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Adebayo O, Akpa O, Asowata OJ, Fakunle A, Sarfo FS, Akpalu A, Wahab K, Obiako R, Komolafe M, Owolabi L, Osaigbovo GO, Okekunle AP, Sunmonu T, Tiwari HK, Jenkins C, Arulogun O, Appiah L, Akinyemi J, Adeoye AM, Ogbole G, Yaria J, Arnett D, Adebayo P, Calys-Tagoe B, Ogah OS, Balogun O, Ogunjimi L, Mensah Y, Agbogu-Ike OU, Akinyemi R, Ovbiagele B, Owolabi MO. Determinants of First-Ever Stroke Severity in West Africans: Evidence From the SIREN Study. J Am Heart Assoc 2023:e027888. [PMID: 37301737 DOI: 10.1161/jaha.122.027888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/12/2023] [Indexed: 06/12/2023]
Abstract
Background Baseline stroke severity is probably partly responsible for poor stroke outcomes in sub-Saharan Africa. However, there is a paucity of information on determinants of stroke severity among indigenous Africans. We sought to identify the factors associated with stroke severity among West Africans in the SIREN (Stroke Investigative Research and Educational Networks) study. Methods and Results Stroke was diagnosed clinically and confirmed with brain neuroimaging. Severe stroke was defined as a Stroke Levity Scale score of ≤5. A multivariate logistic regression model was constructed to identify factors associated with stroke severity at 95% CI and a nominal cutoff of 5% type 1 error. A total of 3660 stroke cases were included. Overall, 50.7%% had severe stroke, including 47.6% of all ischemic strokes and 56.1% of intracerebral hemorrhage. Factors independently associated with severe stroke were meat consumption (adjusted odds ratio [aOR], 1.97 [95% CI, 1.43-2.73]), low vegetable consumption (aOR, 2.45 [95% CI, 1.93-3.12]), and lesion volume, with an aOR of 1.67 (95% CI, 1.03-2.72) for lesion volume of 10 to 30 cm3 and aOR of 3.88 (95% CI, 1.93-7.81) for lesion volume >30 cm3. Severe ischemic stroke was independently associated with total anterior circulation infarction (aOR, 3.1 [95% CI, 1.5-6.9]), posterior circulation infarction (aOR, 2.2 [95% CI, 1.1-4.2]), and partial anterior circulation infarction (aOR, 2.0 [95% CI, 1.2-3.3]) compared with lacunar stroke. Increasing age (aOR, 2.6 [95% CI, 1.3-5.2]) and lesion volume >30 cm3 (aOR, 6.2 [95% CI, 2.0-19.3]) were independently associated with severe intracerebral hemorrhage. Conclusions Severe stroke is common among indigenous West Africans, where modifiable dietary factors are independently associated with it. These factors could be targeted to reduce the burden of severe stroke.
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Affiliation(s)
| | - Onoja Akpa
- Department of Epidemiology and Medical Statistics University of Ibadan Ibadan Nigeria
- Institute of Cardiovascular Diseases University of Ibadan Ibadan Nigeria
| | - Osahon J Asowata
- Department of Epidemiology and Medical Statistics University of Ibadan Ibadan Nigeria
| | - Adekunle Fakunle
- Department of Public Health Osun State University Osogbo Nigeria
| | - Fred S Sarfo
- Department of Medicine Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Albert Akpalu
- Department of Medicine University of Ghana Medical School Accra Ghana
| | - Kolawole Wahab
- Department of Medicine University of Ilorin Teaching Hospital Ilorin Nigeria
| | - Reginald Obiako
- Department of Medicine Ahmadu Bello University Zaria Nigeria
| | - Morenikeji Komolafe
- Department of Medicine Obafemi Awolowo University Teaching Hospital Ile-Ife Nigeria
| | - Lukman Owolabi
- Department of Medicine Aminu Kano Teaching Hospital Kano Nigeria
| | | | | | - Taofiki Sunmonu
- Department of Medicine Federal Medical Centre Ondo State Owo Nigeria
| | | | | | | | - Lambert Appiah
- Department of Medicine Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics University of Ibadan Ibadan Nigeria
| | - Abiodun M Adeoye
- Department of Medicine University College Hospital Ibadan Nigeria
| | - Godwin Ogbole
- Department of Radiology University of Ibadan Ibadan Nigeria
| | - Joseph Yaria
- Department of Medicine University College Hospital Ibadan Nigeria
| | - Donna Arnett
- College of Public Health University of Kentucky KY Lexington USA
| | - Philip Adebayo
- Ladoke Akintola University of Technology (LAUTECH) and LAUTECH Teaching Hospital Oyo State Ogbomoso Nigeria
- Aga-Khan University Dar es Salaam Tanzania
| | | | - Okechukwu S Ogah
- Department of Medicine University College Hospital Ibadan Nigeria
| | - Olayemi Balogun
- Department of Medicine Ahmadu Bello University Zaria Nigeria
| | - Luqman Ogunjimi
- Department of Pharmacology and Therapeutics Olabisi Onabanjo University Abeokuta Nigeria
| | - Yaw Mensah
- Department of Medicine Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | | | - Rufus Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine University of Ibadan Ibadan Nigeria
- Center for Genomic and Precision Medicine, College of Medicine University of Ibadan Ibadan Nigeria
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine University of California San Francisco CA USA
| | - Mayowa O Owolabi
- Department of Medicine University College Hospital Ibadan Nigeria
- Center for Genomic and Precision Medicine, College of Medicine University of Ibadan Ibadan Nigeria
- Lebanese American University Beirut Lebanon
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Barthelemy JC, Pichot V, Hupin D, Berger M, Celle S, Mouhli L, Bäck M, Lacour JR, Roche F. Targeting autonomic nervous system as a biomarker of well-ageing in the prevention of stroke. Front Aging Neurosci 2022; 14:969352. [PMID: 36185479 PMCID: PMC9521604 DOI: 10.3389/fnagi.2022.969352] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Stroke prediction is a key health issue for preventive medicine. Atrial fibrillation (AF) detection is well established and the importance of obstructive sleep apneas (OSA) has emerged in recent years. Although autonomic nervous system (ANS) appears strongly implicated in stroke occurrence, this factor is more rarely considered. However, the consequences of decreased parasympathetic activity explored in large cohort studies through measurement of ANS activity indicate that an ability to improve its activity level and equilibrium may prevent stroke. In support of these observations, a compensatory neurostimulation has already proved beneficial on endothelium function. The available data on stroke predictions from ANS is based on many long-term stroke cohorts. These data underline the need of repeated ANS evaluation for the general population, in a medical environment, and remotely by emerging telemedicine digital tools. This would help uncovering the reasons behind the ANS imbalance that would need to be medically adjusted to decrease the risk of stroke. This ANS unbalance help to draw attention on clinical or non-clinical evidence, disclosing the vascular risk, as ANS activity integrates the cumulated risk from many factors of which most are modifiable, such as metabolic inadaptation in diabetes and obesity, sleep ventilatory disorders, hypertension, inflammation, and lack of physical activity. Treating these factors may determine ANS recovery through the appropriate management of these conditions. Natural aging also decreases ANS activity. ANS recovery will decrease global circulating inflammation, which will reinforce endothelial function and thus protect the vessels and the associated organs. ANS is the whistle-blower of vascular risk and the actor of vascular health. Such as, ANS should be regularly checked to help draw attention on vascular risk and help follow the improvements in response to our interventions. While today prediction of stroke relies on classical cardiovascular risk factors, adding autonomic biomarkers as HRV parameters may significantly increase the prediction of stroke.
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Affiliation(s)
- Jean-Claude Barthelemy
- Physical Exercise and Clinical Physiology Department, CHU Nord, Saint-Étienne, France
- INSERM U1059 Santé Ingénierie Biologie, Université Jean Monnet, Saint-Étienne, France
- *Correspondence: Jean-Claude Barthelemy,
| | - Vincent Pichot
- Physical Exercise and Clinical Physiology Department, CHU Nord, Saint-Étienne, France
- INSERM U1059 Santé Ingénierie Biologie, Université Jean Monnet, Saint-Étienne, France
| | - David Hupin
- Physical Exercise and Clinical Physiology Department, CHU Nord, Saint-Étienne, France
- INSERM U1059 Santé Ingénierie Biologie, Université Jean Monnet, Saint-Étienne, France
- Section of Translational Cardiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mathieu Berger
- Physical Exercise and Clinical Physiology Department, CHU Nord, Saint-Étienne, France
- INSERM U1059 Santé Ingénierie Biologie, Université Jean Monnet, Saint-Étienne, France
- Centre d’Investigation et de Recherche sur le Sommeil, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Sébastien Celle
- Physical Exercise and Clinical Physiology Department, CHU Nord, Saint-Étienne, France
- INSERM U1059 Santé Ingénierie Biologie, Université Jean Monnet, Saint-Étienne, France
| | - Lytissia Mouhli
- Physical Exercise and Clinical Physiology Department, CHU Nord, Saint-Étienne, France
- Département de Neurologie, Hôpital Universitaire Nord, Saint-Étienne, France
| | - Magnus Bäck
- Section of Translational Cardiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jean-René Lacour
- Laboratoire de Physiologie, Faculté de Médecine Lyon-Sud, Oullins, France
| | - Frederic Roche
- Physical Exercise and Clinical Physiology Department, CHU Nord, Saint-Étienne, France
- INSERM U1059 Santé Ingénierie Biologie, Université Jean Monnet, Saint-Étienne, France
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3
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Yang Z, Li Z, He X, Yao Z, Xie X, Zhang S, Shen Y, Li S, Qiao S, Hui Z, Gao C, Chen J. The impact of heart rate circadian rhythm on in-hospital mortality in stroke and critically ill patients: insights from the eICU Collaborative Research Database. Heart Rhythm 2022; 19:1325-1333. [PMID: 35367661 DOI: 10.1016/j.hrthm.2022.03.1230] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/17/2022] [Accepted: 03/25/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Data showing the impact of dysregulated heart rate circadian rhythm in stroke and critically ill patients are scarce. OBJECTIVE The purpose of this study was to investigate whether the circadian rhythm of heart rate was an independent risk factor for in-hospital mortality in stroke and critically ill patients. METHODS Study patients from the recorded eICU Database were included in the current analyses. Three variables, Mesor, Amplitude, and Peak time were used to evaluate the heart rate circadian rhythm. The incremental value of circadian rhythm variables in addition to Acute Physiology and Chronic Health Evaluation (APACHE) IV score to predict in-hospital mortality was also explored. RESULTS A total of 6,201 Patients whose heart rate have cosinor rhythmicity. After adjustments, Mesor per 10 beats per min (bpm) increase was associated with a 1.18-fold (95%CI: 1.12, 1.25, P<0.001) and Amplitude per 5 bpm was associated with a 1.17-fold (95%CI: 1.07, 1.27, P<0.001) increase in the risk of in-hospital mortality, respectively. The risk of in-hospital mortality was highest in patients who had Peak time reached between 12:00-18:00 (OR: 1.35, 95%CI: 1.06, 1.72, P=0.015). Compared with APACHE IV score only (c-index=0.757), combining APACHE IV score and circadian rhythm variables of heart rate (c-index=0.766) was associated with increased discriminative ability (P=0.003). CONCLUSION Circadian rhythm of heart rate is an independent risk factor of the in-hospital mortality in stroke and critically ill patients. Including circadian rhythm variables regarding heart rate might increase the discriminative ability of the risk score to predict the prognosis of patients.
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Affiliation(s)
- Zhengning Yang
- Shaanxi University of Chinese Medicine, 712000, Xian yang, China
| | - Zhe Li
- Department of First Clinical Medicine, Affiliated Hospital of Shaanxi University of Chinese Medicine, 712000, Xian Yang, China
| | - Xu He
- Shaanxi University of Chinese Medicine, 712000, Xian yang, China
| | - Zhen Yao
- Shaanxi University of Chinese Medicine, 712000, Xian yang, China
| | - Xiaoxia Xie
- Shaanxi University of Chinese Medicine, 712000, Xian yang, China
| | - Sha Zhang
- Department of Basic Medicine, Shaanxi University of Chinese Medicine, 712000, Xian Yang, China
| | - Yan Shen
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi Huamen, Xi'an 710000, Shaanxi, China
| | - Shaowei Li
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi Huamen, Xi'an 710000, Shaanxi, China
| | - Shuzhen Qiao
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi Huamen, Xi'an 710000, Shaanxi, China
| | - Zhenliang Hui
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi Huamen, Xi'an 710000, Shaanxi, China
| | - Chao Gao
- Department of Cardiology, Xijing hospital, Xi'an, China; Department of Cardiology, Radboud University, Nijmegen, The Netherlands.
| | - Jun Chen
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi Huamen, Xi'an 710000, Shaanxi, China.
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Yao MX, Qiu DH, Zheng WC, Zhao JH, Yin HP, Liu YL, Chen YK. Effects of Early-Stage Blood Pressure Variability on the Functional Outcome in Acute Ischemic Stroke Patients With Symptomatic Intracranial Artery Stenosis or Occlusion Receiving Intravenous Thrombolysis. Front Neurol 2022; 13:823494. [PMID: 35345407 PMCID: PMC8957087 DOI: 10.3389/fneur.2022.823494] [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: 11/27/2021] [Accepted: 02/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background Studies exploring the relationship between blood pressure (BP) fluctuations and outcome in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) are limited. We aimed to investigate the influence of blood pressure variability (BPV) during the first 24 h after IVT on early neurological deterioration (END) and 3-month outcome after IVT in terms of different stroke subtypes. Methods Clinical data from consecutive AIS patients who received IVT were retrospectively analyzed. The hourly systolic BP of all patients were recorded during the first 24 h following IVT. We calculated three systolic BPV parameters, including coefficient of variability (CV), standard deviation of mean BP (SD) and successive variation (SV), within the first 6, 12, and 24 h after IVT. END was defined as neurological deterioration with an increase in the National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 points within the first 72 h after admission. Follow-up was performed at 90 days after onset, and favorable and poor outcomes were defined as a modified Rankin Scale scores (mRS) of ≤1 or ≥2, respectively. Results A total of 339 patients, which were divided into those with (intracranial artery stenosis or occlusion group, SIASO group) and without (non-SIASO group) SIASO, were included. Among them, 110 patients (32.4%) were with SIASO. Patients in SIASO group had higher NIHSS on admission and difference in term of mRS at 90 days compared with non-SIASO group (P < 0.001). In SIASO group, patients in favorable outcome group were younger and had lower NIHSS on admission, lower SV-24 h (14.5 ± 4.3 vs. 11.8 ± 3.2, respectively) and lower SD-24 h (12.7 ± 3.8 vs. 10.9 ± 3.3, respectively), compared with patients with poor outcome (all P < 0.05). In the multivariable logistic regression analysis, compared with the lowest SV (SV < 25% quartile), SV50−75% [odds ratio (OR) = 4.449, 95% confidence interval (CI) = 1.231–16.075, P = 0.023] and SV>75% (OR = 8.676, 95% CI = 1.892–39.775, P = 0.005) were significantly associated with poor outcome at 3 months in patients with SIASO, adjusted for age, NIHSS on admission and atrial fibrillation. No BPV parameters were associated with END in SIASO group. In non-SIASO group, there were no significant association between BPV patterns and END or 90-day outcome. Conclusions SV-24 h had a negative relationship with 3-month outcome in AIS patients with SIASO treated with IVT, indicating that BPV may affect the outcome of AIS.
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Gatzoulis K, Mavromoustakou K, Doundoulakis I, Soulaidopoulos S, Arsenos P, Laina A, Sideris S, Dilaveris P, Tsiachris D, Kordalis A, Tsioufis K. Impact of atrial fibrillation on the severity, progress, and disability of the ischemic stroke patients. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_27_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Secondary Prevention of Cardioembolic Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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7
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Del Brutto VJ, Rundek T, Sacco RL. Prognosis After Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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Mosarrezaii A, Amiri-Nikpour MR, Dindarian S, Rahimzadeh S, Mohammadi S, Mohammadi H. Causes of mortality in patients after first-ever stroke: A retrospective population-based study. Brain Behav 2021; 11:e2294. [PMID: 34473426 PMCID: PMC8553320 DOI: 10.1002/brb3.2294] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Stroke is the third most common cause of death in developed countries and it is the most common cause of disability in the adult population of Iran. In this study, we aimed to evaluate the effects of age, sex, and other predisposing risk factors on mortality after stroke. METHODS We studied 1572 patients with first-ever stroke during a 7-year period from January 2008 to December 2014. Patients' medical records including demographic information, past medical history, physical examination, and laboratory testing were reviewed. We analyzed the correlation of qualitative and quantitative variables with sex and mortality. RESULTS Of all patients, 252 (16%) died during the hospital stay and of the remaining 1320 patients, 453 (34.3%) died during the follow-up period. There was no significant correlation between mortality and sex (p = .508). Descriptively, the number of women was higher in all age groups except in the age group 55-64 years. No significant correlation was observed between sex and age group (p = .748). We also observed a significant association between age group and mortality (p < .001). Hypertension is the most prevalent disease in both men and women. Higher levels of creatinine, urea, fasting blood sugar, neutrophils, cholesterol, and LDL significantly increase and higher levels of lymphocytes, platelets, RBCs, hemoglobin, and triglyceride significantly decrease the mortality. CONCLUSION There are no sex differences in mortality after first-ever stroke. Elderly patients need more support and attention due to greater stroke mortality. Complete blood count, lipid profile and blood levels of urea, creatinine, and fasting blood sugar may be useful in predicting mortality after first-ever stroke.
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Affiliation(s)
- Arash Mosarrezaii
- Department of Neurology, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Sina Dindarian
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Sedra Mohammadi
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Hozan Mohammadi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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9
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Stroke Awareness of Physicians Working in a Tertiary Healthcare Institution. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.970412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Ponciano V, Pires IM, Ribeiro FR, Garcia NM. Data acquisition of timed-up and go test with older adults: accelerometer, magnetometer, electrocardiography and electroencephalography sensors' data. Data Brief 2020; 32:106306. [PMID: 32984486 PMCID: PMC7498745 DOI: 10.1016/j.dib.2020.106306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022] Open
Abstract
We present a dataset related to the acquisition of different sensors data during the performance of the Timed-Up and Go test with the mobile device positioned in a waistband for the acquisition of accelerometer and magnetometer data, and a BITalino device positioned in a chest band for the acquisition of Electrocardiography and Electroencephalography for further processing. The data acquired from the BITalino device is acquired simultaneously by a Bluetooth connection with the same mobile application. The data was acquired in five institutions, including Centro Comunitário das Lameiras, Lar Nossa Senhora de Fátima, Centro Comunitário das Minas da Panasqueira, Lar da Misericórdia da Santa Casa da Misericórdia do Fundão, and Lar da Aldeia de Joanes da Santa Casa da Misericórdia do Fundão from Fundão and Covilhã municipalities (Portugal). This article describes the data acquired from a several subjects from the different institutions for the acquisition of accelerometer and magnetometer data, where each person performed the Timed-Up and Go test three times, where each output from the sensors was acquired with a sampling rate of 100 Hz. Related to the data acquired by the sensors connected to the BITalino device, 31 persons performed the different experiments related to the Timed-Up and Go Test. Following the data acquired from Electroencephalography and Electrocardiography sensors, only the data acquired from 14 individuals was considered valid. The data acquired by a BITalino device has a sampling rate of 100 Hz. These data can be reused for testing machine learning methods for the evaluation of the performance of the Timed-Up and Go test with older adults.
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Affiliation(s)
- Vasco Ponciano
- R&D Unit in Digital Services, Applications and Content, Polytechnic Institute of Castelo Branco, 6000-767 Castelo Branco, Portugal.,Altranportugal, 1990-096 Lisbon, Portugal
| | - Ivan Miguel Pires
- Instituto de Telecomunicações, Universidade da Beira Interior, 6200-001 Covilhã, Portugal.,Department of Computer Science, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
| | - Fernando Reinaldo Ribeiro
- R&D Unit in Digital Services, Applications and Content, Polytechnic Institute of Castelo Branco, 6000-767 Castelo Branco, Portugal
| | - Nuno M Garcia
- Instituto de Telecomunicações, Universidade da Beira Interior, 6200-001 Covilhã, Portugal
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Yang HJ, Wang GJ, Shuai W, Shen CJ, Kong B, Huang H. The Value of the CHADS2 and CHA2DS2-VASc Score for Predicting the Prognosis in Lacunar Stroke with or without Atrial Fibrillation Patients. J Stroke Cerebrovasc Dis 2019; 28:104143. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.03.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/24/2019] [Accepted: 03/10/2019] [Indexed: 01/07/2023] Open
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12
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Predicting the Risk of Stroke in Chinese Internal Carotid Artery Stenosis Patients Underwent Carotid Artery Stenting: Validation and Improvement of Siena Carotid Artery Stenting Risk Score. J Stroke Cerebrovasc Dis 2019; 28:104369. [PMID: 31548086 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/18/2019] [Accepted: 08/25/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Siena carotid artery stenting (CAS) risk score is developed based on Chinese internal carotid artery (ICA) stenosis patients recruited in Italy, whether it is equally applicable in Chinese remains unknown. We aimed to investigate Siena CAS risk score value for predicting stroke risk in ICA stenosis patients underwent CAS and explore additional factors for improving accuracy of scoring system. METHODS Totally 401 patients with ICA stenosis who underwent CAS were enrolled. The clinical data (including patient characteristics, lesion features, and procedure-related features) were collected and the Siena CAS score was calculated. Stroke incidence with 30 days was documented. RESULTS The incidence of stroke was 4.5%, and the Siena CAS score in stroke patients was higher compared with nonstroke patients, further receiver operating characteristic (ROC) curve illustrated that Siena CAS score was acceptable at predicting stroke risk with area under curve (AUC) of .743 (95%CI: .638-.848). Multivariate logistic regression model revealed that Siena CAS score and current fasting-blood glucose (FBG) greater than 7.1 mmol/l independently predicted higher stroke risk; followed ROC curve disclosed that Siena CAS score combined with current FBG greater than 7.1 mmol/l was of good value in predicting stroke risk (AUC: .770 (95%CI: .677-.863)), which was numerically increased compared with Siena CAS score alone. CONCLUSIONS Siena CAS risk scoring system exhibits to be a useful tool to predict stroke risk, and the combination of Siena CAS score and current increased FBG might be a more accurate stratification for stroke risk in Chinese ICA stenosis patients after CAS.
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Inohara T, Liang L, Kosinski AS, Smith EE, Schwamm LH, Hernandez AF, Bhatt DL, Fonarow GC, Peterson ED, Xian Y. Recent Myocardial Infarction is Associated With Increased Risk in Older Adults With Acute Ischemic Stroke Receiving Thrombolytic Therapy. J Am Heart Assoc 2019; 8:e012450. [PMID: 31327296 PMCID: PMC6761665 DOI: 10.1161/jaha.119.012450] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Intravenous recombinant tissue‐type plasminogen activator (rtPA) remains the only medical therapy to improve outcomes for acute ischemic stroke (AIS), but the safety of rtPA in AIS patients with a history of recent myocardial infarction (MI) remains controversial. Methods and Results We sought to determine whether the presence of recent MI would alter the risk of mortality and rtPA‐related complications. Multivariate logistic regression models were used to compare in‐hospital outcomes between rtPA‐treated AIS patients with recent MI within 3 months and those with no history of MI from the Get With The Guidelines‐Stroke hospitals between February 2009 and December 2015. Among 40 396 AIS patients aged ≥65 years treated with rtPA, 241 (0.6%) had recent MI, of which 19.5% were ST‐segment–elevation myocardial infarction. Patients with recent MI had more severe stroke than those without (median National Institutes of Health Stroke Scale [interquartile range]: 13.0 [7.0–20.0] versus 11.0 [6.0–18.0]). Recent MI was associated with an increased risk of mortality compared with no history of MI (17.4% versus 9.0%; adjusted odds ratio 1.60 [95% CI, 1.10–2.33]; P=0.014), but no statistically significant differences in rtPA‐related complications (13.5% versus 9.4%; adjusted odds ratio 1.28 [0.88–1.86]; P=0.19). Recent ST‐segment–elevation myocardial infarction was associated with higher risk of death and rtPA‐related complications, but non–ST‐segment–elevation myocardial infarction was not. Conclusions Among older AIS patients treated with rtPA, recent MI was associated with an increased risk of in‐hospital mortality. Further investigations are necessary to determine whether the benefit of rtPA outweighs its risk among AIS patients with recent MI.
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Affiliation(s)
- Taku Inohara
- Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - Li Liang
- Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - Andrzej S Kosinski
- Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - Eric E Smith
- Department of Clinical Neurosciences Hotchkiss Brian Institute University of Calgary Canada
| | - Lee H Schwamm
- Department of Neurology Massachusetts General Hospital Boston MA
| | - Adrian F Hernandez
- Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School Boston MA
| | - Gregg C Fonarow
- Division of Cardiology Ronald Reagan University of California Los Angeles Medical Center Los Angeles CA
| | - Eric D Peterson
- Duke Clinical Research Institute Duke University Medical Center Durham NC
| | - Ying Xian
- Duke Clinical Research Institute Duke University Medical Center Durham NC.,Department of Neurology Duke University Medical Center Durham NC
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14
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Singh RJ, Chen S, Ganesh A, Hill MD. Long-term neurological, vascular, and mortality outcomes after stroke. Int J Stroke 2018; 13:787-796. [DOI: 10.1177/1747493018798526] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Despite improved survival and short-term (90-day) outcomes of ischemic stroke patients, only sparse data exist describing the sustained benefits of acute stroke care interventions and long-term prognosis of stroke survivors. Aim We review the contemporary literature assessing long-term (5 years or more) outcomes after stroke and acute stroke treatment. Summary of review Acute stroke unit care and intravenous thrombolysis have sustained benefits over longer follow-up, but few data exist on the long-term outcome after endovascular thrombectomy (EVT). A large proportion of stroke survivors face challenges of residual disability and neuropsychiatric sequelae (especially affective disorders and epilepsy) which affects their quality of life and is associated with poorer prognosis due to increase in stroke recurrences/mortality. Nearly, a quarter of stroke survivors have a recurrent stroke at 5 years, and nearly double that at 10 years. Mortality after recurrent stroke is high, and half of the stroke survivors are deceased at 5 years after stroke and three fourth at 10 years. Long-term all-cause mortality is largely due to conditions other than stroke. Both stroke recurrence and long-term mortality are affected by several modifiable risk factors, and thus amenable to secondary prevention strategies. Conclusions There is a need for studies reporting longer term effects of acute interventions, especially EVT. Better preventive strategies are warranted to reduce the vascular and non-vascular mortality long after stroke.
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Affiliation(s)
- Ravinder-Jeet Singh
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Shuo Chen
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
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15
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Alkhouli M, Alqahtani F, Aljohani S, Alvi M, Holmes DR. Burden of Atrial Fibrillation-Associated Ischemic Stroke in the United States. JACC Clin Electrophysiol 2018; 4:618-625. [PMID: 29798789 DOI: 10.1016/j.jacep.2018.02.021] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/22/2018] [Accepted: 02/22/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This study aimed to investigate whether the excess morbidity and mortality of atrial fibrillation (AF)-related stroke persists in the contemporary era. BACKGROUND Acute ischemic stroke (AIS) in patients with AF is associated with worse outcomes than in patients without AF. Stroke prevention strategies in patients with AF have improved over the last decade and AIS-related mortality overall has also declined. METHODS Patients ≥18 years of age who were admitted with AIS between 2003 and 2014 were identified in the National Inpatient Sample. The study compared crude and propensity score-matched in-hospital morbidity and mortality, cost, length of stay, and discharge dispositions between patients with and without AF. RESULTS A total of 930,010 patients were admitted with AIS, and 18.2% of these patients had AF. The prevalence of AF in these patients increased from 16.4% in 2003 to 20.4% in 2014, with the greatest increase observed in white and older patients. Propensity score matching attained 2 pairs of 125,203 patients with AIS with and without AF. In these matched cohorts, the mortality rate was higher in patients with AF (9.9% vs. 6.1%; p < 0.001). Ischemic stroke in patients with AF was also associated with higher incidences of acute kidney injury, bleeding and infectious complications, and severe disability. Hospital length of stay was significantly longer, and cost of care was 20% higher in patients with AF. CONCLUSIONS The prevalence of AF in AIS patients continued to rise, particularly in white and older patients. Despite the improvement in AIS-related morality overall, the differential negative impact of AF on the morbidity, mortality, and cost of AIS was steady over the study's 12-year period.
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Affiliation(s)
- Mohamad Alkhouli
- Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia; Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota.
| | - Fahad Alqahtani
- Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Sami Aljohani
- Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Muhammad Alvi
- Department of Neurology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - David R Holmes
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota
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16
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Farzadfard MT, Thrift AG, Amiri A, Kapral MK, Hashemi P, Sposato LA, Salehi M, Shoeibi A, Hoseini A, Mokhber N, Azarpazhooh MR. Five-Year Case Fatality Following First-Ever Stroke in the Mashhad Stroke Incidence Study: A Population-Based Study of Stroke in the Middle East. J Stroke Cerebrovasc Dis 2018; 27:1085-1089. [PMID: 29433933 DOI: 10.1016/j.jstrokecerebrovasdis.2017.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/08/2017] [Accepted: 11/16/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Despite recent declines in stroke mortality in high-income countries, the incidence and mortality of stroke have increased in many low- and middle-income countries. Population-based information on stroke in such countries is a research priority to address this rising trend. This study was designed to evaluate 5-year stroke mortality and its associated factors. METHODS During a 12-month period beginning from November 2006, 624 patients with first-ever stroke (FES) living in Mashhad, Iran, were recruited and followed longitudinally. Kaplan-Meier analyses were used to determine the cumulative risk of death. Prognostic variables associated with death were assessed using a Cox proportional hazard, backward logistic regression model. RESULTS The 5-year cumulative risk of death was 53.8% for women and 60.5% for men (log rank = .1). The most frequent causes of death were stroke (41.2%), myocardial infarction/vascular diseases (16.4%), and pneumonia (14.2%). In multivariable Cox proportional hazard analysis, male gender (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.01-1.64), age (HR: 1.04, 95% CI: 1.03-1.05, per 1-year increase), National Institute of Health Stroke Scale score at admission (HR: 1.11, 95% CI: 1.09-1.12, per 1-point increase), atrial fibrillation (HR: 1.78, CI: 1.24-2.54), and education < 12 years (HR: 1.61, 95% CI: 1.08-2.4) were associated with greater 5-year case fatality. CONCLUSIONS Long-term case fatality following stroke in Iran is greater than that observed in many high-income countries. Targeting strategies to reduce the poor outcome following stroke, such as treating AF, is likely to reduce this disparate outcome.
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Affiliation(s)
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Amin Amiri
- Department of Neurology, Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Moira K Kapral
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto General Research Institute, Toronto, Canada
| | - Peyman Hashemi
- Department of Orthopedic Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Luciano A Sposato
- Department of Clinical Neurological Science, University Hospital, Western University, Ontario, Canada
| | - Maryam Salehi
- Research center for patient safety, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Shoeibi
- Department of Neurology, Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Hoseini
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naghmeh Mokhber
- Department of Psychiatry & Behavioural Neurosciences, Western University, London, Ontario, Canada; Department of Psychiatry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Reza Azarpazhooh
- Department of Neurology, Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Clinical Neurological Science, University Hospital, Western University, Ontario, Canada; Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Dentistry, Western University, London, Ontario, Canada.
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17
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Abstract
Stroke is a major public health issue. Many are treatable in the acute stage, provided patients are admitted soon enough. The overall incidence of stroke in Western countries is approximately 2400 per year per million inhabitants, and 80% are due to cerebral ischaemia. The prevalence is approximately 12,000 per million inhabitants. Stroke is associated with increased long-term mortality, handicap, cognitive and behavioural impairments, recurrence, and an increased risk of other types of vascular events. There is strong evidence that stroke patients should be treated in dedicated stroke units; each time 24 patients are treated in a stroke unit, instead of a conventional ward, one death and one dependence are prevented. This effect does not depend on age, severity, and the stroke subtype. For this reason, stroke unit care is the cornerstone of the treatment of stroke, aiming at the detection and management of life-threatening emergencies, stabilization of most physiological parameters, and prevention of early complications. In cerebral ischaemia, besides this general management, specific therapies include intravenous recombinant tissue plasminogen activator, given as soon as possible and before 4.5hours, mechanical thrombectomy on top of rt-PA or alone in case of contra-indication to rt-PA, in patients with proximal large-vessel occlusion, aspirin 300mg, immediately or after 24hours in case of thrombolysis, and, in a few patients, decompressive surgery.
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18
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Abstract
Cardiac patient-care technology in home care has added value to the nursing practice and made it more cost effective. From electrocardiogram (ECG) monitoring to computerized disease management systems to hemodynamic monitoring, the field of home care has been under attack by the technology industry. Nurses need to know what technologies are available for home care utilization, and how they are used, in order to decide which devices will best meet patient care needs as well as facilitate nursing practice.
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19
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Zhang XD, Chen YR, Ge L, Ge ZM, Zhang YH. Features of Stroke in Chinese Diabetes Patients: A Hospital-based Study. J Int Med Res 2016; 35:540-6. [PMID: 17697532 DOI: 10.1177/147323000703500414] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In this study, demographic characteristics, risk factors, stroke subtypes and outcome were compared in 2532 patients with and without diabetes hospitalized for first-ever stroke. Diabetes was present in 471 (18.6%) of the patients. Patients with diabetes presented more frequently with ischaemic stroke (92.1% versus 71.3%), especially lacunar infarction (41.2% versus 35.2%), compared with non-diabetics. Cerebral haemorrhage was less frequent in diabetics than non-diabetics (4.2% versus 18.1%). In-hospital mortality rates from ischaemic stroke were similar in the two groups (18.2% in diabetics and 16.9% in non-diabetics). Predictors of in-hospital mortality in diabetic patients included decreased consciousness, congestive heart failure and atrial fibrillation. In conclusion, stroke in diabetic patients was different to stroke in non-diabetic patients: in diabetics the frequency of cerebral haemorrhage was lower and the rate of lacunar infarct syndrome was higher, but in-hospital mortality from ischaemic stroke was not increased. Clinical factors evident at the onset of stroke have a major influence on in-hospital mortality and may help clinicians provide a more accurate prognosis.
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Affiliation(s)
- X-D Zhang
- School of Life Science, Lanzhou University, Lanzhou 730000, The People's Republic of China.
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20
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Ali AN, Abdelhafiz A. Clinical and Economic Implications of AF Related Stroke. J Atr Fibrillation 2016; 8:1279. [PMID: 27909470 DOI: 10.4022/jafib.1279] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/02/2015] [Accepted: 09/02/2015] [Indexed: 12/24/2022]
Abstract
A major cause of morbidity and mortality among patients with atrial fibrillation (AF) relates to the increased risk of stroke. The burden of illness that AF imparts on stroke is likely to increase with our aging populations and increasingly sophisticated cardiac monitoring techniques. Understanding the clinical and economic differences between AF related ischaemic stroke and non-AF related stroke is important if we are to improve future cost effectiveness analyses of potential preventative treatments, but also to help educate clinical and policy decision makers on use or availability of treatments to prevent AF related stroke. In this article we review the existing evidence that highlights differences in the clinical characteristics and outcomes between AF and non-AF stroke, as well as differences in their economic impact and discuss ways to improve future economic analyses.
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Affiliation(s)
- Ali N Ali
- Sheffield NHS Teaching Hospitals Foundation Trust, UK
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21
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Stróżyńska E, Fiszer U, Ryglewicz D, Zaborski J. The Impact of Risk Burden Differences between Men and Women on the Clinical Course of Ischemic Stroke. J Stroke Cerebrovasc Dis 2016; 25:843-7. [PMID: 26796054 DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 12/09/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGOUND Our objective is to assess the impact of varying risk profiles in men and women on the clinical picture of ischemic stroke. MATERIALS AND METHODS The study involved 185 patients, 100 women and 85 men. We assessed the patients' neurological status upon admission, 1 and 2 weeks following stroke onset, using the Scandinavian Stroke Scale and the Barthel Index; stroke syndromes according to the Oxfordshire Classification; their etiology and pathogenesis according to the Trial of Org 10172 in Acute Stroke Treatment; and the prevalence of vascular risk factors. We used cranial magnetic resonance imaging to locate infarcts. RESULTS Women had more total anterior circulation infarct subtype strokes, whereas men had more posterior circulation infarct and lacunar infarct. On neuroimaging, women had more infarcts in the middle cerebral artery circulation, whereas men had more in the brain stem and/or cerebellum. Women had a higher prevalence of atrial fibrillation (AF) and coronary artery disease, whereas men were more likely to smoke and abuse alcohol. Women had more cases of cardioembolism, whereas men had more strokes caused by atherosclerosis of large vessels. CONCLUSIONS In the present study, heart diseases, such as coronary artery disease and AF, were more prevalent among women. It seems that AF is a risk factor with significant impact on the epidemiological differences regarding ischemic stroke in men and women.
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Affiliation(s)
- Ewa Stróżyńska
- Department of Neurology and Neurorehabilitation, Miedzyleski Szpital Specjalistyczny, Warsaw, Poland.
| | - Urszula Fiszer
- Department of Neurology and Epileptology, Medical Centre of Postgraduate Training, Warsaw, Poland
| | - Danuta Ryglewicz
- First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Jacek Zaborski
- Department of Neurology and Neurorehabilitation, Miedzyleski Szpital Specjalistyczny, Warsaw, Poland
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22
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Furie K, Khan M. Secondary Prevention of Cardioembolic Stroke. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00062-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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A closer look at the rural-urban health disparities: Insights from four major diseases in the Commonwealth of Virginia. Soc Sci Med 2015. [DOI: 10.1016/j.socscimed.2015.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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24
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Wang XG, Zhang LQ, Liao XL, Pan YS, Shi YZ, Wang CJ, Wang YL, Liu LP, Zhao XQ, Wang YJ, Li D, Wang CX. Unfavorable Outcome of Thrombolysis in Chinese Patients with Cardioembolic Stroke: a Prospective Cohort Study. CNS Neurosci Ther 2015; 21:657-61. [PMID: 26096605 DOI: 10.1111/cns.12421] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Thrombolysis with alteplase is an effective and safe treatment for acute ischemic stroke (AIS). It is controversial whether the outcome of thrombolysis in cardioembolic stroke is different from that of other stroke subtypes. This study compares the outcomes at 3 months postthrombolysis in Chinese patients with AIS secondary to cardioembolism (CE) to the outcomes of those with large-artery atherosclerosis (LAA). METHODS Using the Thrombolysis Implementation and Monitoring of Acute Ischemic Stroke in China (TIMS-China) cohort, we prospectively followed 827 patients treated within 4.5 h of onset symptoms with alteplase as an intravenous thrombolytic agent. CE and LAA were defined according to TOAST criteria. We compared symptomatic intracerebral hemorrhage (SICH), mortality, and functional outcome at 3 months using multivariables logistic regression analysis. RESULTS In this cohort, 221 (19.6%) had CE and 606 (53.7%) had LAA. Approximately 2/3 of patients with CE had atrial fibrillation. Symptoms at onset were more severe in patients with CE than in those with LAA (NIHSS, 15.0 vs. 11.0; P < 0.0001); increased rate of SICH (5.9% vs. 0.8%; P < 0.0001); higher mortality (18.6% vs. 10.3%; P = 0.0015); and reduced functional independence (43.6% vs. 55.9%; P = 0.0018) at 3-month follow-up. After adjustment for baseline variables, the clinical outcome of patients with CE was worse than that of patients with LAA (OR, 0.62; 95% CI, 0.39 to 0.97, P = 0.0378). CONCLUSIONS Patients with cardioembolic stroke had more SICH after thrombolysis, and worse clinical outcome at 3-month follow-up compared with those with LAA. This emphasizes the importance of preventing cardioembolism.
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Affiliation(s)
- Xin-Gao 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
| | - Li-Qun Zhang
- Neurology Department, St George's Hospital, London, UK
| | - Xiao-Ling Liao
- 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
| | - Yue-Song Pan
- 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
| | - Yu-Zhi Shi
- 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
| | - Chun-Juan 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
| | - Yi-Long 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
| | - Li-Ping Liu
- 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
| | - Xing-Quan Zhao
- 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
| | - Yong-Jun 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
| | - Dong Li
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Los Angeles, CA, USA
| | - Chun-Xue 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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Memetoglu OG, Taraktas A, Badur NB, Ozkan FU. Impact of stroke etiology on clinical symptoms and functional status. North Clin Istanb 2014; 1:101-105. [PMID: 28058311 PMCID: PMC5175059 DOI: 10.14744/nci.2014.40327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 08/11/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The aim of this study is to investigate the differences between hemorrhagic and ischemic stroke patients in terms of clinical and functional features. METHODS Medical records of the patients with stroke were analyzed retrospectively. The patients' demographic characteristics, stroke etiology, time interval after the event, comorbid illness and functional status were recorded. RESULTS The stroke etiology was ischemia for 60 (36 male/24 female) (75%) patients, and haemorrhage for 20 (10 male/10 female) (25%) patients. Patients with ischemic stroke were classified as Group 1, and patients with hemorrhagic stroke were classified as Group 2. The mean age for Group 1 was 62.2±13.2, and 55.8±17.1 years for Group 2 (p=0.592). In Group 1, 33 (55%) patients, and in Group 2, 11 (55%) patients were primary school graduates (p=0.984). Localization of the lesion was in the right side for 33 (55%) patients in Group 1, and for 15 (75%) patients in Group 2 (p=0.372). The mean time interval after event for Group 1 was 7 months (0-211 days), and for Group 2 it was 14.5 (1-420 days) months (p=0.592). FIM score for Group 1 was 71.9±28.0, and 68.1±21.0 for Group 2 (p=0.575). The mean Brunnstrom score for upper extremity was 3.5 for Group 1, 3 for Group 2, (p=0.866), and for lower extremity, it was 3.5 for Group 1, and 3 for Group 2 (p=0.143). Spasticity was present in 45 (75%) patients in Group 1, and in 12 (60%) patients in Group 2 (p=0.311). In Group 1 51 (85%) of the patients and 18 (95%) patients had a history of comorbid disease (p=0.554). CONCLUSION Etiology of stroke is thought to be not effective on the patient's clinical and functional status.
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Affiliation(s)
- Ozge Gulsum Memetoglu
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Aslihan Taraktas
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Naciye Bilgin Badur
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Feyza Unlu Ozkan
- Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
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Mooe T. Risk, mechanisms and prevention of stroke after an acute myocardial infarction. Expert Rev Neurother 2014; 2:177-86. [DOI: 10.1586/14737175.2.2.177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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European Stroke Prevention Study 2: A study of low-dose acetylsalicylic acid and of high dose dipyridamole in secondary prevention of cerebro-vascular accidents. Eur J Neurol 2013; 2:416-24. [PMID: 24283721 DOI: 10.1111/j.1468-1331.1995.tb00150.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In spite of some data being added to our knowledge of the effect of antiplatelets in secondary prevention of brain ischemic lesion in recent years, the main reasons to perform a second European Stroke Prevention Study (ESPS 2), which started in 1987-1988, were: (a) clarify the relative roles of aspirin (ASA) and dipyridamole (DP) alone or in combination; (b) confirm the efficacy of small doses of ASA and, so doing, decrease the number of drop-outs due to ASA side effects; (c) join information to the effect of antiplatelets in complete stroke. General characteristics of the sample of 6602 patients are presented and compared with other major trials and series. The patients in the four treatment arms (aspirin, dipyridamole, aspirin + dipyridamole and placebo) are compared. The more relevant features and risk factors known to influence long term prognosis are described and discussed. The small proportion of patients included with TIA (23.7%) and the comparability among treatment groups are stressed. No relevant differences have been found, among groups, on the sex or age distribution, prevalence of hypertension, diabetes, previous vascular events or atrial fibrillation, nor in the characteristics of the accident leading to the inclusion in trial.
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Sarzyńska-Długosz I, Gromadzka G, Barańska-Gieruszczak M, Ciesielska A, Członkowska A. APOE does not predict poor outcome 1 year after ischemic stroke. Neurol Res 2013; 29:64-9. [PMID: 17427278 DOI: 10.1179/174313206x152528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The apolipoprotein E gene (APOE) polymorphism may influence outcome in various forms of brain injury. The association between APOE genotype and long-term ischemic stroke (IS) outcome is controversial. We have examined the effect of stroke risk factors, clinical status at admission and APOE genotype on survival and dependency 1 year after IS. METHODS We investigated 496 consecutively subjects with IS. Information concerning risk factors and clinical data were collected prospectively. Functional dependency was estimated with modified Rankin scale (mRS) and defined as a score of 3-5. Each patient was offered a I year follow-up evaluation. APOE genotyping was performed by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Multivariate regression models were used to analyse predictors of death and poor outcome (death or dependency) within 1 year after the stroke. RESULTS The distribution ofAPOE genotypes was 69% with genotype E3/E3, 18% with genotype F3/ E4, 12% with genotype E2/13 and 1% with genotype F2/14. At year 1, 169 patients (38%) had died and 78 of the survivors (28%) were functionally dependent. The best predictors of death at year 1 were: age over 70 years, congestive heart failure, atrial fibrillation, disturbed consciousness and severe hand paresis. Poor outcome was independently predicted by: age over 70 years, congestive heart failure, pre-stroke mRS> or =3, marked disturbance of consciousness and severe hand paresis. CONCLUSION We did not find any impact of APOE genotype on mortality or poor outcome 1 year after IS.
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Abstract
Stroke is one of the most common causes of morbidity and mortality in hospitalized patients in the United States. A proper understanding of stroke mechanisms helps to guide specific case management. The only therapy approved by the US Food and Drug Administration for the management of acute ischemic stroke is initiation of intravenous recombinant tissue plasminogen activator within 3 hours of symptom onset. Other treatment options include intra-arterial recombinant tissue plasminogen activator, mechanical thrombectomy, clot retrieval, or a combination of these approaches. In this article, we provide an evidence-based review of the diagnostic approach for acute ischemic stroke, including recognizing common stroke mimics. We detail the initial medical management of acute stroke and the medical and surgical therapeutic interventions for patients who have sustained acute ischemic stroke.
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Andrew N, Kilkenny M, Harris D, Price C, Cadilhac DA. Outcomes for people with atrial fibrillation in an Australian national audit of stroke care. Int J Stroke 2013; 9:270-7. [PMID: 23834233 DOI: 10.1111/ijs.12087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 11/26/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrial fibrillation is associated with poorer outcomes poststroke. It is unclear how the quality of stroke care in hospitals influences outcomes in these patients. AIMS The study aims to compare outcomes in stroke patients with and without atrial fibrillation and identify hospital processes of care associated with poor outcomes. METHODS Data were collected using retrospective, consecutive medical record audits from participating hospitals in the 2009 and 2011 National Stroke Foundation acute services audit program. Patient characteristics, stroke severity, and hospital management data were compared for those with and without atrial fibrillation. Multiple regression analyses for outcomes of in-hospital death, dependency at discharge (modified Rankin Score 3-5), and discharge destination were undertaken, adjusted for patient clustering by hospital. RESULTS Atrial fibrillation status was known for 5473 (80%) cases; 2049 had atrial fibrillation. Atrial fibrillation was independently associated with in-hospital mortality (aOR 1.46, 95% CI 1.06, 2.02). Management on a stroke unit (aOR 0.57, 95% CI 0.40, 0.80) and having a swallow assessment within 24 h (aOR 0.71, 95% CI 0.51, 0.98) were associated with increased survival among all stroke types, as was receiving aspirin within 48 h poststroke (aOR 0.65, 95% CI 0.44, 0.97), for patients with an ischemic stroke. Stroke patients with atrial fibrillation were less likely to receive important processes of care associated with reduced mortality. CONCLUSIONS Hospital processes of care can influence outcomes in stroke patients with atrial fibrillation. The greater in-hospital mortality experienced by stroke patients with atrial fibrillation may be attenuated by admission to a stroke unit, and for ischemic stroke, early administration of aspirin.
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Affiliation(s)
- Nadine Andrew
- Translational Public Health Unit, Stroke & Ageing Research Centre, Department of Medicine, Monash Medical Centre, Southern Clinical School, Monash University, Clayton, Victoria, Australia
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Hong KS, Lee J, Bae HJ, Lee JS, Kang DW, Yu KH, Han MK, Cho YJ, Song P, Park JM, Oh MS, Koo J, Lee BC. Greater stroke severity predominates over all other factors for the worse outcome of cardioembolic stroke. J Stroke Cerebrovasc Dis 2013; 22:e373-80. [PMID: 23697762 DOI: 10.1016/j.jstrokecerebrovasdis.2013.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 04/05/2013] [Accepted: 04/06/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cardioembolic (CE) strokes are more disabling and more fatal than non-CE strokes. Multiple prognostic factors have been recognized, but the magnitude of their relative contributions has not been well explored. METHODS Using a prospective stroke outcome database, we compared the 3-month outcomes of CE and non-CE strokes. We assessed the relative contribution of each prognostic factor of initial stroke severity, poststroke complications, and baseline characteristics with multivariable analyses and model fitness improvement using -2 log-likelihood and Nagelkerke R2. RESULTS This study included 1233 patients with acute ischemic stroke: 193 CE strokes and 1040 non-CE strokes. Compared with the non-CE group, CE group had less modified Rankin Scale (mRS) 0-2 outcomes (47.2% versus 68.5%; odds ratio [95% confidence interval], .41 [.30-.56]), less mRS 0-1 outcomes (33.7% versus 53.5%; .44 [.32-.61]), more mRS 5-6 outcomes (32.1% versus 10.9%; 3.88 [2.71-5.56]), and higher mortality (19.2% versus 5.2%; 4.33 [2.76-6.80]) at 3 months. When adjusting either baseline characteristics or poststroke complications, the outcome differences between the 2 groups remained significant. However, adjusting initial National Institute of Health Stroke Scale (NIHSS) score alone abolished all outcome differences except for mortality. For mRS 0-2 outcomes, the decrement of -2 log-likelihood and the Nagelkerke R2 of the model adjusting initial NIHSS score alone approached 70.2% and 76.7% of the fully adjusting model. CONCLUSION Greater stroke severity predominates over all other factors for the worse outcome of CE stroke. Primary prevention and more efficient acute therapy for stroke victims should be given top priorities to reduce the burden of CE strokes.
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Affiliation(s)
- Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang
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Rønning OM. Very long-term mortality after ischemic stroke: predictors of cardiovascular death. Acta Neurol Scand 2013. [PMID: 23190295 DOI: 10.1111/ane.12053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this article is to find possible predictors associated with long-term mortality and long-term cardiovascular death after stroke. METHODS A cohort of 550 patients with acute stroke admitted to a single hospital within 24 h of a stroke were recruited consecutively. Patients were followed for 12 years or until death. Information on death was collected through linkage with the National Population Register of Statistics Norway, an official register containing name, date of birth, address, and date of death, and the National Register of Cause of Death. Cardiovascular deaths were defined as ICD 9 codes 390 to 448 and ICD 10 codes I00 to I99. RESULTS The proportion of cardiovascular deaths was 71%. In multivariate Cox regression analysis of cardiovascular mortality, stroke severity (HR 2.78; 95% CI 2.13-3.57), hemorrhagic stroke (2.0; 1.43-2.78), diabetes (1.85; 1.37-2.50), male gender (1.69; 1.31-2.17), ischemic heart disease (1.56; 1.16-2.13), age (1.06; 1.04-1.08), and right hemispheric stroke (1.49; 1.16-1.89) were significant predictors. DISCUSSION This study shows that age, male gender, stroke severity, hemorrhagic stroke, diabetes, ischemic heart disease, and right hemispheric stroke are predictors associated with increased risk of long-term cardiovascular mortality. Neither atrial fibrillation, antihypertensive treatment on admission, smoking, or living alone was risk factors for late cardiovascular deaths.
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Affiliation(s)
- O. M. Rønning
- Medical Division; Department of Neurology; Akershus University Hospital; Lørenskog; Norway
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Oliveira-Filho J, Martins SCO, Pontes-Neto OM, Longo A, Evaristo EF, Carvalho JJFD, Fernandes JG, Zétola VF, Gagliardi RJ, Vedolin L, Freitas GRD. Guidelines for acute ischemic stroke treatment: part I. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 70:621-9. [PMID: 22899035 DOI: 10.1590/s0004-282x2012000800012] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Jamary Oliveira-Filho
- Rua Reitor Miguel Calmon s/n; Instituto de Ciências da Saúde / sala 455; 40110-100 Salvador BA - Brasil
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Arboix A, Alio J. Acute cardioembolic cerebral infarction: answers to clinical questions. Curr Cardiol Rev 2013; 8:54-67. [PMID: 22845816 PMCID: PMC3394108 DOI: 10.2174/157340312801215791] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/02/2012] [Accepted: 05/03/2012] [Indexed: 01/15/2023] Open
Abstract
Cardioembolic cerebral infarction (CI) is the most severe subtype of ischaemic stroke but some clinical aspects of this condition are still unclear. This article provides the reader with an overview and up-date of relevant aspects related to clinical features, specific cardiac disorders and prognosis of CI. CI accounts for 14-30% of ischemic strokes; patients with CI are prone to early and long-term stroke recurrence, although recurrences may be preventable by appropriate treatment during the acute phase and strict control at follow-up. Certain clinical features are suggestive of CI, including sudden onset to maximal deficit, decreased level of consciousness at onset, Wernicke's aphasia or global aphasia without hemiparesis, a Valsalva manoeuvre at the time of stroke onset, and co-occurrence of cerebral and systemic emboli. Lacunar clinical presentations, a lacunar infarct and especially multiple lacunar infarcts, make cardioembolic origin unlikely. The most common disorders associated with a high risk of cardioembolism include atrial fibrillation, recent myocardial infarction, mechanical prosthetic valve, dilated myocardiopathy and mitral rheumatic stenosis. Patent foramen ovale and complex atheromatosis of the aortic arch are potentially emerging sources of cardioembolic infarction. Mitral annular calcification can be a marker of complex aortic atheroma in stroke patients of unkown etiology. Transthoracic and transesophageal echocardiogram can disclose structural heart diseases. Paroxysmal atrial dysrhythmia can be detected by Holter monitoring. Magnetic resonance imaging, transcranial Doppler, and electrophysiological studies are useful to document the source of cardioembolism. In-hospital mortality in cardioembolic stroke (27.3%, in our series) is the highest as compared with other subtypes of cerebral infarction. Secondary prevention with anticoagulants should be started immediately if possible in patients at high risk for recurrent cardioembolic stroke in which contraindications, such as falls, poor compliance, uncontrolled epilepsy or gastrointestinal bleeding are absent. Dabigatran has been shown to be non-inferior to warfarin in the prevention of stroke or systemic embolism. All significant structural defects, such as atrial septal defects, vegetations on valve or severe aortic disease should be treated. Aspirin is recommended in stroke patients with a patent foramen ovale and indications of closure should be individualized. CI is an important topic in the frontier between cardiology and vascular neurology, occurs frequently in daily practice, has a high impact for patients, and health care systems and merits an update review of current clinical issues, advances and controversies.
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Affiliation(s)
- Adria Arboix
- Cerebrovascular Division, Department of Neurology, Capio-Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Spain.
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Early and Delayed Fatality of Stroke in Kolkata, India: Results From a 7-Year Longitudinal Population-Based Study. J Stroke Cerebrovasc Dis 2013; 22:281-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2011.09.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 08/31/2011] [Accepted: 09/05/2011] [Indexed: 11/20/2022] Open
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Hedna VS, Favilla CG, Guerrero WR, Patel A, Gottipati A, Bidari S, Beaver T, Waters MF. Trends in the management of atrial fibrillation: A neurologist's perspective. J Cardiovasc Dis Res 2012; 3:255-64. [PMID: 23233767 PMCID: PMC3516003 DOI: 10.4103/0975-3583.102690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Cardiac embolism, primarily from atrial fibrillation (AF), is implicated in a quarter of all ischemic strokes. In the setting of AF, contraindications to traditional therapies can create a clinical dilemma when choosing an agent for secondary stroke prophylaxis. Newer horizons in the medical and surgical management of AF have helped us choose from a wide variety of available therapies, the best possible management. In this article, we review the current trends in AF management including newer oral anticoagulants as well as surgical devices from a neurologist's view.
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Flaherty ML, Kissela B, Khoury JC, Alwell K, Moomaw CJ, Woo D, Khatri P, Ferioli S, Adeoye O, Broderick JP, Kleindorfer D. Carotid artery stenosis as a cause of stroke. Neuroepidemiology 2012; 40:36-41. [PMID: 23075828 PMCID: PMC3626492 DOI: 10.1159/000341410] [Citation(s) in RCA: 234] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 06/21/2012] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Population-based studies have estimated that about 15% of ischemic strokes are caused by large-vessel cerebrovascular disease. We determined the types of large-vessel atherosclerosis responsible for ischemic strokes in a population-based stroke study. METHODS Patients with first-ever or recurrent ischemic stroke in the Greater Cincinnati area were identified during 2005 at all local hospitals. Study physicians assigned ischemic stroke subtypes. Overall event rates and incidence rates for first-ever events were calculated, and age-, race- and sex-adjusted to the 2000 US population. RESULTS There were 2,204 ischemic strokes, including 365 strokes of large-vessel subtype (16.6% of all ischemic strokes). Extracranial internal carotid artery (ICA) stenosis was associated with 8.0% of all ischemic strokes, while extracranial ICA occlusion and intracranial atherosclerosis were each associated with 3.5% of strokes. The annual rate of first-ever and recurrent stroke attributed to extracranial ICA was 13.4 (11.4-15.4) per 100,000 persons. We conservatively estimate that about 41,000 strokes may be attributed to extracranial ICA stenosis annually in the United States. CONCLUSIONS Large-vessel atherosclerosis is an important cause of stroke, with extracranial ICA stenosis being significantly more common than extracranial ICA occlusion or intracranial atherosclerotic disease.
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Affiliation(s)
- Matthew L Flaherty
- Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio 45267-0525, USA.
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Amin M, Gamal A, Ali M, Awad O. Cardiac troponin T: A sensitive and specific indicator of myocardial injury in patients with cerebrovascular stroke. Egypt Heart J 2012. [DOI: 10.1016/j.ehj.2011.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Age- and gender-specific prevalence of risk factors in patients with first-ever ischemic stroke in china. Stroke Res Treat 2012; 2012:136398. [PMID: 22762013 PMCID: PMC3385649 DOI: 10.1155/2012/136398] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 03/18/2012] [Accepted: 04/29/2012] [Indexed: 11/22/2022] Open
Abstract
Background. Evidences are accumulating that age and gender have great impact on the distribution of stroke risk factors. Such data are lacking in Chinese population. Methods. 1027 patients with first-ever ischemic stroke (IS) were recruited and divided into young adult (<50 years), middle-aged (50∼80 years), and very old (>80 years) groups according to stroke onset ages. Vascular risk factors were collected and compared among groups. Results. Female patients were globally older than male patients at stroke onset and having higher prevalence of diabetes mellitus (DM), heart diseases, and atrial fibrillation (AF). However, females were less likely to drink heavily or smoke than males. Young patients had a much higher proportion of smoking and drinking than middle-aged and very old patients and the highest family history of hypertension, while very old patients had the highest prevalence of heart diseases and AF but lowest proportion of positive family history of vascular diseases. Hypertension and DM were equally frequent among three groups. Conclusion. Our study showed that vascular risk factors had a specific age and gender distribution pattern in Chinese IS patients. Secondary prevention strategy should emphasize on the control of different risk factors based on patient's age and gender.
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Cimminiello C, Zaninelli A, Carolei A, Sacco S, Toni D, Gensini G. Atherothrombotic burden and medium-term prognosis in patients with acute ischemic stroke: findings of the SIRIO study. Cerebrovasc Dis 2012; 33:341-7. [PMID: 22378350 DOI: 10.1159/000335833] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 12/12/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Short- and medium-term mortality after acute stroke is related to the severity of the index event and the patient's age. However, recent studies have reassessed the prognostic value of the systemic atherothrombotic burden in these patients, not only in the long term. This post hoc analysis of the findings of the SIRIO trial (Stroke in Italy and Related Impact on Outcome) examined the prognostic impact of systemic atherothrombosis. METHODS SIRIO was a multicenter observational study enrolling patients during the acute phase of stroke of both ischemic and hemorrhagic origin. The present analysis, however, only covered patients with ischemic stroke. At baseline, the main personal and clinical details were recorded and patients were classified as having either polyvascular disease or single arterial disease on the basis of whether they had symptomatic atherothrombotic disease in other sites besides the cerebrovascular location. For all patients we calculated the Essen Stroke Risk Score (ESRS), dividing them into groups with scores of less than 3 or 3 and more. We recorded total mortality and nonfatal vascular events 12 months after enrolment. Multivariate logistic regression analysis was used to select predictors of medium-term mortality and nonfatal cardiovascular events. There were 2,561 patients with ischemic stroke, 823 of them classified as having polyvascular disease; 940 (out of 2,485) had an ESRS of less than 3 and 1,545 had a score of 3 or more. RESULTS The combined endpoint 'death (all causes) and nonfatal cardiovascular events within 12 months of hospital discharge' was significantly dependent on the following factors: ESRS, Rankin scale and National Institutes of Health Stroke Scale scores, and polyvascular disease. Polyvascular disease status significantly affected mortality and nonfatal cardio- and cerebrovascular events after discharge (OR = 1.44, 95% CI = 1.10-1.88). Age was also confirmed as a significant predictor of the combined endpoint. CONCLUSIONS Besides age and the clinical severity of the index event, symptomatic involvement of several vascular districts was also an important predictor of mortality and nonfatal cardiovascular events in the medium term in patients with ischemic stroke.
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Affiliation(s)
- Claudio Cimminiello
- Department of Medicine, Vimercate Hospital, Azienda Ospedaliera di Desio e Vimercate, Vimercate, Italy.
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Arboix A, Alió J. Cardioembolic stroke: clinical features, specific cardiac disorders and prognosis. Curr Cardiol Rev 2011; 6:150-61. [PMID: 21804774 PMCID: PMC2994107 DOI: 10.2174/157340310791658730] [Citation(s) in RCA: 247] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 04/10/2010] [Accepted: 05/25/2010] [Indexed: 12/13/2022] Open
Abstract
This article provides the reader with an overview and up-date of clinical features, specific cardiac disorders and prognosis of cardioembolic stroke. Cardioembolic stroke accounts for 14-30% of ischemic strokes and, in general, is a severe condition; patients with cardioembolic infarction are prone to early and long-term stroke recurrence, although recurrences may be preventable by appropriate treatment during the acute phase and strict control at follow-up. Certain clinical features are suggestive of cardioembolic infarction, including sudden onset to maximal deficit, decreased level of consciousness at onset, Wernicke’s aphasia or global aphasia without hemiparesis, a Valsalva manoeuvre at the time of stroke onset, and co-occurrence of cerebral and systemic emboli. Lacunar clinical presentations, a lacunar infarct and especially multiple lacunar infarcts, make cardioembolic origin unlikely. The more common high risk cardioembolic conditions are atrial fibrillation, recent myocardial infarction, mechanical prosthetic valve, dilated myocardiopathy, and mitral rheumatic stenosis. Transthoracic and transesophageal echocardiogram can disclose structural heart diseases. Paroxysmal atrial dysrhyhtmia can be detected by Holter monitoring. In-hospital mortality in cardioembolic stroke (27.3%, in our series) is the highest as compared with other subtypes of cerebral infarction. In our experience, in-hospital mortality in patients with early embolic recurrence (within the first 7 days) was 77%. Patients with alcohol abuse, hypertension, valvular heart disease, nausea and vomiting, and previous cerebral infarction are at increased risk of early recurrent systemic embolization. Secondary prevention with anticoagulants should be started immediately if possible in patients at high risk for recurrent cardioembolic stroke in which contraindications, such as falls, poor compliance, uncontrolled epilepsy or gastrointestinal bleeding are absent.
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Affiliation(s)
- Adrià Arboix
- Cerebrovascular Division, Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Spain
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Whiting R, Shen Q, Hung WT, Cordato D, Chan DKY. Predictors for 5-year survival in a prospective cohort of elderly stroke patients. Acta Neurol Scand 2011; 124:309-16. [PMID: 21241254 DOI: 10.1111/j.1600-0404.2010.01476.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine predictors for 5-year survival in elderly stroke patients. MATERIALS AND METHODS Prospective cohort study of 186 consecutive acute stroke patients aged ≥65 years admitted to Bankstown-Lidcombe Hospital, Australia 03/2002 to 03/2003. All subjects were followed up in 2007/8, at 5 years post-stroke, for outcome measures. Logistic regression analysis was performed to predict 5-year survival using covariables, including functional status, age, stroke type and severity and vascular risk factors. Patients lost to follow-up (n = 20) were excluded from the analyses. RESULTS One hundred patients (60%) were dead at study end. Predictors for survival in final logistic regression model were as follows: Glasgow Coma Scale (GCS) on admission (OR 1.49, 95%CI 1.1-2.0, P = 0.01), preadmission functional independence measure (FIM) score (OR 1.04, 95%CI 1.0-1.1, P = 0.01), age (OR 0.93, 95%CI 0.87-0.98, P = 0.01) and atrial fibrillation (OR 0.43, 95% CI 0.19-0.95, P = 0.04). For 5-year survivors, mean Modified Rankin Scale was 3.1 ± 1.5, total FIM score 85 ± 32, mini-mental state examination (MMSE) 22 ± 8 and Hospital Anxiety and Depression (HAD) scores 5.4 ± 3.4 and 5.2 ± 3.9, respectively. FIM cognition score was significantly lower at 5 years when compared to baseline (24 ± 8 vs 29 ± 8, P < 0.05) (all scores expressed as mean ± SD). In contrast, MMSE, HAD and total FIM scores were not significantly different at 5 years when compared to baseline. CONCLUSIONS The study identified lower GCS on admission, lower preadmission FIM score, age and atrial fibrillation as negative predictors for 5-year survival following stroke.
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Affiliation(s)
- R Whiting
- Department of Clinical Geratology, John Radcliffe Hospital, Oxford, UK
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Giantin V, Semplicini A, Franchin A, Simonato M, Baccaglini K, Attanasio F, Toffanello ED, Manzato E. Outcome after acute ischemic stroke (AIS) in older patients: Effects of age, neurological deficit severity and blood pressure (BP) variations. Arch Gerontol Geriatr 2011; 52:e185-91. [DOI: 10.1016/j.archger.2010.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 10/28/2010] [Accepted: 10/29/2010] [Indexed: 10/18/2022]
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Nam HS, Lee KY, Kim YD, Choi HY, Cho HJ, Cha MJ, Nam CM, Heo JH. Failure of complete recanalization is associated with poor outcome after cardioembolic stroke. Eur J Neurol 2011; 18:1171-8. [PMID: 21309926 DOI: 10.1111/j.1468-1331.2011.03360.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recanalization is strongly associated with outcomes after thrombolytic treatment. Cardiac emboli are known as better response to fibrinolytic agents because they are fibrin-rich; however, cardioembolic stroke itself is associated with poor outcomes and high mortality. Completeness of recanalization may therefore affect the outcome of cardioembolic stroke. We investigated whether degree of recanalization influences outcomes following fibrinolytic therapy in cardioembolic stroke. METHODS Consecutive stroke patients with relevant artery occlusions on baseline CT angiography who had received thrombolytic treatment were enrolled. Completeness of recanalization was assessed by the Thrombolysis in Myocardial Infarction (TIMI) grade, which was compared between patients with and without cardiac sources of embolism (CSE). We also investigated independent predictors of poor outcome (modified Rankin scale score 3-6) at 3 months. RESULTS Of the 127 patients enrolled, 65 (51%) had one or more CSE. Although the overall recanalization rates (TIMI 2 or 3) in patients with CSE (65%) and patients without CSE (68%) were similar (P=0.710), patients with CSE were less likely to show complete recanalization (TIMI 3) compared with those without CSE (19% vs. 39%, P=0.011). Multivariate analysis revealed that CSE was associated with failure of complete recanalization (OR 2.809, 95% CI 1.097-7.192) and was an independent predictor of poor outcome at 3months (OR 3.629, 95% CI 1.205-8.869). CONCLUSIONS In cardioembolic strokes, failure of complete recanalization following thrombolytic therapy was frequent and was associated with poor outcome after thrombolysis.
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Affiliation(s)
- H S Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
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Feigin V, Wiebers D, Nikitin Y, Whisnant J, Novokchatskaya M, Belenko A, Khatsenko V, O'Fallon W. Epidemiology of stroke in different regions of Siberia, Russia, 1987-1988: population-based study in Novosibirsk, Krasnoyarsk, Tynda and Anadyr. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.1996.tb00183.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Secondary Prevention of Cardioembolic Stroke. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Rønning OM, Stavem K. Predictors of mortality following acute stroke: a cohort study with 12 years of follow-up. J Stroke Cerebrovasc Dis 2010; 21:369-72. [PMID: 21075646 DOI: 10.1016/j.jstrokecerebrovasdis.2010.09.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 09/29/2010] [Accepted: 09/30/2010] [Indexed: 11/26/2022] Open
Abstract
In this study, we investigated predictors for long-term all-cause mortality in a cohort of patients hospitalized for acute stroke. We prospectively followed 550 patients aged ≥ 60 years who were consecutively admitted within 24 hours of sustaining acute stroke. The patients were followed for 12 years or until death, whichever came first. Multivariate Cox regression models were used to analyze predictors of all-cause mortality, with the following independent variables: age, sex, living alone, previous stroke, ischemic heart disease, atrial fibrillation, hypertension, diabetes, cancer, current smoker, hemorrhagic stroke, treatment in an acute stroke unit, and stroke severity (measured with the Scandinavian Stroke Scale). The 12-year mortality rate was 86.5%. In a multivariate model, all-cause mortality was associated with the following variables: age (hazard ratio, 1.08; 95% confidence interval, 1.07-1.10), male sex (1.69, 1.40-2.05), previous stroke (1.34, 1.08-1.65), ischemic heart disease (1.30, 1.02-1.64), diabetes (1.74, 1.36-2.23), hemorrhagic stroke (1.58, 1.20-2.08), and stroke severity (1.03, 1.03-1.04); Age, male sex, stroke severity, ischemic heart disease, diabetes, and hemorrhagic stroke were all independently associated with an increased risk of all-cause mortality over the 12-year period after stroke.
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Affiliation(s)
- Ole Morten Rønning
- Department of Neurology, Medical Division, Akershus University Hospital, Lørenskog, Norway.
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Brodaty H, Altendorf A, Withall A, Sachdev PS. Mortality and institutionalization in early survivors of stroke: the effects of cognition, vascular mild cognitive impairment, and vascular dementia. J Stroke Cerebrovasc Dis 2010; 19:485-93. [PMID: 20538487 DOI: 10.1016/j.jstrokecerebrovasdis.2009.09.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 08/21/2009] [Accepted: 09/10/2009] [Indexed: 11/26/2022] Open
Abstract
We explored th effects of vascular mild cognitive impairment (VaMCI), vascular dementia (VaD), and other predictors on mortality and institutionalization in early survivors of ischemic stroke without previous dementia who had been admitted to a stroke unit. A total of 202 consecutive consenting eligible ischemic stroke survivors and a matched sample of 97 community controls were followed for up to 10 years. Data for 167 patients who underwent detailed assessment 3-6 months after stroke were analyzed to determine predictors of outcomes. Cumulative mortality rates for patients (and controls) were 27% (4%) for the first 5 years and rose to 83% (10%) by 10 years. Predictors of mortality were older age, any cognitive impairment, less independent function, and less education. Nursing home admission rates were 24% at 5 years and 32% at 10 years for patients and 0 for controls over 8.9 years. Predictors of institutionalization were less independent function and older age. Patients with ischemic stroke who survive the first week have moderate, lower-than-expected mortality rates in the first 5 years that increase thereafter. VaMCI, VaD, and functional decline are predictors of mortality, while functional decline and older age predict institutionalization.
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Affiliation(s)
- Henry Brodaty
- School of Psychiatry, Primary Dementia Collaborative Research Centre, University of New South Wales, Sydney, Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, Sydney, New South Wales, Australia
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Maraldi C, Lattanzio F, Onder G, Gallerani M, Bustacchini S, De Tommaso G, Volpato S. Variability in the Prescription of Cardiovascular Medications in Older Patients. Drugs Aging 2009; 26 Suppl 1:41-51. [DOI: 10.2165/11534650-000000000-00000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Kruk M, Kadziela J, Reynolds HR, Forman SA, Sadowski Z, Barton BA, Mark DB, Maggioni AP, Leor J, Webb JG, Kapeliovich M, Marin-Neto JA, White HD, Lamas GA, Hochman JS. Predictors of outcome and the lack of effect of percutaneous coronary intervention across the risk strata in patients with persistent total occlusion after myocardial infarction: Results from the OAT (Occluded Artery Trial) study. JACC Cardiovasc Interv 2009; 1:511-20. [PMID: 19194534 DOI: 10.1016/j.jcin.2008.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study sought to determine predictors of outcome and examine the influence of baseline risk on therapeutic impact of late mechanical opening of a persistently occluded infarct related artery after myocardial infarction in stable patients. BACKGROUND Previous studies in patients with acute coronary syndromes suggest that the impact of infarct-related artery recanalization on clinical outcome is greatest in patients at highest risk. METHODS Of 2,201 patients (age 58.6 +/- 11.0 years) with infarct-related artery occlusion on days 3 to 28 after myocardial infarction in the OAT (Occluded Artery Trial) study, 1,101 were assigned to percutaneous coronary intervention (PCI) and 1,100 to medical therapy alone and followed for a mean of 3.2 years. The primary end point was a composite of death, reinfarction, or New York Heart Association functional class IV heart failure. Interaction of treatment effect with tertiles of predicted survival were examined using the Cox survival model. RESULTS The 5-year rate for the primary end point was 18.9% versus 16.1% for patients assigned to PCI and medical treatment alone, respectively (hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 0.92 to 1.43, p 0.23). Lack of benefit of PCI was consistent across the risk spectrum for both the primary end point and total mortality, including for the highest tertile (33.9% PCI vs. 27.3% medical treatment alone, HR: 1.27, 99% CI: 0.87 to 1.85 primary end point and 23.5% PCI vs. 21.7% medical treatment alone, HR: 1.16, 99% CI: 0.73 to 1.85 mortality). The independent predictors of the composite outcome were history of heart failure (HR: 2.06, p < 0.001), peripheral vascular disease (HR: 1.93, p 0.001), diabetes (HR: 1.49, p 0.002), rales (HR: 1.88, p < 0.001), decreasing ejection fraction (HR: 1.48 per 10%, p < 0.001), decreasing days from myocardial infarction to randomization (HR: 1.04 per day, p < 0.001), and decreasing glomerular filtration rate (HR: 1.11 per 10 ml/min/1.73 m(2), p < 0.001). CONCLUSIONS In the OAT study, there was no variation in the effect of PCI on clinical outcomes at different levels of patient risk, including the subset with very high event rates. (Occluded Artery Trial [OAT]; NCT00004562)
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