662 DOI: 10.1161/strokeaha.120.032814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Differences in sex in the incidence, presentation, and outcome of events after ischemic stroke have been studied in depth. In contrast, only limited data are available after transient ischemic attack (TIA). We aim to assess sex-related differences in the presentation, cause, neuroimaging features, and predictors of long-term prognosis in patients with TIA.
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Affiliation(s)
- Francisco Purroy
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Mikel Vicente-Pascual
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Gloria Arque
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Mariona Baraldes-Rovira
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Robert Begue
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Yhovany Gallego
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - M Isabel Gil
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - M Pilar Gil-Villar
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Gerard Mauri
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Alejandro Quilez
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Jordi Sanahuja
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
| | - Daniel Vazquez-Justes
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Spain (F.P., M.V.-P., M.B.-R., Y.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.). Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Spain (F.P., M.V.-P., G.A., R.B., M.I.G., M.P.G.-V., G.M., A.Q., J.S., D.V.-J.)
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Ban JW, Perera R, Stevens R. GPs' familiarity with and use of cardiovascular clinical prediction rules: a UK survey study. BJGP Open 2020; 4:bjgpopen20X101081. [PMID: 33023870 PMCID: PMC7880194 DOI: 10.3399/bjgpopen20x101081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/19/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinical prediction rules (CPRs) can help general practitioners (GPs) address challenges in cardiovascular disease. A survey published in 2014 evaluated GPs' awareness and use of CPRs in the UK. However, many new CPRs have been published since and it is unknown which cardiovascular CPRs are currently recognised and used. AIM To identify cardiovascular CPRs recognised and used by GPs, and to assess how GPs' familiarity and use have changed over time. DESIGN & SETTING An online survey of GPs in the UK was undertaken. METHOD Using comparable methods to the 2014 survey, GPs were recruited from a network of doctors in the UK. They were asked how familiar they were with cardiovascular CPRs, how frequently they used them, and why they used them. The results were compared with the 2014 survey. RESULTS Most of 401 GPs were familiar with QRISK scores, ABCD scores, CHADS scores, HAS-BLED score, Wells scores for deep vein thrombosis, and Wells scores for pulmonary embolism. The proportions of GPs using these CPRs were 96.3%, 65.1%, 97.3%, 93.0%, 92.5%, and 82.0%, respectively. GPs' use increased by 31.2% for QRISK scores, by 13.5% for ABCD scores, by 54.6% for CHADS scores, by 33.2% for Wells scores for deep vein thrombosis, and by 43.6% for Wells scores for pulmonary embolism; and decreased by 45.9% for the Joint British Societies (JBS) risk calculator, by 38.7% for Framingham risk scores, and by 8.7% for New Zealand tables. GPs most commonly used cardiovascular CPRs to guide therapy and referral. CONCLUSION The study found GPs' familiarity and use of cardiovascular CPRs changed substantially. Integrating CPRs into guidelines and practice software might increase familiarity and use.
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Affiliation(s)
- Jong-Wook Ban
- Evidence-Based Health Care Programme, Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, Medical Science Division, University of Oxford, Oxford, UK
| | - Richard Stevens
- Nuffield Department of Primary Care Health Sciences, Medical Science Division, University of Oxford, Oxford, UK
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Siket MS, Cadena R. Novel Treatments for Transient Ischemic Attack and Acute Ischemic Stroke. Emerg Med Clin North Am 2020; 39:227-242. [PMID: 33218660 DOI: 10.1016/j.emc.2020.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The treatment of acute ischemic stroke is one of the most rapidly evolving areas in medicine. Like all ischemic vascular emergencies, the priority is reperfusion before irreversible infarction. The central nervous system is sensitive to brief periods of hypoperfusion, making stroke a golden hour diagnosis. Although the phrase "time is brain" is relevant today, emerging treatment strategies use more specific markers for consideration of reperfusion than time alone. Innovations in early stroke detection and individualized patient selection for reperfusion therapies have equipped the emergency medicine clinician with more opportunities to help stroke patients and minimize the impact of this disease.
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Affiliation(s)
- Matthew S Siket
- Division of Emergency Medicine, Department of Surgery, Larner College of Medicine at the University of Vermont, 111 Colchester Avenue, EC2-216, Burlington, VT 05401, USA; Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, 111 Colchester Avenue, EC2-216, Burlington, VT 05401, USA.
| | - Rhonda Cadena
- Division of Neurocritical Care, Department of Neurology, University of North Carolina, 170 Manning Drive, CB#7025, Chapel Hill, NC 27517, USA; Department of Neurosurgery, University of North Carolina, 170 Manning Drive, CB#7025, Chapel Hill, NC 27517, USA; Department of Emergency Medicine, University of North Carolina, 170 Manning Drive, CB#7025, Chapel Hill, NC 27517, USA
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Wang G, Jing J, Li J, Pan Y, Yan H, Meng X, Zhao X, Liu L, Li H, Wang DZ, Wang Y, Wang Y. Association of elevated hs-CRP and multiple infarctions with outcomes of minor stroke or TIA: subgroup analysis of CHANCE randomised clinical trial. Stroke Vasc Neurol 2020; 6:80-86. [PMID: 32958697 PMCID: PMC8005909 DOI: 10.1136/svn-2020-000369] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/05/2020] [Accepted: 06/18/2020] [Indexed: 01/15/2023] Open
Abstract
Background and purpose The relationship of high-sensitive C-reactive protein (hs-CRP) levels and infarction numbers with the prognosis of stroke is uncertain. This study evaluated the association of different hs-CRP levels and infarction numbers with the prognosis of acute minor ischaemic stroke or transient ischaemic attack (TIA). Methods A subset of 807 patients with both hs-CRP measurement and baseline MRI was included from the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events trial. The primary efficacy outcome was the occurrence of an ischaemic stroke at the 1-year follow-up. Infarction numbers were classified as multiple acute infarctions (MAIs), single acute infarction and no acute infarction (NAI). The association between different hs-CRP levels with different infarction numbers and the risk of any outcome was analysed using multivariable Cox regression models. Results Among the 807 patients, 84 (10.4%) patients had a recurrent ischaemic stroke within 1 year. After adjustment for conventional confounding factors, patients with both elevated hs-CRP levels and MAIs were associated with approximately 4.7-fold of risk of ischaemic stroke within 1 year (16.7% vs 3.5%, HR 4.68, 95% CI 1.54 to 14.23, p=0.007), compared with those with non-elevated hs-CRP levels and NAI. Similar results were observed for the composite events. Conclusions Combined elevated hs-CRP levels and MAIs may increase 1-year stroke risk stratification efficiency in patients with minor ischaemic stroke or TIA compared with using those markers alone, which indicated that the combination of inflammatory and imaging markers might improve the effectiveness of risk stratification concerning minor ischaemic stroke or TIA. ClinicalTrials.gov Registry (NCT00979589).
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Affiliation(s)
- Guangyao Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jiejie Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hongyi Yan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - David Z Wang
- Neurovascular Division, Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Strambo D, Zachariadis A, Lambrou D, Schwarz G, Sirimarco G, Aarnio K, Putaala J, Ntaios G, Vemmos K, Michel P. A score to predict one-year risk of recurrence after acute ischemic stroke. Int J Stroke 2020; 16:602-612. [PMID: 32878590 DOI: 10.1177/1747493020932787] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND An acute ischemic stroke carries a substantial risk of further recurrences. We aimed at developing and validating a prognostic tool to predict one-year stroke recurrence after acute ischemic stroke. METHODS An integer score was derived by Cox regression analysis on a hospital-referred cohort of 3246 acute ischemic stroke patients from Switzerland, and tested for external validity in three similar independent cohorts from Athens (n = 2495), Milan (n = 1279), and Helsinki (n = 714) by means of calibration and discrimination. RESULTS In the derivation cohort, the recurrence rate was 7% (n = 228/3246). We developed a nine-point score comprising: previous stroke or transient ischemic attack (1-point), stroke mechanism (small vessel disease and unknown mechanism: 0-points; rare stroke mechanism: 3-points; other mechanisms: 1-point), pre-stroke antiplatelets (1-point), active malignancy (2-points), chronic cerebrovascular lesions on imaging (1-point) and absence of early ischemic changes on first imaging (1-point). In the derivation cohort, the one-year risk of re-stroke was 3.0% (95%CI 1.9-4.1) in 932 (29%) patients with a score 0-1, 7.2% (6.1-8.3) in 2038 (63%) with a score 2-4, and 19.2% (14.6-23.9) in 276 (8%) with a score ≥ 5. The score calibrated well in the Athens (recurrences = 208/2495), but not in the Helsinki (recurrences = 15/714) or Milan (recurrences = 65/1279) cohorts. The AUC was 0.67 in the derivation cohort, and 0.56, 0.70, and 0.63 in the Athens, Helsinki, and Milan cohorts, respectively. CONCLUSION We developed a score to predict one-year stroke recurrence risk in patients with acute ischemic stroke. Since the score was not completely validated when applied to external datasets where it displayed poor to fair calibration and discrimination, additional efforts are required to ameliorate our accuracy for predicting stroke recurrence, by better refining this prognostic tool or developing new ones. Clinical and radiological markers of established cerebrovascular disease and stroke etiology were better predictors than the usual demographic vascular risk factors.
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Affiliation(s)
- Davide Strambo
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland.,Stroke Unit, Department of Neurology and Neurophysiology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Dimitris Lambrou
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Ghil Schwarz
- Stroke Unit, Department of Neurology and Neurophysiology, San Raffaele Scientific Institute, Milan, Italy
| | - Gaia Sirimarco
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Karolinaa Aarnio
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - George Ntaios
- Department of Medicine, University of Thessaly, Larissa, Greece
| | | | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
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Foschi M, Pavolucci L, Rondelli F, Spinardi L, Favaretto E, Filippini M, Degli Esposti D, Strocchi E, Faggioli G, Cortelli P, Guarino M. Prospective observational cohort study of early recurrent TIA: Features, frequency, and outcome. Neurology 2020; 95:e1733-e1744. [PMID: 32727840 DOI: 10.1212/wnl.0000000000010317] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 04/06/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To evaluate the frequency, clinical and etiologic features, and short- and long-term outcomes of early recurrent TIA. METHODS This prospective observational cohort study enrolled all consecutive patients with TIA referred to our emergency department and diagnosed by a vascular neurologist. Expedited assessment and best secondary prevention were performed within 24 hours. Primary endpoints were stroke and a composite outcome including stroke, acute coronary syndrome, and vascular death at 3, 12, and, for a subset of patients, 60 months; secondary outcomes were TIA relapse, cerebral hemorrhage, new-onset atrial fibrillation, and death resulting from other causes. Concordance between index TIA and subsequent stroke etiologies was also evaluated. RESULTS A total of 1,035 patients (822 with a single TIA, 213 with recurrent TIA = 21%) were enrolled from August 2010 to December 2017. Capsular warning syndrome and large artery atherosclerosis showed the strongest relationship with early recurrent TIA. The risk of stroke was significantly higher in the early recurrent TIA subgroup at each follow-up, and most stroke episodes occurred within 48 hours of index TIA. TIAs with lesion, dysarthria, and leukoaraiosis were the 3- and 12-month independent predictors of stroke incidence after early recurrent TIA subgroup. Index TIA and subsequent stroke etiologies showed substantial concordance. An ABCD3 score >6 predicted a higher risk of stroke recurrence over the entire follow-up. CONCLUSIONS Our study evaluated long-term outcome after early recurrent TIA. Our observations support the importance of promptly detecting and treating patients with early recurrent TIAs to reduce the high early and long-term risk of poor clinical outcomes.
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Affiliation(s)
- Matteo Foschi
- From the Neurology Unit (M.F., L.P., F.R., M.G.), Neuroradiology Unit (L.S.), Angiology and Blood Coagulation Unit (E.F., M.F.), Internal Medicine Unit (D.D.E., E.S.), and Vascular Surgery Unit (G.F.), S. Orsola-Malpighi University Hospital; and IRCCS Istituto delle Scienze Neurologiche di Bologna (F.R., P.C., M.G.), Italy
| | - Lucia Pavolucci
- From the Neurology Unit (M.F., L.P., F.R., M.G.), Neuroradiology Unit (L.S.), Angiology and Blood Coagulation Unit (E.F., M.F.), Internal Medicine Unit (D.D.E., E.S.), and Vascular Surgery Unit (G.F.), S. Orsola-Malpighi University Hospital; and IRCCS Istituto delle Scienze Neurologiche di Bologna (F.R., P.C., M.G.), Italy
| | - Francesca Rondelli
- From the Neurology Unit (M.F., L.P., F.R., M.G.), Neuroradiology Unit (L.S.), Angiology and Blood Coagulation Unit (E.F., M.F.), Internal Medicine Unit (D.D.E., E.S.), and Vascular Surgery Unit (G.F.), S. Orsola-Malpighi University Hospital; and IRCCS Istituto delle Scienze Neurologiche di Bologna (F.R., P.C., M.G.), Italy
| | - Luca Spinardi
- From the Neurology Unit (M.F., L.P., F.R., M.G.), Neuroradiology Unit (L.S.), Angiology and Blood Coagulation Unit (E.F., M.F.), Internal Medicine Unit (D.D.E., E.S.), and Vascular Surgery Unit (G.F.), S. Orsola-Malpighi University Hospital; and IRCCS Istituto delle Scienze Neurologiche di Bologna (F.R., P.C., M.G.), Italy
| | - Elisabetta Favaretto
- From the Neurology Unit (M.F., L.P., F.R., M.G.), Neuroradiology Unit (L.S.), Angiology and Blood Coagulation Unit (E.F., M.F.), Internal Medicine Unit (D.D.E., E.S.), and Vascular Surgery Unit (G.F.), S. Orsola-Malpighi University Hospital; and IRCCS Istituto delle Scienze Neurologiche di Bologna (F.R., P.C., M.G.), Italy
| | - Massimo Filippini
- From the Neurology Unit (M.F., L.P., F.R., M.G.), Neuroradiology Unit (L.S.), Angiology and Blood Coagulation Unit (E.F., M.F.), Internal Medicine Unit (D.D.E., E.S.), and Vascular Surgery Unit (G.F.), S. Orsola-Malpighi University Hospital; and IRCCS Istituto delle Scienze Neurologiche di Bologna (F.R., P.C., M.G.), Italy
| | - Daniela Degli Esposti
- From the Neurology Unit (M.F., L.P., F.R., M.G.), Neuroradiology Unit (L.S.), Angiology and Blood Coagulation Unit (E.F., M.F.), Internal Medicine Unit (D.D.E., E.S.), and Vascular Surgery Unit (G.F.), S. Orsola-Malpighi University Hospital; and IRCCS Istituto delle Scienze Neurologiche di Bologna (F.R., P.C., M.G.), Italy
| | - Enrico Strocchi
- From the Neurology Unit (M.F., L.P., F.R., M.G.), Neuroradiology Unit (L.S.), Angiology and Blood Coagulation Unit (E.F., M.F.), Internal Medicine Unit (D.D.E., E.S.), and Vascular Surgery Unit (G.F.), S. Orsola-Malpighi University Hospital; and IRCCS Istituto delle Scienze Neurologiche di Bologna (F.R., P.C., M.G.), Italy
| | - Gianluca Faggioli
- From the Neurology Unit (M.F., L.P., F.R., M.G.), Neuroradiology Unit (L.S.), Angiology and Blood Coagulation Unit (E.F., M.F.), Internal Medicine Unit (D.D.E., E.S.), and Vascular Surgery Unit (G.F.), S. Orsola-Malpighi University Hospital; and IRCCS Istituto delle Scienze Neurologiche di Bologna (F.R., P.C., M.G.), Italy
| | - Pietro Cortelli
- From the Neurology Unit (M.F., L.P., F.R., M.G.), Neuroradiology Unit (L.S.), Angiology and Blood Coagulation Unit (E.F., M.F.), Internal Medicine Unit (D.D.E., E.S.), and Vascular Surgery Unit (G.F.), S. Orsola-Malpighi University Hospital; and IRCCS Istituto delle Scienze Neurologiche di Bologna (F.R., P.C., M.G.), Italy
| | - Maria Guarino
- From the Neurology Unit (M.F., L.P., F.R., M.G.), Neuroradiology Unit (L.S.), Angiology and Blood Coagulation Unit (E.F., M.F.), Internal Medicine Unit (D.D.E., E.S.), and Vascular Surgery Unit (G.F.), S. Orsola-Malpighi University Hospital; and IRCCS Istituto delle Scienze Neurologiche di Bologna (F.R., P.C., M.G.), Italy.
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Yaghi S, Henninger N, Scher E, Giles J, Liu A, Nagy M, Kaushal A, Azher I, Mac Grory B, Fakhri H, Espaillat KB, Asad SD, Pasupuleti H, Martin H, Tan J, Veerasamy M, Liberman AL, Esenwa C, Cheng N, Moncrieffe K, Moeini-Naghani I, Siddu M, Trivedi T, Leon Guerrero CR, Khan M, Nouh A, Mistry E, Keyrouz S, Furie K. Early ischaemic and haemorrhagic complications after atrial fibrillation-related ischaemic stroke: analysis of the IAC study. J Neurol Neurosurg Psychiatry 2020; 91:750-755. [PMID: 32404380 PMCID: PMC8179007 DOI: 10.1136/jnnp-2020-323041] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Predictors of long-term ischaemic and haemorrhagic complications in atrial fibrillation (AF) have been studied, but there are limited data on predictors of early ischaemic and haemorrhagic complications after AF-associated ischaemic stroke. We sought to determine these predictors. METHODS The Initiation of Anticoagulation after Cardioembolic stroke study is a multicentre retrospective study across that pooled data from consecutive patients with ischaemic stroke in the setting of AF from stroke registries across eight comprehensive stroke centres in the USA. The coprimary outcomes were recurrent ischaemic event (stroke/TIA/systemic arterial embolism) and delayed symptomatic intracranial haemorrhage (d-sICH) within 90 days. We performed univariate analyses and Cox regression analyses including important predictors on univariate analyses to determine independent predictors of early ischaemic events (stroke/TIA/systemic embolism) and d-sICH. RESULTS Out of 2084 patients, 1520 patients qualified; 104 patients (6.8%) had recurrent ischaemic events and 23 patients (1.5%) had d-sICH within 90 days from the index event. In Cox regression models, factors associated with a trend for recurrent ischaemic events were prior stroke or transient ischemic attack (TIA) (HR 1.42, 95% CI 0.96 to 2.10) and ipsilateral arterial stenosis with 50%-99% narrowing (HR 1.54, 95% CI 0.98 to 2.43). Those associated with sICH were male sex (HR 2.68, 95% CI 1.06 to 6.83), history of hyperlipidaemia (HR 2.91, 95% CI 1.08 to 7.84) and early haemorrhagic transformation (HR 5.35, 95% CI 2.22 to 12.92). CONCLUSION In patients with ischaemic stroke and AF, predictors of d-sICH are different than those of recurrent ischaemic events; therefore, recognising these predictors may help inform early stroke versus d-sICH prevention strategies.
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Affiliation(s)
- Shadi Yaghi
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Erica Scher
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - James Giles
- Department of Neurology, Washington University in Saint Louis, St Louis, Missouri, USA
| | - Angela Liu
- Department of Neurology, Washington University in Saint Louis, St Louis, Missouri, USA
| | - Muhammad Nagy
- Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Ashutosh Kaushal
- Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Idrees Azher
- Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.,Department of Neurology, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Brian Mac Grory
- Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Hiba Fakhri
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Syed Daniyal Asad
- Department of Neurology, Hartford Hospital, Hartford, Connecticut, USA
| | | | - Heather Martin
- Department of Neurology, Spectrum Health, Grand Rapids, Michigan, USA
| | - Jose Tan
- Department of Neurology, Spectrum Health, Grand Rapids, Michigan, USA
| | | | - Ava L Liberman
- Department of Neurology, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Charles Esenwa
- Department of Neurology, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Natalie Cheng
- Department of Neurology, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Khadean Moncrieffe
- Department of Neurology, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Iman Moeini-Naghani
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Mithilesh Siddu
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Tushar Trivedi
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Christopher R Leon Guerrero
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Muhib Khan
- Department of Neurology, Spectrum Health, Grand Rapids, Michigan, USA.,Department of Neurology, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Amre Nouh
- Department of Neurology, Hartford Hospital, Hartford, Connecticut, USA
| | - Eva Mistry
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Salah Keyrouz
- Department of Neurology, Washington University in Saint Louis, St Louis, Missouri, USA
| | - Karen Furie
- Department of Neurology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
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Affiliation(s)
- Pierre Amarenco
- From the Department of Neurology and Stroke Center, Assistance Publique-Hôpitaux de Paris, SOS-TIA Clinic, Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, University of Paris, Paris
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Guo L, Wang L, Liu W. Ability of the number of territories involved on DWI-MRI to predict occult systemic malignancy in cryptogenic stroke patients. J Stroke Cerebrovasc Dis 2020; 29:104823. [PMID: 32362555 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/01/2020] [Accepted: 03/19/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Lesions in multiple arterial territories is one of the typical features of malignancy patients with cryptogenic stroke. Hence, if patients with cryptogenic stroke display such feature, occult cancer could be predicted. The study aimed to analyze the predictive ability of the number of territories involved on DWI-MRI for occult systemic malignancy (OSM) in patients with cryptogenic stroke. METHODS We enrolled patients with cryptogenic stroke without a diagnosis of malignancy at stroke onset between January 2013 and November 2018. Clinical variables were analyzed between cryptogenic stroke patients with and without OSM through univariate and multiple logistic regression analyses. Points for OSM were generated by β-coefficients. The sensitivity and specificity of the risk score were assessed by the area under the receiver operating characteristic curve (AUROC). The cutoff value for predicting OSM was determined by the maximum Youden index. RESULTS Among 108 cyptogenic stroke patients, compared to patients without OSM (n = 96), patients with OSM (n = 12) had a lower nutrition status (P = 0.031), higher plasma D-dimer levels (P < 0.001) and more territories involved on DWI-MRI (P < 0.001). Multiple logistic regression analysis revealed that plasma D-dimer levels (OR, 3.54; 95% Cl, 1.62-7.76; P = 0.002) and the number of territories involved (OR, 4.45; 95% CI, 1.25-15.80; P = 0.021) independently predicted OSM. The predictive score system built upon the number of territories showed good discrimination with an AUROC of 0.84 (95% CI, 0.71-0.96). The cutoff value was 2 with a maximum Youden's index of 0.56, which means that patients with more than one territory involved on DWI-MRI may need extensive screening for OSM. CONCLUSIONS The number of territories involved on DWI-MRI was a valid predictor for OSM in cryptogenic stroke patients who need to undergo further evaluations .
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Affiliation(s)
- Linjia Guo
- Department of Neurology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
| | - Lili Wang
- Department of Neurology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Wenhong Liu
- Department of Neurology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Dahlquist RT, Young JM, Reyner K, Farzad A, Moleno RB, Gandham G, Ho AF, Wang H. Initiation of the ABCD3-I algorithm for expediated evaluation of transient ischemic attack patients in an emergency department. Am J Emerg Med 2020; 38:741-745. [PMID: 31230922 DOI: 10.1016/j.ajem.2019.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/08/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The use of ABCD3-I score for Transient ischemic attack (TIA) evaluation has not been widely investigated in the ED. We aim to determine the performance and cost-effectiveness of an ABCD3-I based pathway for expedited evaluation of TIA patients in the ED. METHODS We conducted a single-center, pre- and post-intervention study among ED patients with possible TIA. Accrual occurred for seven months before (Oct. 2016-April 2017) and after (Oct. 2017-April 2018) implementing the ABCD3-I algorithm with a five-month wash-in period (May-Sept. 2017). Total ED length of stay (LOS), admissions to the hospital, healthcare cost, and 90-day ED returns with subsequent stroke were analyzed and compared. RESULTS Pre-implementation and post-implementation cohorts included 143 and 118 patients respectively. A total of 132 (92%) patients were admitted to the hospital in the pre-implementation cohort in comparison to 28 (24%) patients admitted in the post-implementation cohort (p < 0.001) with similar 90-day post-discharge stroke occurrence (2 in pre-implementation versus 1 in post-implementation groups, p > 0.05). The mean ABCD2 scores were 4.5 (1.4) in pre- and 4.1 (1.3) in post-implementation cohorts (p = 0.01). The mean ABCD3-I scores were 4.5 (1.8) in post-implementation cohorts. Total ED LOS was 310 min (201, 420) in pre- and 275 min (222, 342) in post-implementation cohorts (p > 0.05). Utilization of the ABCD3-I algorithm saved an average of over 40% of total healthcare cost per patient in the post-implementation cohort. CONCLUSIONS The initiation of an ABCD3-I based pathway for TIA evaluation in the ED significantly decreased hospital admissions and cost with similar 90-day neurological outcomes.
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Affiliation(s)
- Robert T Dahlquist
- Department of Emergency Medicine, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX 75246, United States of America
| | - Joseph M Young
- Department of Emergency Medicine, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX 75246, United States of America
| | - Karina Reyner
- Department of Emergency Medicine, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX 75246, United States of America
| | - Ali Farzad
- Department of Emergency Medicine, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX 75246, United States of America
| | - Richard B Moleno
- Department of Emergency Medicine, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX 75246, United States of America
| | - Gautami Gandham
- Texas A&M University, 801 Main St., Dallas, TX 75202, United States of America
| | - Amy F Ho
- Department of Emergency Medicine, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX 75246, United States of America; Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, United States of America
| | - Hao Wang
- Department of Emergency Medicine, Baylor University Medical Center, 3500 Gaston Ave., Dallas, TX 75246, United States of America; Department of Emergency Medicine, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, United States of America.
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Jia Z, Song Y, Hu W. Dysphasia is associated with diffusion-weighted MRI abnormalities in patients with transient neurological symptoms. Neurol Sci 2020; 41:1765-1771. [PMID: 32034558 PMCID: PMC7359169 DOI: 10.1007/s10072-020-04258-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/15/2020] [Indexed: 01/17/2023]
Abstract
Background The clinical characteristics of diffusion-weighted imaging (DWI) abnormalities after transient neurological symptoms are of great significance for the early diagnosis and urgent intervention of transient ischemic attack (TIA). This study was aimed to investigate the clinical characteristics associated with acute DWI lesions in transient neurological symptoms. Methods We retrospectively recruited 302 patients with transient neurological symptoms. According to DWI findings, they were divided into DWI positive and DWI negative group. The clinical characteristics and the TIA-related scores such as ABCD2, ABCD3, ABCD3I, Dawson score, and the Diagnosis of TIA (DOT) score were compared between the two groups. Logistic regression analysis and receiver operating characteristic curves were used to identify the independent factors and compare the predictive value of different TIA scores for acute DWI lesions. Results A total of 302 patients were enrolled in this study. The mean age was 61.8 years, and 67.2% were male. We found 89 (29.5%) patients with DWI positivity. Logistic regression analysis showed the characteristic associated with DWI lesions was dysphasia (OR 2.226, 95% CI 1.220–4.062). The area under the curve for Dawson score and the DOT score was 0.610 (95% CI 0.543–0.678) and 0.625 (95% CI 0.559–0.691), respectively. Conclusion We found that DWI lesions were detected in 29.5% of patients with transient neurological symptoms and were associated with dysphasia. Dawson score and DOT score could have a higher predictability of DWI lesions in patients with transient neurological symptoms.
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Affiliation(s)
- Zejin Jia
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yangguang Song
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
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Zhang C, Zang Y, Song Q, Zhao W, Li H, Hu L, Zhang Q, Gu F, Zhang C. Effects of butylphthalide injection on treatment of transient ischemic attack as shown by diffusion-weighted magnetic resonance imaging abnormality. Int J Neurosci 2020; 130:454-460. [PMID: 31822157 DOI: 10.1080/00207454.2019.1692835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Chenhao Zhang
- Department of Neurology, The Second Hospital of Baoding City, Baoding, Hebei, China
| | - Yanjing Zang
- Department of Geriatric, The Second Hospital of Baoding City, Baoding, Hebei, China
| | - Qin Song
- Second Neurology Department, The Second Hospital of Baoding City, Baoding, Hebei, China
| | - Weidong Zhao
- Second Neurology Department, The Second Hospital of Baoding City, Baoding, Hebei, China
| | - Hongxuan Li
- Department of Neurology, The Second Hospital of Baoding City, Baoding, Hebei, China
| | - Lei Hu
- Department of Neurology, The Second Hospital of Baoding City, Baoding, Hebei, China
| | - Qing Zhang
- Department of Neurology, The Second Hospital of Baoding City, Baoding, Hebei, China
| | - Fang Gu
- Fifth Department of Internal Medicine, Baoding Children’s Hospital, Baoding, Hebei, China
| | - Chunliang Zhang
- Department of Neurology, The Second Hospital of Baoding City, Baoding, Hebei, China
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Chaudhary D, Abedi V, Li J, Schirmer CM, Griessenauer CJ, Zand R. Clinical Risk Score for Predicting Recurrence Following a Cerebral Ischemic Event. Front Neurol 2019; 10:1106. [PMID: 31781015 PMCID: PMC6861423 DOI: 10.3389/fneur.2019.01106] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/02/2019] [Indexed: 12/30/2022] Open
Abstract
Introduction: Recurrent stroke has a higher rate of death and disability. A number of risk scores have been developed to predict short-term and long-term risk of stroke following an initial episode of stroke or transient ischemic attack (TIA) with limited clinical utilities. In this paper, we review different risk score models and discuss their validity and clinical utilities. Methods: The PubMed bibliographic database was searched for original research articles on the various risk scores for risk of stroke following an initial episode of stroke or TIA. The validation of the models was evaluated by examining the internal and external validation process as well as statistical methodology, the study power, as well as the accuracy and metrics such as sensitivity and specificity. Results: Different risk score models have been derived from different study populations. Validation studies for these risk scores have produced conflicting results. Currently, ABCD2 score with diffusion weighted imaging (DWI) and Recurrence Risk Estimator at 90 days (RRE-90) are the two acceptable models for short-term risk prediction whereas Essen Stroke Risk Score (ESRS) and Stroke Prognosis Instrument-II (SPI-II) can be useful for prediction of long-term risk. Conclusion: The clinical risk scores that currently exist for predicting short-term and long-term risk of recurrent cerebral ischemia are limited in their performance and clinical utilities. There is a need for a better predictive tool which can overcome the limitations of current predictive models. Application of machine learning methods in combination with electronic health records may provide platform for development of new-generation predictive tools.
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Affiliation(s)
- Durgesh Chaudhary
- Neuroscience Institute, Geisinger Health System, Danville, PA, United States
| | - Vida Abedi
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA, United States.,Biocomplexity Institute, Virginia Tech, Blacksburg, VA, United States
| | - Jiang Li
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA, United States
| | - Clemens M Schirmer
- Neuroscience Institute, Geisinger Health System, Danville, PA, United States.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Christoph J Griessenauer
- Neuroscience Institute, Geisinger Health System, Danville, PA, United States.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Ramin Zand
- Neuroscience Institute, Geisinger Health System, Danville, PA, United States
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Clinical Usefulness of the Serum Cystatin C Levels in Patients with Transient Ischemic Attack. Neurotox Res 2019; 36:645-652. [DOI: 10.1007/s12640-019-00082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/31/2019] [Accepted: 06/21/2019] [Indexed: 12/09/2022]
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48
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Bang OY, Li W. Applications of diffusion-weighted imaging in diagnosis, evaluation, and treatment of acute ischemic stroke. PRECISION AND FUTURE MEDICINE 2019. [DOI: 10.23838/pfm.2019.00037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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49
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Guan L, Wang Y, Claydon VE, Mazowita G, Wang Y, Brant R, Collet JP. Autonomic Parameter and Stress Profile Predict Secondary Ischemic Events After Transient Ischemic Attack or Minor Stroke. Stroke 2019; 50:2007-2015. [PMID: 31238826 DOI: 10.1161/strokeaha.118.022844] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background and Purpose- Traditional risk factors for ischemic stroke are body stressors that are related to autonomic autonomic system (ANS) dysfunction. The value of ABCD2 score (age, blood pressure, clinical features, duration of symptoms, diabetes) to predict ischemic stroke after transient ischemic attack is compromised by the inclusion of a limited number of stressors. We aimed to assess whether markers of ANS function and stress could predict the occurrence of secondary ischemic events after transient ischemic attack or minor stroke. Methods- This is a prospective cohort study in which 201 patients were recruited within 48 hours after initial transient ischemic attack or minor stroke and followed for 90 days to assess the development of secondary ischemic events. ABCD2 score, heart rate variability (HRV) parameters as markers of ANS function, and psychological stress were assessed. Logistic regression and area under the curve (AUC) were used to assess the models' predictive ability. Results- Morning high frequency (HF) HRV power and changes in HF HRV from morning to afternoon (daytime HF changes) were the most useful HRV predictors for both ischemic events (AUC=0.61 and 0.70) and ischemic stroke (AUC=0.62 and 0.72). Compared with ABCD2 score, 2 HRV-based stress models showed higher predictive ability for ischemic events (AUC=0.82 versus 0.63, 0.76 versus 0.63; P<0.05) and ischemic stroke (AUC=0.87 versus 0.64, 0.82 versus 0.64; P<0.05). Conclusions- Assessing the effects of stress on the ANS may be an innovative way to stratify the risk of ischemic events after transient ischemic attack or minor stroke. New risk stratification by assessing the dynamic features of ANS dysfunction and stress may help identify high-risk sub-populations that may benefit from added management.
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Affiliation(s)
- Ling Guan
- From the Department of Medicine (L.G., J.-P.C.), University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute (L.G., J.-P.C.), University of British Columbia, Vancouver, Canada
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, China (Yongjun Wang, Yilong Wang)
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Canada (V.E.C.)
| | - Garey Mazowita
- Department of Family Practice (G.M.), University of British Columbia, Vancouver, Canada.,Department of Family and Community Medicine, Providence Healthcare, Canada (G.M.)
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, China (Yongjun Wang, Yilong Wang)
| | - Rollin Brant
- Department of Statistics (R.B.), University of British Columbia, Vancouver, Canada
| | - Jean-Paul Collet
- From the Department of Medicine (L.G., J.-P.C.), University of British Columbia, Vancouver, Canada.,BC Children's Hospital Research Institute (L.G., J.-P.C.), University of British Columbia, Vancouver, Canada.,Advanced Innovation Center for Human Brain Protection, Beijing Tiantan Hospital, Capital Medical University, China (J.-P.C.)
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Xi HY, Si ZH, Li JC, Zhu JG, Yan HY. Assessment of cerebral infarction after transient cerebral ischemic attack by ABCD2 score combined with the position of intracranial vascular stenosis. Medicine (Baltimore) 2019; 98:e15081. [PMID: 30985660 PMCID: PMC6485873 DOI: 10.1097/md.0000000000015081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aims to investigate the value of the ABCD score combined with the position of the offending vessel stenosis in predicting the risk of transient ischemic attack (TIA) to develop into cerebral infarction.The ABCD score and head magnetic resonance imaging + magnetic resonance angiography (MRA) results of 192 patients with TIA were retrospectively analyzed. With the 7th day as the endpoint time, these patients were divided into 3 groups, according to ABCD scores: low-risk group (n = 105), moderate-risk group (n = 60), and high-risk group (n = 27). Blood vessels were screened using head MRA results, and patients were accordingly divided into 2 groups: proximal vascular stenosis group (n = 71) and nonproximal vascular stenosis group (n = 171). Then, the association of the position of the intracranial vascular stenosis and ABCD score with short-term prognosis was analyzed.Based on the ABCD score, the incidence of cerebral infarction after 1 week was significantly higher in the high-risk group (85.7%) than in the moderate-risk group (16.7%) and low-risk group (1.9%), and the differences were statistically significant (P < .05). When the ABCD score was ≥4 points, the incidence of cerebral infarction after 1 week was significantly higher in the proximal vascular stenosis group (59.1%) than in the nonproximal vascular stenosis group (30.8%), and the difference was statistically significant (P < .05). When the ABCD score was <4 points, the incidence of cerebral infarction after 1 week in the proximal stenosis group (2%) was not significantly different from that in the nonproximal stenosis group (1.9%, P > .05).The ABCD score combined with proximal offending vessel stenosis can improve the short-term prediction of cerebral infarction in patients with TIA.
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