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Fry CH, Fluck A, Affley B, Kakar P, Sharma P, Fluck D, Han TS. Urinary incontinence indicates mortality, disability, and infections in hospitalised stroke patients. BJU Int 2024; 133:604-613. [PMID: 38419275 DOI: 10.1111/bju.16320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVES To assess the impact of urinary incontinence (UI) on health outcomes over the entire spectrum of acute stroke severity (National Institutes of Health Stroke Scale [NIHSS] scores: 0-42), due to a paucity of data on patients with milder strokes. PATIENTS AND METHODS Data were prospectively collected (2014-2016) from the Sentinel Stroke National Audit Programme (1593 men, 1591 women; mean [SD] age 76.8 [13.3] years) admitted to four UK hyperacute stroke units (HASUs). Relationships between variables were assessed by multivariable logistic regression. Data were adjusted for age, sex, comorbidities, pre-stroke disability and intra-cranial haemorrhage, and presented as odds ratios with 95% confidence intervals. RESULTS Amongst patients with no symptoms or a minor stroke (NIHSS scores of 0-4), compared to patients without UI, patients with UI had significantly greater risks of poor outcomes including: in-hospital mortality; disability at discharge; in-hospital pneumonia; urinary tract infection within 7 days of admission; prolonged length of stay on the HASU; palliative care by discharge; activity of daily living (ADL) support, and new discharge to care home. In patients with more moderate stroke (NIHSS score of 5-15) the same outcomes were identified; being at greater risk for patients with UI, except for palliative care by discharge and ADL support. With the highest stroke severity group (NIHSS score of 16-48) all outcomes were identified except in-patient mortality, pneumonia, and ADL support. However, odds ratios diminished as NIHSS scores increased. CONCLUSIONS Urinary incontinence is a useful indicator of poor short-term outcomes in older patients with an acute stroke, but irrespective of stroke severity. This provides valuable information to healthcare professionals to identify at-risk individuals.
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Affiliation(s)
- Christopher H Fry
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - Adam Fluck
- Faculty of Medical Sciences, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Brendan Affley
- Department of Stroke, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Puneet Kakar
- Department of Stroke, Epsom and St Helier University Hospitals, Epsom, UK
| | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK
- Department of Clinical Neuroscience, Imperial College Healthcare NHS Trust, London, UK
| | - David Fluck
- Department of Cardiology, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
| | - Thang S Han
- Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
- Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK
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Huang Y, Li Z, Yin X. Long-term survival in stroke patients: insights into triglyceride-glucose body mass index from ICU data. Cardiovasc Diabetol 2024; 23:137. [PMID: 38664780 DOI: 10.1186/s12933-024-02231-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The Triglyceride Glucose-Body Mass Index (TyG-BMI) has been established as a robust indicator of insulin resistance (IR), reflecting metabolic health across various populations. In general, lower TyG-BMI values are often associated with better metabolic health outcomes and a reduced risk of adverse health events in non-critically ill populations. Previous studies have highlighted a significant negative association between TyG-BMI and all-cause mortality (ACM) among critically ill atrial fibrillation patients. Given the high prevalence and severe outcomes associated with stroke, understanding how TyG-BMI at the time of ICU admission correlates with ACM in critically ill stroke patients becomes imperative. This study aims to assess the correlation between TyG-BMI and ACM in this specific patient cohort, exploring how traditional associations between TyG-BMI and metabolic health may differ in the context of acute, life-threatening illness. METHODS Patient data were retrieved by accessing the Medical Information Mart for Intensive Care IV (MIMIC-IV 2.2) database, categorizing patients into three groups on the basis of TyG-BMI tertiles. The study evaluated both primary and secondary outcomes: the primary outcomes included the 90-day, 180-day, and 1-year ACM, while secondary outcomes encompassed ICU, in-hospital, and 30-day ACM. Our study employed the Kaplan-Meier (K-M) curve method for outcome comparison across the groups while utilizing multivariate Cox proportional-hazards regression models and restricted cubic splines (RCS) to explore TyG-BMI association with these outcomes. Additionally, interaction and subgroup analyses were performed, focusing on different mortality time points. RESULTS Among a cohort of 1707 individuals diagnosed with stroke, the average age was 68 years (interquartile range [IQR]: 58-78 years), with 946 (55.42%) of the participants being male. The analysis of K-M curves suggested that patients having a lower TyG-BMI level faced a heightened risk of long-term ACM, whereas the short-term ACM exhibited no statistically significant differences across the three TyG-BMI groups. Furthermore, Cox proportional-hazards regression analysis validated a statistically significant increased risk of long-term ACM among patients belonging to the lowest TyG-BMI tertile. Additionally, RCS analysis results demonstrated L-shaped correlations between the TyG-BMI index and both short- and long-term ACM. These findings underscore the TyG-BMI predictive value for long-term mortality in stroke patients, highlighting a nuanced relationship that varies over different time frames. The results revealed no interactions between TyG-BMI and the stratified variables, with the exception of age. CONCLUSION In our study, lower TyG-BMI levels in critically ill stroke patients are significantly related to a higher risk of long-term ACM within the context of the United States. This finding suggests the potential of TyG-BMI as a marker for stratifying long-term risk in this patient population. However, it's crucial to note that this association was not observed for short-term ACM, indicating that the utility of TyG-BMI may be more pronounced in long-term outcome prediction. Additionally, our conclusion that TyG-BMI could serve as a reliable indicator for managing and stratifying stroke patients over the long term is preliminary. To confirm our findings and assess the universal applicability of TyG-BMI as a prognostic tool, it is crucial to conduct rigorously designed research across various populations.
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Affiliation(s)
- Yongwei Huang
- Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Zongping Li
- Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China.
| | - Xiaoshuang Yin
- Department of Immunology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China.
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Zhang H, Xu Y, Xu Y. The association of the platelet/high-density lipoprotein cholesterol ratio with self-reported stroke and cardiovascular mortality: a population-based observational study. Lipids Health Dis 2024; 23:121. [PMID: 38659020 PMCID: PMC11040779 DOI: 10.1186/s12944-024-02115-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Previous studies have shown that the relationship between high-density lipoprotein cholesterol (HDL-C) and stroke is controversial, and the association between the platelet/high-density lipoprotein cholesterol ratio (PHR), a novel marker for inflammation and hypercoagulability states, and stroke has not been established. METHODS This study presents an analysis of cross-sectional data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES). Stroke history, HDL-C levels, and platelet counts were obtained during cross-sectional surveys. The PHR was calculated as the ratio of the number of platelets to HDL-C concentration. Weighted logistic regression was used to assess the associations of HDL-C and the PHR with stroke. Nonlinearity of this relationship was determined through restricted cubic splines (RCSs) and two-piecewise linear regression for identifying inflection points. Furthermore, Cox regression was utilized to prospectively analyze the associations of the PHR and HDL-C concentration with cardiovascular disease (CVD) mortality in stroke survivors. RESULTS A total of 27,301 eligible participants were included in the study; mean age, 47.28 years and 50.57% were female, among whom 1,040 had a history of stroke. After full adjustment, the odds ratio (OR) of stroke associated with a per standard deviation (SD) increase in the PHR was estimated at 1.13 (95% confidence interval (CI): 1.03 - 1.24, P = 0.01), and the OR of stroke associated with a per SD increase in HDL-C was 0.95 (95% CI: 0.86-1.05, P = 0.30). The RCS indicated a nonlinear relationship for both variables (PPHR = 0.018 and PHDL-C = 0.003), and further piecewise linear regression identified inflection points at PHR = 223.684 and HDL-C = 1.4 mmol/L. Segmental regression indicated that in the PHR ≥ 223.684 segment, the estimated OR of stroke associated with a per-SD increase in the PHR was 1.20 (95% CI: 1.09 - 1.31, P < 0.001), while the association of stroke with HDL-C was not significant before or after the inflection point (P > 0.05). Furthermore, Cox regression and RCS showed that a per-SD increase in the PHR was linearly associated with a greater risk of CVD mortality among stroke survivors (HR: 1.14, 95% CI: 1.06 - 1.22, P < 0.001; nonlinear, P = 0.956), while HDL-C was not significantly associated with CVD mortality. CONCLUSION The association between the PHR and stroke incidence exhibited a significant threshold effect, with an inflection point at 223.684. A PHR exceeding 223.684 was positively associated with stroke, while the association between HDL-C and stroke was not significant. Additionally, the PHR was positively and linearly associated with CVD mortality among stroke survivors.
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Affiliation(s)
- Huifeng Zhang
- Department of Cardiovascular, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, No. 24, Jinghua Road, Jianxi District, Luoyang City, Henan Province, China.
| | - Ying Xu
- Department of Hematology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Yaying Xu
- Department of Endocrinology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
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Marfella R, Prattichizzo F, Sardu C, Fulgenzi G, Graciotti L, Spadoni T, D'Onofrio N, Scisciola L, La Grotta R, Frigé C, Pellegrini V, Municinò M, Siniscalchi M, Spinetti F, Vigliotti G, Vecchione C, Carrizzo A, Accarino G, Squillante A, Spaziano G, Mirra D, Esposito R, Altieri S, Falco G, Fenti A, Galoppo S, Canzano S, Sasso FC, Matacchione G, Olivieri F, Ferraraccio F, Panarese I, Paolisso P, Barbato E, Lubritto C, Balestrieri ML, Mauro C, Caballero AE, Rajagopalan S, Ceriello A, D'Agostino B, Iovino P, Paolisso G. Microplastics and Nanoplastics in Atheromas and Cardiovascular Events. N Engl J Med 2024; 390:900-910. [PMID: 38446676 PMCID: PMC11009876 DOI: 10.1056/nejmoa2309822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Microplastics and nanoplastics (MNPs) are emerging as a potential risk factor for cardiovascular disease in preclinical studies. Direct evidence that this risk extends to humans is lacking. METHODS We conducted a prospective, multicenter, observational study involving patients who were undergoing carotid endarterectomy for asymptomatic carotid artery disease. The excised carotid plaque specimens were analyzed for the presence of MNPs with the use of pyrolysis-gas chromatography-mass spectrometry, stable isotope analysis, and electron microscopy. Inflammatory biomarkers were assessed with enzyme-linked immunosorbent assay and immunohistochemical assay. The primary end point was a composite of myocardial infarction, stroke, or death from any cause among patients who had evidence of MNPs in plaque as compared with patients with plaque that showed no evidence of MNPs. RESULTS A total of 304 patients were enrolled in the study, and 257 completed a mean (±SD) follow-up of 33.7±6.9 months. Polyethylene was detected in carotid artery plaque of 150 patients (58.4%), with a mean level of 21.7±24.5 μg per milligram of plaque; 31 patients (12.1%) also had measurable amounts of polyvinyl chloride, with a mean level of 5.2±2.4 μg per milligram of plaque. Electron microscopy revealed visible, jagged-edged foreign particles among plaque macrophages and scattered in the external debris. Radiographic examination showed that some of these particles included chlorine. Patients in whom MNPs were detected within the atheroma were at higher risk for a primary end-point event than those in whom these substances were not detected (hazard ratio, 4.53; 95% confidence interval, 2.00 to 10.27; P<0.001). CONCLUSIONS In this study, patients with carotid artery plaque in which MNPs were detected had a higher risk of a composite of myocardial infarction, stroke, or death from any cause at 34 months of follow-up than those in whom MNPs were not detected. (Funded by Programmi di Ricerca Scientifica di Rilevante Interesse Nazionale and others; ClinicalTrials.gov number, NCT05900947.).
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Affiliation(s)
- Raffaele Marfella
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Francesco Prattichizzo
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Celestino Sardu
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Gianluca Fulgenzi
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Laura Graciotti
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Tatiana Spadoni
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Nunzia D'Onofrio
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Lucia Scisciola
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Rosalba La Grotta
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Chiara Frigé
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Valeria Pellegrini
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Maurizio Municinò
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Mario Siniscalchi
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Fabio Spinetti
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Gennaro Vigliotti
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Carmine Vecchione
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Albino Carrizzo
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Giulio Accarino
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Antonio Squillante
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Giuseppe Spaziano
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Davida Mirra
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Renata Esposito
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Simona Altieri
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Giovanni Falco
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Angelo Fenti
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Simona Galoppo
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Silvana Canzano
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Ferdinando C Sasso
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Giulia Matacchione
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Fabiola Olivieri
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Franca Ferraraccio
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Iacopo Panarese
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Pasquale Paolisso
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Emanuele Barbato
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Carmine Lubritto
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Maria L Balestrieri
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Ciro Mauro
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Augusto E Caballero
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Sanjay Rajagopalan
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Antonio Ceriello
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Bruno D'Agostino
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Pasquale Iovino
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
| | - Giuseppe Paolisso
- From the Departments of Advanced Medical and Surgical Sciences (R.M., C.S., L.S., F.C.S., G.P.), Precision Medicine (N.D., M.L.B.), Engineering (A.F., S.G.), and Mental Health and Public Medicine, Section of Statistics (F.F., I.P.), University of Campania Luigi Vanvitelli, the Department of Forensic, Evaluative, and Necroscopic Medicine, Azienda Sanitaria Locale Napoli 2 Nord (M.M.), the Department of Cardiology, Hospital Cardarelli (M.S., C.M.), the Department of Vascular Surgery, Ospedale del Mare Azienda Sanitaria Locale Napoli 1 (F.S., G.V.), Environmental Technologies, spinoff of University of Campania Luigi Vanvitelli (S.C.), and the Department of Advanced Biomedical Sciences, University Federico II (P.P.), Naples, IRCCS MultiMedica, Milan (F.P., R.L.G., C.F., V.P., A. Ceriello), the Departments of Clinical and Molecular Sciences (G. Fulgenzi, F.O.) and Excellence SBSP-Biomedical Sciences and Public Health (L.G., T.S.), Polytechnic University of Marche, and IRCCS Istituto Nazionale Ricovero e Cura per Anziani (G.M., F.O.), Ancona, the Vascular Physiopathology Unit, IRCCS Neuromed, Pozzilli (C.V.), the Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno (C.V., A. Carrizzo, G.A., A.S.), the Department of Environmental, Biologic, and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta (G.S., D.M., R.E., S.A., G. Falco, C.L., B.D., P.I.), and the Department of Clinical and Molecular Medicine, Sapienza University of Rome (E.B.), and UniCAMILLUS, International Medical University (G.P.), Rome - all in Italy; Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium (P.P.); Harvard Medical School and the Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Boston (A.E.C.); and University Hospitals, Case Western Reserve School of Medicine, Cleveland (S.R.)
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Gigante A, Imbimbo G, Andreini M, Proietti M, Palladino M, Molfino A, Alunni Fegatelli D, Muscaritoli M. CHA 2DS 2-VASc score as a predictor of clinical outcomes in hospitalized patients with and without chronic kidney disease. J Nephrol 2024; 37:409-417. [PMID: 37938543 PMCID: PMC11043197 DOI: 10.1007/s40620-023-01805-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/11/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND High CHA2DS2-VASc score (Congestive heart failure, Hypertension, Age > 75 years, Diabetes mellitus, prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65-74 and Sex category) was associated with adverse clinical outcomes in different settings. The aim of the present study was to evaluate the association between CHA2DS2-VASc score and R2CHA2DS2-VASc score (which includes renal impairment) with in-hospital mortality and length of hospital stay in patients hospitalized in an internal medicine ward. METHODS We enrolled 983 consecutive patients admitted during 3 years in an internal medicine ward. R2CHA2DS2-VASc score was calculated by adding 2 points to CHA2DS2-VASc for the presence of chronic kidney disease (CKD), defined according to K-DOQI. The primary outcome was a composite of all-cause mortality and length of hospital stay > 10 days. RESULTS Patients with CKD stages 3-5 presented with increased CHA2DS2-VASc vs stages 1-2 (p < 0.001). The composite outcome occurred in 47.3% of inpatients. Multivariable linear logistic regression analyses adjusted for presence of infectious diseases and cancer, with the occurrence of composite outcome showed an adjusted OR of 1.349 (95% CI 1.248-1.462) and 1.254 (95% CI 1.179-1.336) for CHA2DS2-VASc and R2CHA2DS2-VASc scores, respectively. No differences were found in the association between CHA2DS2-VASc and R2CHA2DS2-VASc scores with the composite outcome (AUC 0.631 vs 0.630), and furthermore, adding the presence/absence of infectious diseases during hospitalization and positive cancer history to the models increased the AUC (0.667 and 0.663). CONCLUSIONS Incrementally higher CHA2DS2-VASc score is associated with increased length of hospital stay and mortality in patients hospitalized in an internal medicine ward, regardless of the presence of CKD.
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Affiliation(s)
- Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
| | - Giovanni Imbimbo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Martina Andreini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Marco Proietti
- Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Mariangela Palladino
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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Albers GW, Jumaa M, Purdon B, Zaidi SF, Streib C, Shuaib A, Sangha N, Kim M, Froehler MT, Schwartz NE, Clark WM, Kircher CE, Yang M, Massaro L, Lu XY, Rippon GA, Broderick JP, Butcher K, Lansberg MG, Liebeskind DS, Nouh A, Schwamm LH, Campbell BCV. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. N Engl J Med 2024; 390:701-711. [PMID: 38329148 DOI: 10.1056/nejmoa2310392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Thrombolytic agents, including tenecteplase, are generally used within 4.5 hours after the onset of stroke symptoms. Information on whether tenecteplase confers benefit beyond 4.5 hours is limited. METHODS We conducted a multicenter, double-blind, randomized, placebo-controlled trial involving patients with ischemic stroke to compare tenecteplase (0.25 mg per kilogram of body weight, up to 25 mg) with placebo administered 4.5 to 24 hours after the time that the patient was last known to be well. Patients had to have evidence of occlusion of the middle cerebral artery or internal carotid artery and salvageable tissue as determined on perfusion imaging. The primary outcome was the ordinal score on the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability and a score of 6 indicating death) at day 90. Safety outcomes included death and symptomatic intracranial hemorrhage. RESULTS The trial enrolled 458 patients, 77.3% of whom subsequently underwent thrombectomy; 228 patients were assigned to receive tenecteplase, and 230 to receive placebo. The median time between the time the patient was last known to be well and randomization was approximately 12 hours in the tenecteplase group and approximately 13 hours in the placebo group. The median score on the modified Rankin scale at 90 days was 3 in each group. The adjusted common odds ratio for the distribution of scores on the modified Rankin scale at 90 days for tenecteplase as compared with placebo was 1.13 (95% confidence interval, 0.82 to 1.57; P = 0.45). In the safety population, mortality at 90 days was 19.7% in the tenecteplase group and 18.2% in the placebo group, and the incidence of symptomatic intracranial hemorrhage was 3.2% and 2.3%, respectively. CONCLUSIONS Tenecteplase therapy that was initiated 4.5 to 24 hours after stroke onset in patients with occlusions of the middle cerebral artery or internal carotid artery, most of whom had undergone endovascular thrombectomy, did not result in better clinical outcomes than those with placebo. The incidence of symptomatic intracerebral hemorrhage was similar in the two groups. (Funded by Genentech; TIMELESS ClinicalTrials.gov number, NCT03785678.).
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Affiliation(s)
- Gregory W Albers
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Mouhammad Jumaa
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Barbara Purdon
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Syed F Zaidi
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Christopher Streib
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Ashfaq Shuaib
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Navdeep Sangha
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Minjee Kim
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Michael T Froehler
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Neil E Schwartz
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Wayne M Clark
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Charles E Kircher
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Ming Yang
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Lori Massaro
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Xiao-Yu Lu
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Gregory A Rippon
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Joseph P Broderick
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Ken Butcher
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Maarten G Lansberg
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - David S Liebeskind
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Amre Nouh
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Lee H Schwamm
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
| | - Bruce C V Campbell
- From Stanford Stroke Center, Department of Neurology and Neurological Sciences, Stanford University, Palo Alto (G.W.A., N.E.S., M.G.L.), Genentech, South San Francisco (B.P., M.Y., L.M., X.-Y.L., G.A.R.), and the Department of Neurology, Southern California Permanente Medical Group, Los Angeles Medical Center (N.S.), and the Department of Neurology, University of California, Los Angeles (D.S.L.), Los Angeles - all in California; the Department of Neurology, ProMedica Toledo Hospital, University of Toledo, Toledo (M.J., S.F.Z.), and the Department of Emergency Medicine (C.E.K.) and the Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute (J.P.B.), College of Medicine, University of Cincinnati, Cincinnati - both in Ohio; the Department of Neurology, University of Minnesota, Minneapolis (C.S.); the Department of Medicine, University of Alberta, Edmonton, Canada (A.S.); the Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago (M.K.); Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville (M.T.F.); Oregon Stroke Center, Oregon Health and Science University, Portland (W.M.C.); the School of Medicine, University of New South Wales, Sydney (K.B.), and the Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C.) - both in Australia; the Department of Neurology, Cleveland Clinic Florida, Weston Hospital, Weston (A.N.); the Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (L.H.S.); and the Department of Neurology, Yale School of Medicine, New Haven, CT (L.H.S.)
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7
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Zhang S, Xu W, Xu J, Qiu Y, Wan Y, Fan Y. Association of C-reactive protein level with adverse outcomes in patients with atrial fibrillation: A meta-analysis. Am J Med Sci 2024; 367:41-48. [PMID: 37979919 DOI: 10.1016/j.amjms.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/28/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Studies on the association between C-reactive protein (CRP) level and poor outcomes have been yielded controversial results in patients with atrial fibrillation (AF). This meta-analysis sought to investigate the utility of elevated CRP level in predicting adverse outcomes in AF patients. METHODS Two authors systematically searched PubMed and Embase databases (until December 10, 2022) for studies evaluating the value of elevated CRP level in predicting all-cause mortality, cardiovascular death, stroke, or major adverse cardiovascular events (MACEs) in AF patients. The predictive value of CRP was expressed by pooling adjusted hazard ratio (HR) with 95% confidence intervals (CI) for the highest versus the lowest level or per unit of log-transformed increase. RESULTS Ten studies including 30,345 AF patients satisfied our inclusion criteria. For the highest versus the lowest CRP level, the pooled adjusted HR was 1.57 (95% CI 1.34-1.85) for all-cause mortality, 1.18 (95% CI 0.92-1.50) for cardiovascular death, and 1.57 (95% CI 1.10-2.24) for stroke, respectively. When analyzed the CRP level as continuous data, per unit of log-transformed increase was associated with a 27% higher risk of all-cause mortality (HR 1.27; 95% CI 1.23-1.32) and 16% higher risk of MACEs (HR 1.16; 95% CI 1.05-1.28). CONCLUSIONS Elevated CRP level may be an independent predictor of all-cause mortality, stroke, and MACEs in patients with AF. CRP level at baseline can provide important prognostic information in risk classification of AF patients.
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Affiliation(s)
- Shiqi Zhang
- Department of Gastroenterology, The Suqian Clinical College of Xuzhou Medical University, Suqian, Jiangsu, China
| | - Wei Xu
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Juan Xu
- Department of Oncology, Ganyu District People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China
| | - Yue Qiu
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yanluan Wan
- Department of Geriatric Disease, Ganyu District People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China
| | - Yu Fan
- Cancer Institute, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China.
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8
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Elman C, Cunningham SA, Howard VJ, Judd SE, Bennett AM, Dupre ME. Birth in the U.S. Plantation South and Racial Differences in all-cause mortality in later life. Soc Sci Med 2023; 335:116213. [PMID: 37717468 DOI: 10.1016/j.socscimed.2023.116213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 07/26/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
The American South has been characterized as a Stroke Belt due to high cardiovascular mortality. We examine whether mortality rates and race differences in rates reflect birthplace exposure to Jim Crow-era inequalities associated with the Plantation South. The plantation mode of agricultural production was widespread through the 1950s when older adults of today, if exposed, were children. We use proportional hazards models to estimate all-cause mortality in Non-Hispanic Black and White birth cohorts (1920-1954) in a sample (N = 21,941) drawn from REasons for Geographic and Racial Differences in Stroke (REGARDS), a national study designed to investigate Stroke Belt risk. We link REGARDS data to two U.S. Plantation Censuses (1916, 1948) to develop county-level measures that capture the geographic overlap between the Stroke Belt, two subregions of the Plantation South, and a non-Plantation South subregion. Additionally, we examine the life course timing of geographic exposure: at birth, adulthood (survey enrollment baseline), neither, or both portions of life. We find mortality hazard rates higher for Black compared to White participants, regardless of birthplace, and for the southern-born compared to those not southern-born, regardless of race. Race-specific models adjusting for adult Stroke Belt residence find birthplace-mortality associations fully attenuated among White-except in one of two Plantation South subregions-but not among Black participants. Mortality hazard rates are highest among Black and White participants born in this one Plantation South subregion. The Black-White mortality differential is largest in this birthplace subregion as well. In this subregion, the legacy of pre-Civil War plantation production under enslavement was followed by high-productivity plantation farming under the southern Sharecropping System.
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Affiliation(s)
- Cheryl Elman
- Social Science Research Institute, Duke University, Durham, NC, 27708, USA.
| | | | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama-Birmingham, USA.
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama-Birmingham, USA.
| | - Aleena M Bennett
- Department of Biostatistics, School of Public Health, University of Alabama-Birmingham, USA.
| | - Matthew E Dupre
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA; Department of Sociology, Duke University, Durham, NC 27710, USA.
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9
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Haneuse S, Rencsok E, Kaufman JS. Comment on: Chen et al. Trends and ethnic differences in stroke recurrence and mortality in a biethnic population, 2000-2019: a novel application of an illness-death model. Annals of Epidemiology, in press. Ann Epidemiol 2023; 85:86-87. [PMID: 37201668 DOI: 10.1016/j.annepidem.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Sebastien Haneuse
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Emily Rencsok
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics, & Occupational Health, McGill University, Montreal, Quebec, Canada
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10
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Chen C, He K, Morgenstern LB, Shi X, Shafie-Khorassani F, Lisabeth LD. Trends and ethnic differences in stroke recurrence and mortality in a biethnic population, 2000-2019: a novel application of an illness-death model. Ann Epidemiol 2023; 85:51-58.e5. [PMID: 37054958 DOI: 10.1016/j.annepidem.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE To estimate temporal trends in post-stroke outcomes in Mexican Americans (MAs) and non-Hispanic whites (NHWs). METHODS We included first-ever ischemic strokes from a population-based study in South Texas (n = 5343, 2000-2019). We applied an illness-death model with three jointly specified Cox-type models to estimate ethnic differences and ethnic-specific temporal trends in recurrence (first stroke to recurrence), recurrence-free mortality (first stroke to death without recurrence), recurrence-affected mortality (first stroke to death with recurrence), and postrecurrence mortality (recurrence to death). RESULTS MAs had higher rates of postrecurrence mortality than NHWs in 2019 but lower rates in 2000. One-year risk of this outcome increased in MAs and decreased in NHWs, resulting in ethnic differences changing from -14.9% (95% CI -35.9%, -2.8%) in 2000 to 9.1% (1.7%, 18.9%) in 2018. For recurrence-free mortality, lower rates were observed in MAs until 2013. Ethnic differences in 1-year risk changed from -3.3% (95% CI -4.9%, -1.6%) in 2000 to -1.2% (-3.1%, 0.8%) in 2018. For stroke recurrence and recurrence-affected mortality, significant ethnic disparities persisted over the study period. CONCLUSIONS An ethnic disparity in postrecurrence mortality was newly identified, driven by the increasing trend in MAs but a decreasing trend in NHWs.
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Affiliation(s)
- Chen Chen
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Kevin He
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | - Lewis B Morgenstern
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor; Stroke Program, University of Michigan Medical School, Ann Arbor
| | - Xu Shi
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | | | - Lynda D Lisabeth
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor; Stroke Program, University of Michigan Medical School, Ann Arbor.
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11
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Acharya A, Chowdhury HR, Ihyauddin Z, Mahesh PKB, Adair T. Cardiovascular disease mortality based on verbal autopsy in low- and middle-income countries: a systematic review. Bull World Health Organ 2023; 101:571-586. [PMID: 37638359 PMCID: PMC10452938 DOI: 10.2471/blt.23.289802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 08/29/2023] Open
Abstract
Objective To conduct a systematic review of verbal autopsy studies in low- and middle-income countries to estimate the fraction of deaths due to cardiovascular disease. Method We searched MEDLINE®, Embase® and Scopus databases for verbal autopsy studies in low- and middle-income countries that reported deaths from cardiovascular disease. Two reviewers screened the studies, extracted data and assessed study quality. We calculated cause-specific mortality fractions for cardiovascular disease for each study, both overall and according to age, sex, geographical location and type of cardiovascular disease. Findings We identified 42 studies for inclusion in the review. Overall, the cardiovascular disease cause-specific mortality fractions for people aged 15 years and above was 22.9%. This fraction was generally higher for males (24.7%) than females (20.9%), but the pattern varied across World Health Organization regions. The highest cardiovascular disease mortality fraction was reported in the Western Pacific Region (26.3%), followed by the South-East Asia Region (24.1%) and the African Region (12.7%). The cardiovascular disease mortality fraction was higher in urban than rural populations in all regions, except the South-East Asia Region. The mortality fraction for ischaemic heart disease (12.3%) was higher than that for stroke (8.7%). Overall, 69.4% of cardiovascular disease deaths were reported in people aged 65 years and above. Conclusion The burden of cardiovascular disease deaths outside health-care settings in low- and middle-income countries is substantial. Increasing coverage of verbal autopsies in these countries could help fill gaps in cardiovascular disease mortality data and improve monitoring of national, regional and global health goals.
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Affiliation(s)
- Ajay Acharya
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition St, Melbourne, Victoria, 3000 VIC, Australia
| | | | - Zulfikar Ihyauddin
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition St, Melbourne, Victoria, 3000 VIC, Australia
| | - Pasyodun Koralage Buddhika Mahesh
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition St, Melbourne, Victoria, 3000 VIC, Australia
| | - Tim Adair
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition St, Melbourne, Victoria, 3000 VIC, Australia
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12
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Mosisa W, Gezehagn Y, Kune G, Chego M, Yigezu HF, Getnet M. Survival status and predictors of mortality among adult Stroke patients admitted to Jimma University Medical Center, South west Ethiopia: A retrospective Cohort study. Vasc Health Risk Manag 2023; 19:527-541. [PMID: 37649671 PMCID: PMC10464890 DOI: 10.2147/vhrm.s399815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023] Open
Abstract
Background Stroke is the leading cause of cardiovascular disease death in sub-Saharan Africa and the second leading cause of mortality worldwide. In 2016, 6.23% of all fatalities in Ethiopia were stroke-related. Objective To assess survival status and predictors of mortality among adult stroke patients admitted to Jimma University Medical Center from April 1/2017 to March 31/2022. Methods A retrospective cohort study was conducted on 480 adult stroke patients selected by simple random sampling from patients admitted to the Jimma University Medical Center Stroke Unit from April 1, 2017 to March 31, 2022. Data were extracted from May to June 2022 and entered Epi-data v.3.1 and analyzed by R v.4.2. The Kaplan-Meier curve with Log rank test was used to estimate survival time and to compare survival experience between categories of explanatory variables. The Cox regression model was computed to identify predictors of survival status in stroke patients. Then the 95% CI of the hazard ratio was set with corresponding p-value < 0.05 to declare statistical significance. Results During 4350 person-days of follow-up; 88 (18.33%) patients died; resulting in an incidence mortality of 20.23 per 1000 person-days, with a median survival time of 38 days. Glasgow coma score <8 on admission (AHR = 7.71; 95% CI: 3.78, 15.69), dyslipidemia (AHR = 3.96; 95% CI: 2.04, 7.69), aspiration pneumonia (AHR 2.30; 95% CI: 1.23-4.26), and increased intracranial pressure (AHR = 4.27; 95% CI: 2.33, 7.81), were the independent predictors of the time until death. Conclusion The incidence of stroke mortality was higher at the seven and fourteen days. Glasgow Coma Scale, increased intracranial pressure, dyslipidemia, and aspiration pneumonia were independent predictors of mortality.
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Affiliation(s)
- Wakgari Mosisa
- Department of Public Health, Institute of Health Sciences, Dambi Dollo University, Dambi Dollo, Ethiopia
| | - Yenealem Gezehagn
- Department of Epidemiology, College of Public Health, Jimma University, Jimma, Ethiopia
| | - Guta Kune
- Department of Epidemiology, College of Public Health, Jimma University, Jimma, Ethiopia
| | - Melese Chego
- Department of Public Health, Wollega University, Nekemte, Ethiopia
| | - Hamba Fida Yigezu
- Department of Public Health, Institute of Health Sciences, Dambi Dollo University, Dambi Dollo, Ethiopia
| | - Masrie Getnet
- Department of Epidemiology, College of Public Health, Jimma University, Jimma, Ethiopia
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13
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Ma Y, Wang T, Wang H, Amin-Hanjani S, Tong X, Wang J, Tong Z, Kuai D, Cai Y, Ren J, Wang D, Duan L, Maimaitili A, Hang C, Yu J, Bai X, Powers WJ, Derdeyn CP, Wu Y, Ling F, Gu Y, Jiao L. Extracranial-Intracranial Bypass and Risk of Stroke and Death in Patients With Symptomatic Artery Occlusion: The CMOSS Randomized Clinical Trial. JAMA 2023; 330:704-714. [PMID: 37606672 PMCID: PMC10445185 DOI: 10.1001/jama.2023.13390] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/29/2023] [Indexed: 08/23/2023]
Abstract
Importance Prior trials of extracranial-intracranial (EC-IC) bypass surgery showed no benefit for stroke prevention in patients with atherosclerotic occlusion of the internal carotid artery (ICA) or middle cerebral artery (MCA), but there have been subsequent improvements in surgical techniques and patient selection. Objective To evaluate EC-IC bypass surgery in symptomatic patients with atherosclerotic occlusion of the ICA or MCA, using refined patient and operator selection. Design, Setting, and Participants This was a randomized, open-label, outcome assessor-blinded trial conducted at 13 centers in China. A total of 324 patients with ICA or MCA occlusion with transient ischemic attack or nondisabling ischemic stroke attributed to hemodynamic insufficiency based on computed tomography perfusion imaging were recruited between June 2013 and March 2018 (final follow-up: March 18, 2020). Interventions EC-IC bypass surgery plus medical therapy (surgical group; n = 161) or medical therapy alone (medical group; n = 163). Medical therapy included antiplatelet therapy and stroke risk factor control. Main Outcomes and Measures The primary outcome was a composite of stroke or death within 30 days or ipsilateral ischemic stroke beyond 30 days through 2 years after randomization. There were 9 secondary outcomes, including any stroke or death within 2 years and fatal stroke within 2 years. Results Among 330 patients who were enrolled, 324 patients were confirmed eligible (median age, 52.7 years; 257 men [79.3%]) and 309 (95.4%) completed the trial. For the surgical group vs medical group, no significant difference was found for the composite primary outcome (8.6% [13/151] vs 12.3% [19/155]; incidence difference, -3.6% [95% CI, -10.1% to 2.9%]; hazard ratio [HR], 0.71 [95% CI, 0.33-1.54]; P = .39). The 30-day risk of stroke or death was 6.2% (10/161) in the surgical group and 1.8% (3/163) in the medical group, and the risk of ipsilateral ischemic stroke beyond 30 days through 2 years was 2.0% (3/151) and 10.3% (16/155), respectively. Of the 9 prespecified secondary end points, none showed a significant difference including any stroke or death within 2 years (9.9% [15/152] vs 15.3% [24/157]; incidence difference, -5.4% [95% CI, -12.5% to 1.7%]; HR, 0.69 [95% CI, 0.34-1.39]; P = .30) and fatal stroke within 2 years (2.0% [3/150] vs 0% [0/153]; incidence difference, 1.9% [95% CI, -0.2% to 4.0%]; P = .08). Conclusions and Relevance Among patients with symptomatic ICA or MCA occlusion and hemodynamic insufficiency, the addition of bypass surgery to medical therapy did not significantly change the risk of the composite outcome of stroke or death within 30 days or ipsilateral ischemic stroke beyond 30 days through 2 years. Trial Registration ClinicalTrials.gov Identifier: NCT01758614.
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Affiliation(s)
- Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China
| | - Haibo Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Sepideh Amin-Hanjani
- Cerebrovascular and Skull Base Surgery, Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Xiaoguang Tong
- Department of Neurosurgery, Huanhu Hospital, Tianjin, China
| | - Jiyue Wang
- Department of Neurosurgery, Liaocheng People’s Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Liaocheng City, Shandong, China
| | - Zhiyong Tong
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Dong Kuai
- Department of Neurosurgery, The Affiliated Cardiovascular Hospital of Shanxi Medical University and Shanxi Cardiovascular Hospital (Institute), Taiyuan, Shanxi, China
| | - Yiling Cai
- Department of Neurology, Strategic Support Force Medical Center, Beijing, China
| | - Jun Ren
- Department of Neurosurgery, The Second Hospital of Lan Zhou University, Lan Zhou, China
| | - Donghai Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, China
- Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China
| | - Lian Duan
- Department of Neurosurgery, The First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, HaiDian District, Beijing, China
| | - Aisha Maimaitili
- Department of Neurosurgery, The First Affiliated Hospital of Xinjiang Medical University, Xinshi District, Urumqi, Xinjiang,China
| | - Chunhua Hang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Neurosurgical Institute of Nanjing University, Nanjing University Medical School, Nanjing, China
| | - Jiasheng Yu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China
| | - William J. Powers
- Department of Neurology, Duke University School of Medicine, Duke South, Durham, North Carolina
| | - Colin P. Derdeyn
- Departments of Radiology and Neurology, University of Iowa Hospitals and Clinics, Iowa City
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Feng Ling
- Department of Neurosurgery and Interventional Neuroradiology, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China
| | - Yuxiang Gu
- Department of Neurosurgery, Huashan Hospital, Fudan University, National Center for Neurological Disorders, Shanghai, China
| | - Liqun Jiao
- Department of Neurosurgery and Interventional Neuroradiology, Xuanwu Hospital, China International Neuroscience Institute, Capital Medical University, National Center for Neurological Disorders, Beijing, China
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Soltanisarvestani M, Lynskey N, Gray S, Gill JMR, Pell JP, Sattar N, Welsh P, Ho FK, Celis-Morales C, Peterman-Rocha F. Associations of grip strength and walking pace with mortality in stroke survivors: A prospective study from UK Biobank. Scand J Med Sci Sports 2023; 33:1190-1200. [PMID: 36932055 DOI: 10.1111/sms.14352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Although stroke is an emerging cause of disability and mortality globally, associations between physical capability markers and mortality in stroke survivors are elusive. This study investigated the individual and combined associations of walking pace and grip strength with all-cause and stroke mortality in stroke survivors. METHODS Individual and combined associations of walking pace and grip strength with stroke deaths and all-cause mortality were investigated using Cox proportional-hazard models adjusted for sociodemographic, lifestyle, and health-related variables. RESULTS Seven thousand four hundred eighty-six stroke survivors from the UK Biobank study (aged 40-70 years; 42.4% women) were included in this prospective study. Over a median follow-up of 12.6 (IQR: 11.9-13.3) years, 1490 (19.9%) participants died, of whom 222 (3.0%) died from stroke. After adjusting for confounding factors, and compared to individuals in the average/brisk walking pace category, those who reported a slow walking pace had 2.00 (95% CI: 1.50-2.68) and 1.99 (95% CI: 1.78-2.23) times higher risk of stroke mortality and all-cause mortality, respectively. Similar associations were identified for participants with low grip strength compared with those with normal levels. For combined associations, those with both slow walking pace and low grip strength showed the highest risk of stroke mortality (hazard ratio: 2.86 [95% CI: 1.93-4.22]). Similar results were found for all-cause mortality. CONCLUSIONS Low grip strength and slow walking pace were associated with a higher risk of stroke and all-cause mortality in stroke survivors. If these associations are causal, improving physical capability among stroke survivors might potentially prolong survival.
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Affiliation(s)
- Maryam Soltanisarvestani
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Nathan Lynskey
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Stuart Gray
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Jason M R Gill
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Paul Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Frederick K Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Carlos Celis-Morales
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Laboratorio de Rendimiento Humano, Grupo de Estudio en Educación, Actividad Física y Salud (GEEAFyS), Universidad Católica del Maule, Talca, Chile
| | - Fanny Peterman-Rocha
- British Heart Foundation Glasgow Cardiovascular Research Centre, School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
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15
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Looti AL, Ovbiagele B, Markovic D, Towfighi A. All-Cause, Cardiovascular, and Stroke Mortality Among Foreign-Born Versus US-Born Individuals of African Ancestry. J Am Heart Assoc 2023; 12:e026331. [PMID: 37119071 PMCID: PMC10227213 DOI: 10.1161/jaha.122.026331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 03/03/2023] [Indexed: 04/30/2023]
Abstract
Background Little is known about the effect of region of origin on all-cause mortality, cardiovascular mortality, and stroke mortality among Black individuals. We examined associations between nativity and mortality (all-cause, cardiovascular, and stroke) in Black individuals in the United States. Methods and Results Using the National Health Interview Service 2000 to 2014 data and mortality-linked files through 2015, we identified participants aged 25 to 74 years who self-identified as Black (n=64 717). Using a Cox regression model, we examined the association between nativity and all-cause, cardiovascular, and stroke mortality. We recorded 4329 deaths (205 stroke and 932 cardiovascular deaths). In the model adjusted for age and sex, compared with US-born Black individuals, all-cause (hazard ratio [HR], 0.44 [95% CI, 0.37-0.53]) and cardiovascular mortality (HR, 0.66 [95% CI, 0.44-0.87]) rates were lower among Black individuals born in the Caribbean, South America, and Central America, but stroke mortality rates were similar (HR, 1.01 [95% CI, 0.52-1.94]). African-born Black individuals had lower all-cause mortality (HR, 0.43 [95% CI, 0.27-0.69]) and lower cardiovascular mortality (HR, 0.42 [95% CI, 0.18-0.98]) but comparable stroke mortality (HR, 0.48 [95% CI, 0.11-2.05]). When the model was further adjusted for education, income, smoking, body mass index, hypertension, and diabetes, the difference in mortality between foreign-born Black individuals and US-born Black individuals was no longer significant. Time since migration did not significantly affect mortality outcomes among foreign-born Black individuals. Conclusions In the United States, foreign-born Black individuals had lower all-cause mortality, a difference that was observed in recent and well-established immigrants. Foreign-born Black people had age- and sex-adjusted lower cardiovascular mortality than US-born Black people.
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Affiliation(s)
- Alain Lekoubou Looti
- Department of NeurologyPenn State University, Hershey Medical CenterHersheyPAUSA
| | - Bruce Ovbiagele
- Department of NeurologyUniversity of CaliforniaSan FranciscoCAUSA
| | - Daniela Markovic
- Department of BiomathematicsUniversity of California at Los AngelesLos AngelesCAUSA
| | - Amytis Towfighi
- Department of NeurologyUniversity of Southern CaliforniaLos AngelesCAUSA
- Los Angeles County Department of Health ServicesLos AngelesCAUSA
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16
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Pan R, Xie M, Chen M, Zhang Y, Ma J, Zhou J. The impact of heat waves on the mortality of Chinese population: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33345. [PMID: 37000079 PMCID: PMC10063284 DOI: 10.1097/md.0000000000033345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Many studies had shown that with global warming, heat waves may increase the mortality risk of Chinese populations. However, these findings are not consistent. Therefore, we elucidated the associations by meta-analysis and quantified the magnitude of these risks, as well as the underlying factors. METHODS We searched the China National Knowledge Infrastructure (CNKI), Wanfang database, PubMed, EMBASE, and Web of Science for literature screening up to Nov 10, 2022, to analyze the effect of heat waves on mortality in the Chinese population. Literature screening and data extraction were performed independently by two researchers and the data were merged by meta-analysis. In addition, we conducted subgroup analysis by sex, age, years of education, region, and number of events to explore the source of heterogeneity. RESULTS Fifteen related studies on the impact on heat waves of the death of Chinese people were included in this study. The results of the meta-analysis showed that heat waves were significantly associated with increased mortality from non-accidental deaths, cardiovascular diseases, stroke, respiratory diseases, and circulatory diseases in the Chinese population: non-accidental mortality (RR = 1.19, 95% CI: 1.13-1.27, P < .01), cardiovascular diseases (RR = 1.25, 95% CI: 1.14-1.38), stroke (RR = 1.11, 95% CI: 1.03-1.20), respiratory diseases (RR = 1.18, 95% CI: 1.09-1.28), and circulatory diseases (RR = 1.11, 95% CI: 1.06-1.17). Subgroup analyses showed that heat waves had a higher risk of non-accidental death for those with <6 years of education than for those with ≥6 years of education. Meta-regression analysis showed that the contribution of the study year to the inter studied heterogeneity was 50.57%. The sensitivity analysis showed that the exclusion of any single study did not materially alter the overall combined effect. The meta-analysis method indicated no obvious evidence of publication bias. CONCLUSIONS The results of the review indicated that heat waves were associated with increased mortality in the Chinese population, that attention should be paid to high-risk groups, and that public health policies and strategies should be implemented to more effectively respond to and adapt to climate change.
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Affiliation(s)
- Ranran Pan
- Department of Science and Education, Shuyang Hospital of Traditional Chinese Medicine, Shuyang, China
| | - Ming Xie
- Department of Science and Education, The Third Hospital of Changsha, Changsha, China
| | - Mengxiang Chen
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Yannan Zhang
- Jiangyin Center for Disease Control and Prevention, Jiangyin, China
| | - Jian Ma
- Huaian Center for Disease Control and Prevention, Huaian, China
| | - Junhua Zhou
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
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17
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Liou L, Mostofsky E, Lehman L, Salia S, Gupta S, Barrera FJ, Mittleman MA. Racial disparities in post-transplant stroke and mortality following stroke in adult cardiac transplant recipients in the United States. PLoS One 2023; 18:e0268275. [PMID: 36795697 PMCID: PMC9934340 DOI: 10.1371/journal.pone.0268275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/13/2022] [Indexed: 02/17/2023] Open
Abstract
Black heart transplant recipients have a higher mortality rate than white recipients 6-12 months after transplant. Whether there are racial disparities in post-transplant stroke incidence and all-cause mortality following post-transplant stroke among cardiac transplant recipients is unknown. Using a nationwide transplant registry, we assessed the association between race and incident post-transplant stroke using logistic regression and the association between race and mortality among adults who survived a post-transplant stroke using Cox proportional hazards regression. We found no evidence of an association between race and the odds of post-transplant stroke (OR = 1.00, 95% CI: 0.83-1.20). The median survival time of those with a post-transplant stroke in this cohort was 4.1 years (95% CI: 3.0, 5.4). There were 726 deaths among the 1139 patients with post-transplant stroke, including 127 deaths among 203 Black patients and 599 deaths among 936 white patients. Among post-transplant stroke survivors, Black transplant recipients experienced a 23% higher rate of mortality compared to white recipients (HR = 1.23, 95% CI: 1.00-1.52). This disparity is strongest in the period beyond the first 6 months and appears to be mediated by differences in the post-transplant setting of care between Black and white patients. The racial disparity in mortality outcomes was not evident in the past decade. The improved survival of Black patients in the recent decade may reflect overall protocol improvements for heart transplant recipients irrespective of race, such as advancements in surgical techniques and immediate postoperative care as well as increased awareness about reducing racial disparities.
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Affiliation(s)
- Lathan Liou
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Merck & Co., Merck Research Laboratories, Boston, Massachusetts, United States of America
| | - Elizabeth Mostofsky
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Laura Lehman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Soziema Salia
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Suruchi Gupta
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Francisco J. Barrera
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Murray A. Mittleman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- * E-mail:
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18
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Gao P, Wang T, Jiao L. Stenting Plus Medical Therapy and Risk of Stroke and Death in Patients With Symptomatic Intracranial Stenosis-Reply. JAMA 2022; 328:2457. [PMID: 36573982 DOI: 10.1001/jama.2022.18921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Peng Gao
- Departments of Neurosurgery and Interventional Neuroradiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Tao Wang
- Departments of Neurosurgery and Interventional Neuroradiology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Liqun Jiao
- Departments of Neurosurgery and Interventional Neuroradiology, Xuanwu Hospital of Capital Medical University, Beijing, China
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19
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Zedde M, Pascarella R. Stenting Plus Medical Therapy and Risk of Stroke and Death in Patients With Symptomatic Intracranial Stenosis. JAMA 2022; 328:2455-2456. [PMID: 36573985 DOI: 10.1001/jama.2022.18915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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20
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Alexander MJ, Yu W. Stenting Plus Medical Therapy and Risk of Stroke and Death in Patients With Symptomatic Intracranial Stenosis. JAMA 2022; 328:2456-2457. [PMID: 36573984 DOI: 10.1001/jama.2022.18918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Michael J Alexander
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Wengui Yu
- Irvine Medical Center, Department of Neurology, University of California, Irvine
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21
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Jovin TG, Li C, Wu L, Wu C, Chen J, Jiang C, Shi Z, Gao Z, Song C, Chen W, Peng Y, Yao C, Wei M, Li T, Wei L, Xiao G, Yang H, Ren M, Duan J, Liu X, Yang Q, Liu Y, Zhu Q, Shi W, Zhu Q, Li X, Guo Z, Yang Q, Hou C, Zhao W, Ma Q, Zhang Y, Jiao L, Zhang H, Liebeskind DS, Liang H, Jadhav AP, Wen C, Brown S, Zhu L, Ye H, Ribo M, Chang M, Song H, Chen J, Ji X. Trial of Thrombectomy 6 to 24 Hours after Stroke Due to Basilar-Artery Occlusion. N Engl J Med 2022; 387:1373-1384. [PMID: 36239645 DOI: 10.1056/nejmoa2207576] [Citation(s) in RCA: 174] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The effects and risks of endovascular thrombectomy 6 to 24 hours after stroke onset due to basilar-artery occlusion have not been extensively studied. METHODS In a trial conducted over a 5-year period in China, we randomly assigned, in a 1:1 ratio, patients with basilar-artery stroke who presented between 6 to 24 hours after symptom onset to receive either medical therapy plus thrombectomy or medical therapy only (control). The original primary outcome, a score of 0 to 4 on the modified Rankin scale (range, 0 to 6, with a score of 0 indicating no disability, 4 moderately severe disability, and 6 death) at 90 days, was changed to a good functional status (a modified Rankin scale score of 0 to 3, with a score of 3 indicating moderate disability). Primary safety outcomes were symptomatic intracranial hemorrhage at 24 hours and 90-day mortality. RESULTS A total of 217 patients (110 in the thrombectomy group and 107 in the control group) were included in the analysis; randomization occurred at a median of 663 minutes after symptom onset. Enrollment was halted at a prespecified interim analysis because of the superiority of thrombectomy. Thrombolysis was used in 14% of the patients in the thrombectomy group and in 21% of those in the control group. A modified Rankin scale score of 0 to 3 (primary outcome) occurred in 51 patients (46%) in the thrombectomy group and in 26 (24%) in the control group (adjusted rate ratio, 1.81; 95% confidence interval [CI], 1.26 to 2.60; P<0.001). The results for the original primary outcome of a modified Rankin scale score of 0 to 4 were 55% and 43%, respectively (adjusted rate ratio, 1.21; 95% CI, 0.95 to 1.54). Symptomatic intracranial hemorrhage occurred in 6 of 102 patients (6%) in the thrombectomy group and in 1 of 88 (1%) in the control group (risk ratio, 5.18; 95% CI, 0.64 to 42.18). Mortality at 90 days was 31% in the thrombectomy group and 42% in the control group (adjusted risk ratio, 0.75; 95% CI, 0.54 to 1.04). Procedural complications occurred in 11% of the patients who underwent thrombectomy. CONCLUSIONS Among patients with stroke due to basilar-artery occlusion who presented 6 to 24 hours after symptom onset, thrombectomy led to a higher percentage with good functional status at 90 days than medical therapy but was associated with procedural complications and more cerebral hemorrhages. (Funded by the Chinese National Ministry of Science and Technology; BAOCHE ClinicalTrials.gov number, NCT02737189.).
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Affiliation(s)
- Tudor G Jovin
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Chuanhui Li
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Longfei Wu
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Chuanjie Wu
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Jian Chen
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Changchun Jiang
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Zhonghua Shi
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Zongen Gao
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Cunfeng Song
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Wenhuo Chen
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Ya Peng
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Chen Yao
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Ming Wei
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Tong Li
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Liping Wei
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Guodong Xiao
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Hua Yang
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Ming Ren
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Jiangang Duan
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Xinfeng Liu
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Qingwu Yang
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Yuxiu Liu
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Qingfeng Zhu
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Wanchao Shi
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Qiyi Zhu
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Xiaobo Li
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Zaiyu Guo
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Qi Yang
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Chengbei Hou
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Wenbo Zhao
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Qingfeng Ma
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Yunzhou Zhang
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Liqun Jiao
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Hongqi Zhang
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - David S Liebeskind
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Hui Liang
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Ashutosh P Jadhav
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Changming Wen
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Scott Brown
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Liangfu Zhu
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Huawei Ye
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Marc Ribo
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Mingze Chang
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Haiqing Song
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Jun Chen
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
| | - Xunming Ji
- From the Department of Neurosurgery (T.G.J., Jian Chen, L.J., H.Z., X.J.), the Department of Neurology (C.L., L.W., C.W., W.Z., Q.M., Y.Z., H.S.), the Stroke Center (C.L.), the Department of Emergency Medicine (J.D.), and the Center for Evidence-Based Medicine (C.H.), Xuanwu Hospital, and the Department of Radiology, Beijing Chaoyang Hospital (Q.Y.), Capital Medical University, and Peking University Clinical Research Institute, Peking University First Hospital (C.Y.), Beijing, the Department of Neurology, Baotou Central Hospital of Inner Mongolia Medical University (C.J.), Baotou, the Department of Neurosurgery, the 904th Hospital of the People's Liberation Army (PLA), Wuxi (Z.S.); the Department of Neurology, Central Hospital of Shengli Oil Field, Dongying (Z.G.), the Department of Neurology, Liaocheng Third People's Hospital, Liaocheng (C.S.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurosurgery, the First People's Hospital of Changzhou, Changzhou (Y.P.), the Department of Neurosurgery, Tianjin Huanhu Hospital (M.W.), the Department of Neurosurgery, Binhai Hospital of Beijing University (W.S.), and the Department of Neurosurgery, Tianjin Teda Hospital (Z.G.), Tianjin, the Department of Neurology, Nanning Second People's Hospital, Nanning (T.L.), the Department of Radiology, Luoyang Central Hospital of Zhengzhou University, Luoyang (L.W.), the Department of Neurology and the Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University, Suzhou (G.X.), the Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang (H.Y.), the Department of Neurology, Shanghai Blue Cross Hospital, Shanghai (M.R.), the Department of Neurology (X.L.), and the Department of Critical Care Medicine, Data and Statistics Division (Y.L.), Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, the Department of Neurology, Xinqiao Hospital and Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing (Q.Y.), the Department of Neurosurgery, 985th Hospital of the PLA, Taiyuan (Qingfeng Zhu), the Department of Neurology, Linyi People's Hospital, Linyi (Qiyi Zhu), the Department of Neurology, Subei People's Hospital, Yangzhou (X.L.), the Department of Neurology, Yantaishan Hospital of Shandong First Medical University, Yantai (H.L.), the Department of Neurology, Nanyang Central Hospital of Xinxiang Medical University, Nanyang (C.W.), the Cerebrovascular Center, Henan Provincial People's Hospital, Zhengzhou (L.Z.), the Department of Neurosurgery, Hospital of Baoan People's Hospital, Shenzhen (H.Y.), and the Department of Neurology, Xi'an No.3 Hospital, Xi'an (M.C.), - all in China; Cooper University Healthcare and Cooper Medical School of Rowan University (T.G.J.), Camden, NJ; the Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (D.S.L.); the Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (A.P.J.); Altair Biostatistics, Mooresville, NC (S.B.); the Stroke Unit, Hospital Vall d'Hebrón, Barcelona (M.R.); and the Department of Neurology, Pittsburgh Institute of Brain Disorder and Recovery, University of Pittsburgh Medical Center and Veterans Affairs Pittsburgh Health Care System, Geriatric Research Education and Clinical Center, Pittsburgh (Jun Chen)
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Tao C, Nogueira RG, Zhu Y, Sun J, Han H, Yuan G, Wen C, Zhou P, Chen W, Zeng G, Li Y, Ma Z, Yu C, Su J, Zhou Z, Chen Z, Liao G, Sun Y, Ren Y, Zhang H, Chen J, Yue X, Xiao G, Wang L, Liu R, Liu W, Liu Y, Wang L, Zhang C, Liu T, Song J, Li R, Xu P, Yin Y, Wang G, Baxter B, Qureshi AI, Liu X, Hu W. Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion. N Engl J Med 2022; 387:1361-1372. [PMID: 36239644 DOI: 10.1056/nejmoa2206317] [Citation(s) in RCA: 168] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Data from trials investigating the effects and risks of endovascular thrombectomy for the treatment of stroke due to basilar-artery occlusion are limited. METHODS We conducted a multicenter, prospective, randomized, controlled trial of endovascular thrombectomy for basilar-artery occlusion at 36 centers in China. Patients were assigned, in a 2:1 ratio, within 12 hours after the estimated time of basilar-artery occlusion to receive endovascular thrombectomy or best medical care (control). The primary outcome was good functional status, defined as a score of 0 to 3 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]), at 90 days. Secondary outcomes included a modified Rankin scale score of 0 to 2, distribution across the modified Rankin scale score categories, and quality of life. Safety outcomes included symptomatic intracranial hemorrhage at 24 to 72 hours, 90-day mortality, and procedural complications. RESULTS Of the 507 patients who underwent screening, 340 were in the intention-to-treat population, with 226 assigned to the thrombectomy group and 114 to the control group. Intravenous thrombolysis was used in 31% of the patients in the thrombectomy group and in 34% of those in the control group. Good functional status at 90 days occurred in 104 patients (46%) in the thrombectomy group and in 26 (23%) in the control group (adjusted rate ratio, 2.06; 95% confidence interval [CI], 1.46 to 2.91, P<0.001). Symptomatic intracranial hemorrhage occurred in 12 patients (5%) in the thrombectomy group and in none in the control group. Results for the secondary clinical and imaging outcomes were generally in the same direction as those for the primary outcome. Mortality at 90 days was 37% in the thrombectomy group and 55% in the control group (adjusted risk ratio, 0.66; 95% CI, 0.52 to 0.82). Procedural complications occurred in 14% of the patients in the thrombectomy group, including one death due to arterial perforation. CONCLUSIONS In a trial involving Chinese patients with basilar-artery occlusion, approximately one third of whom received intravenous thrombolysis, endovascular thrombectomy within 12 hours after stroke onset led to better functional outcomes at 90 days than best medical care but was associated with procedural complications and intracerebral hemorrhage. (Funded by the Program for Innovative Research Team of the First Affiliated Hospital of USTC and others; ATTENTION ClinicalTrials.gov number, NCT04751708.).
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Affiliation(s)
- Chunrong Tao
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Raul G Nogueira
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Yuyou Zhu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Jun Sun
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Hongxing Han
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Guangxiong Yuan
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Changming Wen
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Peiyang Zhou
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Wenhuo Chen
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Guoyong Zeng
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Yuwen Li
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Zhengfei Ma
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Chuanqing Yu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Junfeng Su
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Zhiming Zhou
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Zhongjun Chen
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Geng Liao
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Yaxuan Sun
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Youquan Ren
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Hui Zhang
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Jie Chen
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Xincan Yue
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Guodong Xiao
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Li Wang
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Rui Liu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Wenhua Liu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Yong Liu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Li Wang
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Chao Zhang
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Tianlong Liu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Jianlong Song
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Rui Li
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Pengfei Xu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Yamei Yin
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Guoping Wang
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Blaise Baxter
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Adnan I Qureshi
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Xinfeng Liu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
| | - Wei Hu
- From the Stroke Center and Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei (C.T., Y.Z., J. Sun, Li Wang, C.Z., T.L., J. Song, R. Li, P.X., Y.Y., G.W., X.L., W.H.), the Department of Neurology, Linyi People's Hospital, Linyi (H.H.), the Emergency Department, Xiangtan Central Hospital, Xiangtan (G.Y.), the Department of Neurology, Nanyang Central Hospital, Nanyang (C.W.), the Department of Neurology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang (P.Z.), the Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou (W.C.), the Department of Neurology, Ganzhou People's Hospital, Ganzhou (G.Z.), the Department of Neurology, Heze Municipal Hospital, Heze (Y. Li), the Department of Neurology, Suzhou Hospital of Anhui Medical University (Z.M.), and the Department of Neurology and Clinical Research Center of Neurologic Disease, Second Affiliated Hospital of Soochow University (G.X.), Suzhou, the Department of Neurology, First Affiliated Hospital of Anhui University of Science and Technology, First People's Hospital of Huainan, Huainan (C.Y.), the Department of Neurology, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou (J. Su), the Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu (Z.Z.), the Department of Neurointervention, Dalian Municipal Central Hospital Affiliated with Dalian Medical University, Dalian (Z.C.), the Department of Neurology, Maoming People's Hospital, Maoming (G.L.), the Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan (Y.S.), the Department of Neurology, Linquan Country People's Hospital, Linquan (Y.R.), the Department of Neurosurgery, Second Affiliated Hospital of Bengbu Medical College, Bengbu (H.Z.), the Department of Neurosurgery, Tongling People's Hospital, Tongling (J.C.), the Department of Neurosurgery, Zhoukou Central Hospital of Henan University, Zhoukou (X.Y.), the Department of Neurology, Zigong Third People's Hospital, Zigong (Li Wang), the Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing (R. Liu, X.L.), the Department of Neurology, Wuhan No. 1 Hospital, Wuhan (W.L.), and the Department of Neurology, Lu'an Hospital of Anhui Medical University, Lu'an (Y. Liu) - all in China; the UPMC Stroke Institute, Department of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.), and Lehigh Valley Health Network, Allentown (B.B.) - both in Pennsylvania; and the Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia (A.I.Q.)
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Chou R, Cantor A, Dana T, Wagner J, Ahmed AY, Fu R, Ferencik M. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 328:754-771. [PMID: 35997724 DOI: 10.1001/jama.2022.12138] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE A 2016 review for the US Preventive Services Task Force (USPSTF) found use of statins for primary prevention of cardiovascular disease (CVD) was associated with reduced mortality and cardiovascular outcomes. OBJECTIVE To update the 2016 review on statins for primary prevention of CVD to inform the USPSTF. DATA SOURCES Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to November 2021); surveillance through May 20, 2022. STUDY SELECTION Randomized clinical trials on statins vs placebo or no statin and statin intensity in adults without prior cardiovascular events; large cohort studies on harms. DATA EXTRACTION AND SYNTHESIS One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. MAIN OUTCOMES AND MEASURES All-cause and cardiovascular mortality, myocardial infarction, stroke, composite cardiovascular outcomes, and adverse events. RESULTS Twenty-six studies were included: 22 trials (N = 90 624) with 6 months to 6 years of follow-up compared statins vs placebo or no statin, 1 trial (n = 5144) compared statin intensities, and 3 observational studies (n = 417 523) reported harms. Statins were significantly associated with decreased risk of all-cause mortality (risk ratio [RR], 0.92 [95% CI, 0.87 to 0.98]; absolute risk difference [ARD], -0.35% [95% CI, -0.57% to -0.14%]), stroke (RR, 0.78 [95% CI, 0.68 to 0.90]; ARD, -0.39% [95% CI, -0.54% to -0.25%]), myocardial infarction (RR, 0.67 [95% CI, 0.60 to 0.75]; ARD, -0.85% [95% CI, -1.22% to -0.47%]), and composite cardiovascular outcomes (RR, 0.72 [95% CI, 0.64 to 0.81]; ARD, -1.28% [95% CI, -1.61% to -0.95%]); the association with cardiovascular mortality was not statistically significant (RR, 0.91 [95% CI, 0.81 to 1.02]; ARD, -0.13%). Relative benefits were consistent in groups defined by demographic and clinical characteristics, although data for persons older than 75 years were sparse. Statin therapy was not significantly associated with increased risk of serious adverse events (RR, 0.97 [95% CI, 0.93 to 1.01]), myalgias (RR, 0.98 [95% CI, 0.86 to 1.11]), or elevated alanine aminotransferase level (RR, 0.94 [95% CI, 0.78 to 1.13]). Statin therapy was not significantly associated with increased diabetes risk overall (RR, 1.04 [95% CI, 0.92 to 1.19]), although 1 trial found high-intensity statin therapy was significantly associated with increased risk (RR, 1.25 [95% CI, 1.05 to 1.49]). Otherwise, there were no clear differences in outcomes based on statin intensity. CONCLUSIONS AND RELEVANCE In adults at increased CVD risk but without prior CVD events, statin therapy for primary prevention of CVD was associated with reduced risk of all-cause mortality and CVD events. Benefits of statin therapy appear to be present across diverse demographic and clinical populations, with consistent relative benefits in groups defined by demographic and clinical characteristics.
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Affiliation(s)
- Roger Chou
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Amy Cantor
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
- Department of Family Medicine, Oregon Health & Science University, Portland
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Tracy Dana
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Jesse Wagner
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Azrah Y Ahmed
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Rongwei Fu
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland
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Yoshida H, Itoh S, Ferdousi F, Isoda H. Post-stroke treatment with K-134, a phosphodiesterase 3 inhibitor, improves stroke outcomes in the stroke-prone spontaneously hypertensive rat model-A comparative evaluation of antiplatelet drugs. J Pharmacol Sci 2022; 148:229-237. [PMID: 35063138 DOI: 10.1016/j.jphs.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/14/2021] [Accepted: 12/02/2021] [Indexed: 11/17/2022] Open
Abstract
Post-stroke antiplatelet therapy has been proved to reduce the risk of recurrent stroke; however, it may also increase the incidence of intracranial hemorrhage that could offset any benefits. Therefore, the balance between the benefits and risks of antiplatelet drugs is a critical issue to consider. In the present study, we have compared the effects of post-stroke administration of antiplatelet agents on functional outcomes in the stroke-prone spontaneously hypertensive rat (SHRSP), an established animal model that mimics human lacunar stroke and cerebral small vessel disease. We confirmed that a potent phosphodiesterase 3 (PDE3) inhibitor, K-134, significantly improved post-stroke survival rate and survival time, attenuated stroke-induced neurological deficits, and decreased the incidence of cerebral lesion caused by intracerebral hemorrhage and softening. Similarly, cilostazol showed beneficial effects, though to a lower extent with respect to the survival outcome and neurological symptoms. On the other hand, a P2Y12 inhibitor, clopidogrel significantly improved survival outcomes at the higher dose but caused massive bleeding in the brain at both low and high doses. In contrast, no hemorrhagic lesion was observed in K-134-treated SHRSPs despite its antiplatelet activity. Our findings indicate that K-134 may have a superior post-stroke therapeutic outcome in comparison to other antiplatelet drugs.
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Affiliation(s)
- Hideo Yoshida
- Tokyo New Drug Research Laboratories, Kowa Company, Ltd., Tokyo, Japan; Graduate School of Science and Technology, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Shinsuke Itoh
- Tokyo New Drug Research Laboratories, Kowa Company, Ltd., Tokyo, Japan
| | - Farhana Ferdousi
- Alliance for Research on the Mediterranean and North Africa (ARENA), University of Tsukuba, Tsukuba, Ibaraki, Japan; AIST-University of Tsukuba Open Innovation Laboratory for Food and Medicinal Resource Engineering (FoodMed-OIL), University of Tsukuba, Tsukuba, Japan; Faculty of Life and Environmental Sciences, University of Tsukuba, Tsukuba, Japan
| | - Hiroko Isoda
- Alliance for Research on the Mediterranean and North Africa (ARENA), University of Tsukuba, Tsukuba, Ibaraki, Japan; AIST-University of Tsukuba Open Innovation Laboratory for Food and Medicinal Resource Engineering (FoodMed-OIL), University of Tsukuba, Tsukuba, Japan; Faculty of Life and Environmental Sciences, University of Tsukuba, Tsukuba, Japan
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25
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Levy B, Girerd N, Amour J, Besnier E, Nesseler N, Helms J, Delmas C, Sonneville R, Guidon C, Rozec B, David H, Bougon D, Chaouch O, Walid O, Hervé D, Belin N, Gaide-Chevronnay L, Rossignol P, Kimmoun A, Duarte K, Slutsky AS, Brodie D, Fellahi JL, Ouattara A, Combes A. Effect of Moderate Hypothermia vs Normothermia on 30-Day Mortality in Patients With Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation: A Randomized Clinical Trial. JAMA 2022; 327:442-453. [PMID: 35103766 PMCID: PMC8808325 DOI: 10.1001/jama.2021.24776] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/22/2021] [Indexed: 12/12/2022]
Abstract
IMPORTANCE The optimal approach to the use of venoarterial extracorporeal membrane oxygenation (ECMO) during cardiogenic shock is uncertain. OBJECTIVE To determine whether early use of moderate hypothermia (33-34 °C) compared with strict normothermia (36-37 °C) improves mortality in patients with cardiogenic shock receiving venoarterial ECMO. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial of patients (who were eligible if they had been endotracheally intubated and were receiving venoarterial ECMO for cardiogenic shock for <6 hours) conducted in the intensive care units at 20 French cardiac shock care centers between October 2016 and July 2019. Of 786 eligible patients, 374 were randomized. Final follow-up occurred in November 2019. INTERVENTIONS Early moderate hypothermia (33-34 °C; n = 168) for 24 hours or strict normothermia (36-37 °C; n = 166). MAIN OUTCOMES AND MEASURES The primary outcome was mortality at 30 days. There were 31 secondary outcomes including mortality at days 7, 60, and 180; a composite outcome of death, heart transplant, escalation to left ventricular assist device implantation, or stroke at days 30, 60, and 180; and days without requiring a ventilator or kidney replacement therapy at days 30, 60, and 180. Adverse events included rates of severe bleeding, sepsis, and number of units of packed red blood cells transfused during venoarterial ECMO. RESULTS Among the 374 patients who were randomized, 334 completed the trial (mean age, 58 [SD, 12] years; 24% women) and were included in the primary analysis. At 30 days, 71 patients (42%) in the moderate hypothermia group had died vs 84 patients (51%) in the normothermia group (adjusted odds ratio, 0.71 [95% CI, 0.45 to 1.13], P = .15; risk difference, -8.3% [95% CI, -16.3% to -0.3%]). For the composite outcome of death, heart transplant, escalation to left ventricular assist device implantation, or stroke at day 30, the adjusted odds ratio was 0.61 (95% CI, 0.39 to 0.96; P = .03) for the moderate hypothermia group compared with the normothermia group and the risk difference was -11.5% (95% CI, -23.2% to 0.2%). Of the 31 secondary outcomes, 30 were inconclusive. The incidence of moderate or severe bleeding was 41% in the moderate hypothermia group vs 42% in the normothermia group. The incidence of infections was 52% in both groups. The incidence of bacteremia was 20% in the moderate hypothermia group vs 30% in the normothermia group. CONCLUSIONS AND RELEVANCE In this randomized clinical trial involving patients with refractory cardiogenic shock treated with venoarterial ECMO, early application of moderate hypothermia for 24 hours did not significantly increase survival compared with normothermia. However, because the 95% CI was wide and included a potentially important effect size, these findings should be considered inconclusive. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02754193.
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Affiliation(s)
- Bruno Levy
- Médecine Intensive et Réanimation, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy, France
- INSERM U1116, Faculté de Médecine, Vandoeuvre-les-Nancy, France
- Université de Lorraine, Nancy, France
| | - Nicolas Girerd
- Université de Lorraine, INSERM, Centre d’Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, Frances
- INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
| | - Julien Amour
- Institut de Perfusion, de Réanimation et d’Anesthésie de Chirurgie Cardiaque Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Emmanuel Besnier
- Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France
- Normandie University, UNIROUEN, INSERM U1096, EnVi, Rouen, France
| | - Nicolas Nesseler
- Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France
- University Rennes, CHU de Rennes, Inra, INSERM, Institut NUMECAN – UMR_A 1341, UMR_S 1241, CIC 1414 (Centre d’Investigation Clinique de Rennes), Rennes, France
| | - Julie Helms
- Université de Strasbourg, Faculté de Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Strasbourg, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Rangueil University Hospital, Toulouse, France
| | - Romain Sonneville
- AP-HP, Bichat Hospital, Medical and infectious diseases ICU, Paris, France
| | | | - Bertrand Rozec
- Service d’Anesthésie-Réanimation, Hôpital G&R Laennec CHU de Nantes, Nantes, France
- L’institut du Thorax INSERM, CNRS, CHU Nantes, UNIV Nantes, Nantes, France
| | - Helène David
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
- Montpellier University, INSERM, CNRS, PhyMedExp, Montpellier, France
| | - David Bougon
- Service de Réanimation, Centre Hospitalier Annecy, Genevois, France
| | - Oussama Chaouch
- Hôpital Européen Georges Pompidou, AP-HP, Department of Anesthesiology and Critical Care Medicine, Université Paris Descartes, Paris, France
| | - Oulehri Walid
- Service d’Anesthésie-Réanimation et Médecine péri-Opératoire, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Dupont Hervé
- Réanimation Médico-Chirurgicale Cardio-Thoracique, Vasculaire et Respiratoire, CHU Amiens Picardie, Amiens, France
| | - Nicolas Belin
- Service de Réanimation Médicale, CHU Besançon, Besançon, France
| | - Lucie Gaide-Chevronnay
- Unité de Réanimation Cardiovasculaire et Thoracique, Pôle Anesthésie Réanimation, CHU de Grenoble Alpes, Grenoble, France
| | | | - Antoine Kimmoun
- Médecine Intensive et Réanimation, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-les-Nancy, France
| | - Kevin Duarte
- Université de Lorraine, Centre d’Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France
| | - Arthur S. Slutsky
- Keenan Research Center, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, Surgery, and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Brodie
- Department of Medicine, College of Physicians and Surgeons, Columbia University, and the Center for Acute Respiratory Failure, New York-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Jean-Luc Fellahi
- Service d’Anesthésie-Réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
- Laboratoire CarMeN, INSERM 1060, Université Lyon 1 Claude Bernard, Lyon, France
| | - Alexandre Ouattara
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, Bordeaux, France
- University Bordeaux, INSERM, UMR 1034, Biology of Cardiovascular Diseases, Pessac, France
| | - Alain Combes
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié–Salpêtrière, Paris, France
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Kim D, Kim JH, Park SW, Han HW, An SJ, Kim YI, Ju HJ, Choi Y, Kim DY. Predictive value of the videofluoroscopic swallowing study for long-term mortality in patients with subacute stroke. Medicine (Baltimore) 2022; 101:e28623. [PMID: 35089200 PMCID: PMC8797482 DOI: 10.1097/md.0000000000028623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/29/2021] [Indexed: 01/05/2023] Open
Abstract
To investigate the usefulness of the videofluoroscopic swallowing study (VFSS) for subacute stroke in predicting long-term all-cause mortality, including not only simple parameters obtained from VFSS results, but also recommended dietary type as an integrated parameter.This was a retrospective study of patients with subacute (<1 month) stroke at a university hospital between February 2014 and September 2019. The independent risk factors were investigated using stepwise Cox regression analysis, which increased the all-cause mortality of patients with stroke among VFSS parameters.A total of 242 patients with subacute stroke were enrolled. The significant mortality-associated factors were age, history of cancer, recommended dietary type (modified dysphagia diet; adjusted hazard ratio [HR], 6.971; P = .014; tube diet, adjusted HR: 10.169; P = .019), and Modified Barthel Index. In the subgroup survival analysis of the modified dysphagia diet group (n = 173), the parameters for fluid penetration (adjusted HR: 1.911; 95% confidence interval, 1.086-3.363; P = .025) and fluid aspiration (adjusted HR: 2.236; 95% confidence interval, 1.274-3.927; P = .005) were significantly associated with mortality.The recommended dietary type determined after VFSS in subacute stroke was a significant risk factor for all-cause mortality as an integrated parameter for dysphagia. Among the VFSS parameters, fluid penetration and aspiration were important risk factors for all-cause mortality in patients with moderate dysphagia after stroke. Therefore, it is important to classify the degree of dysphagia by performing the VFSS test in the subacute period of stroke and to determine the appropriate diet and rehabilitation intervention for mortality-related prognosis.
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Affiliation(s)
- Daham Kim
- Department of Rehabilitation Medicine, College of Medicine, Catholic Kwandong University International St Mary's Hospital, Incheon, Korea
| | - Jae-Hyung Kim
- Department of Rehabilitation Medicine, College of Medicine, Catholic Kwandong University International St Mary's Hospital, Incheon, Korea
| | - Si-Woon Park
- Department of Rehabilitation Medicine, College of Medicine, Catholic Kwandong University International St Mary's Hospital, Incheon, Korea
| | - Hyung-Wook Han
- Department of Rehabilitation Medicine, College of Medicine, Catholic Kwandong University International St Mary's Hospital, Incheon, Korea
| | - Sang Joon An
- Department of Neurology, College of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, Korea
- The Convergence Institute of Healthcare and Medical Science, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Yeong In Kim
- Department of Neurology, College of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, Korea
- The Convergence Institute of Healthcare and Medical Science, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Hyo Jin Ju
- Department of Medical Humanities, College of Medicine, Catholic Kwandong University, Gangwon, Korea
- The Convergence Institute of Healthcare and Medical Science, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - YoonHee Choi
- The Convergence Institute of Healthcare and Medical Science, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Doo Young Kim
- Department of Rehabilitation Medicine, College of Medicine, Catholic Kwandong University International St Mary's Hospital, Incheon, Korea
- The Convergence Institute of Healthcare and Medical Science, College of Medicine, Catholic Kwandong University, Incheon, Korea
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Kahwati LC, Asher GN, Kadro ZO, Keen S, Ali R, Coker-Schwimmer E, Jonas DE. Screening for Atrial Fibrillation: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 327:368-383. [PMID: 35076660 DOI: 10.1001/jama.2021.21811] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Atrial fibrillation (AF), the most common arrhythmia, increases the risk of stroke. OBJECTIVE To review the evidence on screening for AF in adults without prior stroke to inform the US Preventive Services Task Force. DATA SOURCES PubMed, Cochrane Library, and trial registries through October 5, 2020; references, experts, and literature surveillance through October 31, 2021. STUDY SELECTION Randomized clinical trials (RCTs) of screening among asymptomatic persons without known AF or prior stroke; test accuracy studies; RCTs of anticoagulation among persons with AF; systematic reviews; and observational studies reporting harms. DATA EXTRACTION AND SYNTHESIS Two reviewers assessed titles/abstracts, full-text articles, and study quality and extracted data; when at least 3 similar studies were available, meta-analyses were conducted. MAIN OUTCOMES AND MEASURES Detection of undiagnosed AF, test accuracy, mortality, stroke, stroke-related morbidity, and harms. RESULTS Twenty-six studies (N = 113 784) were included. In 1 RCT (n = 28 768) of twice-daily electrocardiography (ECG) screening for 2 weeks, the likelihood of a composite end point (ischemic stroke, hemorrhagic stroke, systemic embolism, all-cause mortality, and hospitalization for bleeding) was lower in the screened group over 6.9 years (hazard ratio, 0.96 [95% CI, 0.92-1.00]; P = .045), but that study had numerous limitations. In 4 RCTs (n = 32 491), significantly more AF was detected with intermittent and continuous ECG screening compared with no screening (risk difference range, 1.0%-4.8%). Treatment with warfarin over a mean of 1.5 years in populations with clinical, mostly persistent AF was associated with fewer ischemic strokes (pooled risk ratio [RR], 0.32 [95% CI, 0.20-0.51]; 5 RCTs; n = 2415) and lower all-cause mortality (pooled RR, 0.68 [95% CI, 0.50-0.93]) compared with placebo. Treatment with direct oral anticoagulants was also associated with lower incidence of stroke (adjusted odds ratios range, 0.32-0.44) in indirect comparisons with placebo. The pooled RR for major bleeding for warfarin compared with placebo was 1.8 (95% CI, 0.85-3.7; 5 RCTs; n = 2415), and the adjusted odds ratio for major bleeding for direct oral anticoagulants compared with placebo or no treatment ranged from 1.38 to 2.21, but CIs did not exclude a null effect. CONCLUSIONS AND RELEVANCE Although screening can detect more cases of unknown AF, evidence regarding effects on health outcomes is limited. Anticoagulation was associated with lower risk of first stroke and mortality but with increased risk of major bleeding, although estimates for this harm are imprecise; no trials assessed benefits and harms of anticoagulation among screen-detected populations.
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Affiliation(s)
- Leila C Kahwati
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Gary N Asher
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Family Medicine, University of North Carolina at Chapel Hill
| | - Zachary O Kadro
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill
| | - Susan Keen
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Family Medicine, University of North Carolina at Chapel Hill
| | - Rania Ali
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Emmanuel Coker-Schwimmer
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
| | - Daniel E Jonas
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus
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Ciminata G, Geue C, Wu O, Deidda M, Kreif N, Langhorne P. Propensity score methods for comparative-effectiveness analysis: A case study of direct oral anticoagulants in the atrial fibrillation population. PLoS One 2022; 17:e0262293. [PMID: 35073380 PMCID: PMC8786176 DOI: 10.1371/journal.pone.0262293] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/21/2021] [Indexed: 12/22/2022] Open
Abstract
Objective To explore methodological challenges when using real-world evidence (RWE) to estimate comparative-effectiveness in the context of Health Technology Assessment of direct oral anticoagulants (DOACs) in Scotland. Methods We used linkage data from the Prescribing Information System (PIS), Scottish Morbidity Records (SMR) and mortality records for newly anticoagulated patients to explore methodological challenges in the use of Propensity score (PS) matching, Inverse Probability Weighting (IPW) and covariate adjustment with PS. Model performance was assessed by standardised difference. Clinical outcomes (stroke and major bleeding) and mortality were compared for all DOACs (including apixaban, dabigatran and rivaroxaban) versus warfarin. Patients were followed for 2 years from first oral anticoagulant prescription to first clinical event or death. Censoring was applied for treatment switching or discontinuation. Results Overall, a good balance of patients’ covariates was obtained with every PS model tested. IPW was found to be the best performing method in assessing covariate balance when applied to subgroups with relatively large sample sizes (combined-DOACs versus warfarin). With the IPTW-IPCW approach, the treatment effect tends to be larger, but still in line with the treatment effect estimated using other PS methods. Covariate adjustment with PS in the outcome model performed well when applied to subgroups with smaller sample sizes (dabigatran versus warfarin), as this method does not require further reduction of sample size, and trimming or truncation of extreme weights. Conclusion The choice of adequate PS methods may vary according to the characteristics of the data. If assumptions of unobserved confounding hold, multiple approaches should be identified and tested. PS based methods can be implemented using routinely collected linked data, thus supporting Health Technology decision-making.
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Affiliation(s)
- Giorgio Ciminata
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| | - Claudia Geue
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Olivia Wu
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Manuela Deidda
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Noemi Kreif
- Centre for Health Economics, University of York, York, United Kingdom
| | - Peter Langhorne
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, United Kingdom
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Belviso N, Zhang Y, Aronow HD, Wyss R, Barbour M, Kogut S, Lawal OD, Zhan SY, Don PK, Wen X. Addressing Posttreatment Selection Bias in Comparative Effectiveness Research, Using Real-World Data and Simulation. Am J Epidemiol 2022; 191:331-340. [PMID: 34613378 DOI: 10.1093/aje/kwab242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 08/23/2021] [Accepted: 09/28/2021] [Indexed: 11/14/2022] Open
Abstract
To examine methodologies that address imbalanced treatment switching and censoring, 6 different analytical approaches were evaluated under a comparative effectiveness framework: intention-to-treat, as-treated, intention-to-treat with censor-weighting, as-treated with censor-weighting, time-varying exposure, and time-varying exposure with censor-weighting. Marginal structural models were employed to address time-varying exposure, confounding, and possibly informative censoring in an administrative data set of adult patients who were hospitalized with acute coronary syndrome and treated with either clopidogrel or ticagrelor. The effectiveness endpoint included first occurrence of death, myocardial infarction, or stroke. These methodologies were then applied across simulated data sets with varying frequencies of treatment switching and censoring to compare the effect estimate of each analysis. The findings suggest that implementing different analytical approaches has an impact on the point estimate and interpretation of analyses, especially when censoring is highly unbalanced.
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Gan L, Sun D, Cheng Y, Wang D, Wang F, Wang L, Li W, Shen D, Guo D, Zhang Z, Wang H, Li J, Yang Y, Liang T. Post-operative blood pressure and 3-year major adverse cardiac events in Chinese patients undergoing PCI. BMC Cardiovasc Disord 2021; 21:623. [PMID: 34969370 PMCID: PMC8717657 DOI: 10.1186/s12872-021-02435-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is no clear evidence for the target value of blood pressure control after Percutaneous coronary intervention (PCI). Therefore, our study was designed to explore the relationship between blood pressure after PCI and major adverse cardiac events (MACE) during 3-year follow-up. METHODS This study is a prospective study. We included the patients who were diagnosed with acute coronary syndrome and underwent PCI stent implantation operation. The study initially collected information of 552 patients. The start and end times of the study are from January 1, 2017 to December 31, 2020. The independent variables of this study are the average systolic blood pressure and the average diastolic blood pressure after PCI. The dependent variable is the occurrence of MACE events in patients within 3 years after PCI. MACE is defined as acute myocardial infarction, recurring chest pain, heart failure, stroke, revascularization and cardiac death. RESULTS A total of 514 subjects met the inclusion criteria. The average age of the study subjects is 61.92 ± 9.49 years old, of which 67.12% are male. 94 subjects had a MACE event within 3 years, and the occurrence rate was 18.29%. There is no significant non-linear or linear relationship between diastolic blood pressure and MACE events. There is a curvilinear relationship between the average systolic blood pressure of patients after PCI and MACE events within 3 years and the inflection point is 121. On the left side of the inflection point, the effect size and 95% CI are 1.09 and 1.01-1.18, respectively (P = 0.029). The impact size and 95% CI at the right inflection point were 1.00 and 0.98-1.02(P = 0.604), respectively. CONCLUSION There is a curvilinear relationship between systolic blood pressure and prognosis of patients after PCI. Under the premise of ensuring the safety of patients, maintaining lower blood pressure after surgery is beneficial to improve the prognosis of patients.
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Affiliation(s)
- Lijun Gan
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Dandan Sun
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Yuntao Cheng
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Deyang Wang
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Fen Wang
- Department of Cardiology, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Lin Wang
- Catheterization Room, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Wei Li
- Department of Nursing, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Dandan Shen
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Daotong Guo
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Zonglei Zhang
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Haiyan Wang
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Jinli Li
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Yong Yang
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Tao Liang
- School of Nursing, Peking Union Medical College, Beijing, China.
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Ananth CV, Patrick HS, Ananth S, Zhang Y, Kostis WJ, Schuster M. Maternal Cardiovascular and Cerebrovascular Health After Placental Abruption: A Systematic Review and Meta-Analysis (CHAP-SR). Am J Epidemiol 2021; 190:2718-2729. [PMID: 34263291 DOI: 10.1093/aje/kwab206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/25/2022] Open
Abstract
Placental abruption and cardiovascular disease (CVD) have common etiological underpinnings, and there is accumulating evidence that abruption may be associated with future CVD. We estimated associations between abruption and coronary heart disease (CHD) and stroke. The meta-analysis was based on the random-effects risk ratio (RR) and 95% confidence interval (CI) as the effect measure. We conducted a bias analysis to account for abruption misclassification, selection bias, and unmeasured confounding. We included 11 cohort studies comprising 6,325,152 pregnancies, 69,759 abruptions, and 49,265 CHD and stroke cases (1967-2016). Risks of combined CVD morbidity-mortality among abruption and nonabruption groups were 16.7 and 9.3 per 1,000 births, respectively (RR = 1.76, 95% CI: 1.24, 2.50; I2 = 94%; τ2 = 0.22). Women who suffered abruption were at 2.65-fold (95% CI: 1.55, 4.54; I2 = 85%; τ2 = 0.36) higher risk of death related to CHD/stroke than nonfatal CHD/stroke complications (RR = 1.32, 95% CI: 0.91, 1.92; I2 = 93%; τ2 = 0.15). Abruption was associated with higher mortality from CHD (RR = 2.64, 95% CI: 1.57, 4.44; I2 = 76%; τ2 = 0.31) than stroke (RR = 1.70, 95% CI: 1.19, 2.42; I2 = 40%; τ2 = 0.05). Corrections for the aforementioned biases increased these estimates. Women with pregnancies complicated by placental abruption may benefit from postpartum screening or therapeutic interventions to help mitigate CVD risks.
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Livingstone KM, Abbott G, Ward J, Bowe SJ. Unhealthy Lifestyle, Genetics and Risk of Cardiovascular Disease and Mortality in 76,958 Individuals from the UK Biobank Cohort Study. Nutrients 2021; 13:4283. [PMID: 34959842 PMCID: PMC8707428 DOI: 10.3390/nu13124283] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 11/24/2022] Open
Abstract
To examine associations of unhealthy lifestyle and genetics with risk of all-cause mortality, cardiovascular disease (CVD) mortality, myocardial infarction (MI) and stroke. We used data on 76,958 adults from the UK Biobank prospective cohort study. Favourable lifestyle included no overweight/obesity, not smoking, physical activity, not sedentary, healthy diet and adequate sleep. A Polygenic Risk Score (PRS) was derived using 300 CVD-related single nucleotide polymorphisms. Cox proportional hazard ratios (HR) were used to model effects of lifestyle and PRS on risk of CVD and all-cause mortality, stroke and MI. New CVD (n = 364) and all-cause (n = 2408) deaths, and stroke (n = 748) and MI (n = 1140) events were observed during a 7.8 year mean follow-up. An unfavourable lifestyle (0-1 healthy behaviours) was associated with higher risk of all-cause mortality (HR: 2.06; 95% CI: 1.73, 2.45), CVD mortality (HR: 2.48; 95% CI: 1.64, 3.76), MI (HR: 2.12; 95% CI: 1.65, 2.72) and stroke (HR:1.74; 95% CI: 1.25, 2.43) compared to a favourable lifestyle (≥4 healthy behaviours). PRS was associated with MI (HR: 1.35; 95% CI: 1.27, 1.43). There was evidence of a lifestyle-genetics interaction for stroke (p = 0.017). Unfavourable lifestyle behaviours predicted higher risk of all-cause mortality, CVD mortality, MI and stroke, independent of genetic risk.
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Affiliation(s)
- Katherine M. Livingstone
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia;
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia;
| | - Joey Ward
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK;
| | - Steven J. Bowe
- Deakin Biostatistics Unit, Deakin University, Geelong, VIC 3220, Australia;
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Violi F, Cammisotto V, Pignatelli P. Thrombosis in Covid-19 and non-Covid-19 pneumonia: role of platelets. Platelets 2021; 32:1009-1017. [PMID: 34097572 PMCID: PMC8204311 DOI: 10.1080/09537104.2021.1936478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 02/09/2023]
Abstract
Platelets may be a target of bacteria and viruses, which can directly or indirectly activate them so promoting thrombosis. In accordance with this, community-acquired pneumonia (CAP) is complicated by ischemia-related vascular disease (myocardial infarction and stroke) in roughly 10% of patients while the incidence of venous thrombosis is uncertain. In CAP platelet biosynthesis of TxA2 is augmented and associated with myocardial infarction; however, a cause-effect relationship is still unclear as unclear is if platelet activation promotes thrombosis or functional changes of coronary tree such vasospasm. Retrospective studies suggested a potential role of aspirin in reducing mortality but the impact on vascular disease is still unknown. Coronavirus disease 2019 (Covid-19) is complicated by thrombosis in roughly 20% of patients with an almost equivalent localization in arterial and venous circulation. Platelet activation seems to have a pivot role in the thrombotic process in Covid-19 as consistently evidenced by its involvement in promoting Tissue Factor up-regulation via leucocyte interaction. Until now, antiplatelet treatment has been scarcely considered for the treatment of Covid-19; interventional trials, however, are in progress to explore this issue. The aim of this review is 1) to compare the type of vascular diseases complicating CAP and Covid-19 2) to assess the different role of platelets in both diseases and 3) to discuss if antiplatelet treatment is potentially useful to improve clinical outcomes.
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Affiliation(s)
- Francesco Violi
- I Clinica Medica, Department of Clinical Internal, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Vittoria Cammisotto
- Department of General Surgery and Surgical Specialty Paride Stefanini, Sapienza University of Rome, Rome, Italy
| | - Pasquale Pignatelli
- I Clinica Medica, Department of Clinical Internal, Anaesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- Mediterranea Cardiocentro, Naples, Italy
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Heo NH, Lee MR, Yang KH, Hong OR, Shin JH, Lee BY, Lee JY, Ahn JM, Oh HJ, Oh JS. Short- and long-term mortality after intravenous thrombolysis for acute ischemic stroke: A propensity score-matched cohort with 5-year follow-up. Medicine (Baltimore) 2021; 100:e27652. [PMID: 34871239 PMCID: PMC8568431 DOI: 10.1097/md.0000000000027652] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/09/2021] [Indexed: 01/05/2023] Open
Abstract
It remains unknown whether intravenous thrombolysis (IVT), thrombectomy, or poststroke antithrombotic medication lower short- and long-term mortality in acute ischemic stroke (AIS). This study aimed to investigate the efficacy of IVT in AIS using propensity score matching, to determine whether IVT could reduce short- and long-term mortality, and to identify risk factors influencing short- and long-term mortality in AIS.During 2013 to 2014, the nationwide Korea Acute Stroke Assessment registry enrolled 14,394 patients with first-ever recorded ischemic stroke. Propensity score matching was used to match IVT and control cases with a 1:1 ratio. The primary outcome was survival up to 3 months, 1 year, and 5 years, as assessed using Kaplan-Meier estimates and Cox proportional hazards.In total, 1317 patients treated with IVT were matched with 1317 patients not treated with IVT. Survival was higher in the IVT group (median, 3.53 years) than in the non-IVT group (median, 3.37 years, stratified log-rank test, P < .001). Compared with the non-IVT group, thrombolysis performed within 2 hours significantly reduced the risk of 3-month mortality by 37%, and thrombolysis performed between 2 and 4.5 hours significantly reduced the risk of 3-month mortality by 26%. Thrombectomy significantly reduced the risk of 3-month mortality by 28%. Compared with no poststroke medication, poststroke antiplatelet medication was associated with 51%, 55%, and 52% decreases in 3-month, 1-year, and 5-year mortality risk, respectively. Poststroke anticoagulant medication was associated with 51%, 54%, and 44% decreases in the risk of 3-month, 1-year, and 5-year mortality, respectively.IVT and mechanical thrombectomy showed improvement in short-term survival. To improve long-term outcomes, the use of poststroke antithrombotic medication is important in AIS.
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Affiliation(s)
- Nam Hun Heo
- Biostatics, College of Medicine, Soonchunhyang University, Cheonan Hospital, Republic of Korea
| | - Man Ryul Lee
- Soonchunhyang Institute of Medi-bio Science (SIMS), Soonchunhyang University, Cheonan, Republic of Korea
| | - Ki Hwa Yang
- Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Ock Ran Hong
- Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Ji Hyeon Shin
- Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Bo Yeon Lee
- Department of Public Health, Graduate School of Korea University, Seoul, Republic of Korea
| | - Ji Young Lee
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Republic of Korea
| | - Jae Min Ahn
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Republic of Korea
| | - Hyuk Jin Oh
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Republic of Korea
| | - Jae Sang Oh
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Republic of Korea
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Giacinto JJ, Fricker GA, Ritter M, Yost J, Doremus J. Urban forest biodiversity and cardiovascular disease: Potential health benefits from California's street trees. PLoS One 2021; 16:e0254973. [PMID: 34731162 PMCID: PMC8565780 DOI: 10.1371/journal.pone.0254973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/08/2021] [Indexed: 01/14/2023] Open
Abstract
Enhanced immune functioning in response to biodiversity may explain potential health benefits from exposure to green space. Using unique data on urban forest biodiversity at the zip code level for California measured from 2014 to 2019 we test whether greater diversity of street trees is associated with reduced death from cardiovascular disease. We find that urban forests with greater biodiversity measured via the Shannon Index at the genus level are associated with a lower mortality rate for heart disease and stroke. Our estimates imply that increasing the Shannon Index by one standard deviation (0.64) is associated with a decrease in the mortality rate of 21.4 per 100,000 individuals for heart disease or 13% and 7.7 per 100,000 individuals for stroke or 16%. Our estimates remain robust across several sensitivity checks. A policy simulation for tree planting in Los Angeles based on our estimates suggests that if these relationships were causal, investment in planting for a more biodiverse set of street trees would be a cost-effective way to reduce mortality related to cardiovascular disease in urban areas.
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Affiliation(s)
- John J. Giacinto
- Economics, California Polytechnic State University, San Luis Obispo, CA, United States of America
| | - G. Andrew Fricker
- Social Sciences, California Polytechnic State University, San Luis Obispo, CA, United States of America
| | - Matthew Ritter
- Biological Sciences, California Polytechnic State University, San Luis Obispo, CA, United States of America
| | - Jenn Yost
- Biological Sciences, California Polytechnic State University, San Luis Obispo, CA, United States of America
| | - Jacqueline Doremus
- Economics, California Polytechnic State University, San Luis Obispo, CA, United States of America
- * E-mail:
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Liu J, Chen Y, Cai K, Gong Y. Association of metabolic syndrome with cardiovascular outcomes in hypertensive patients: a systematic review and meta-analysis. J Endocrinol Invest 2021; 44:2333-2340. [PMID: 34152572 DOI: 10.1007/s40618-021-01603-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The association between metabolic syndrome (MetS) and cardiovascular outcomes in patients with hypertension is still controversial. This meta-analysis sought to evaluate the association of MetS with cardiovascular outcomes in hypertensive patients. METHODS Two authors comprehensively searched PubMed and Embase databases from their inception to April 18, 2020 for the longitudinal studies that evaluated the association of MetS with cardiovascular outcomes in patients with hypertension. The main outcomes were major adverse cardiovascular events (myocardial infarction, revascularization, stroke, hospitalization due to heart failure, etc.) and stroke. RESULTS Eight studies consisting of 36,614 hypertensive patients were identified and analyzed. Meta-analysis indicated that MetS was associated with an increased risk of major adverse cardiovascular events (risk ratio [RR] 1.55; 95% confidence intervals [CI] 1.28-1.87), cardiovascular mortality (RR 1.44; 95%CI 1.13-1.82), and stroke (RR 1.46; 95%CI 1.22-1.75), respectively. Sensitivity analysis further confirmed the robustness of the prognostic value of MetS. CONCLUSIONS MetS is associated with higher risk of major adverse cardiovascular events, cardiovascular mortality, and stroke in patients with hypertension. Determination of MetS may contribute to improving cardiovascular risk stratification in hypertension.
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Affiliation(s)
- J Liu
- Department of Cardiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, 264100, China
| | - Y Chen
- Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - K Cai
- Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Y Gong
- Department of General Practice, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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Matuja SS, Munseri P, Moshiro C, Khanbhai K, Mahawish K. The burden, correlates and outcomes of left ventricular hypertrophy among young Africans with first ever stroke in Tanzania. BMC Cardiovasc Disord 2021; 21:485. [PMID: 34627161 PMCID: PMC8501668 DOI: 10.1186/s12872-021-02297-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/27/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Left ventricular hypertrophy is a pathophysiological response often due to chronic uncontrolled hypertension. Our primary aim was to investigate the magnitude, correlates and outcomes of left ventricular hypertrophy as a surrogate maker for chronic uncontrolled hypertension in young adults ≤ 45 years with stroke. Our secondary aim was to determine the accuracy of electrocardiography using Sokolow-Lyon and Cornell criteria in detecting left ventricular hypertrophy compared to echocardiography. METHODS This cohort study recruited young strokes who had undergone brain imaging, electrocardiography and transthoracic echocardiography at baseline. The modified Poisson regression model examined baseline correlates for left ventricular hypertrophy. The National Institute of Health Stroke Scale assessed stroke severity and the modified Rankin Scale assessed outcomes to 30-days. Performance of electrical voltage criterions was estimated using receiver operator characteristics. RESULTS We enrolled 101 stroke participants. Brain imaging revealed ischemic strokes in 60 (59.4%) and those with intracerebral hemorrhage, 33 (86.8%) were localized to the basal ganglia. Left ventricular hypertrophy was present in 76 (75.3%:95%CI 65.7%-83.3%), and 30 (39.5%) and 28 (36.8%) had moderate or severe hypertrophy respectively. Young adults with premorbid or a new diagnosis of hypertension were more likely to have left ventricular hypertrophy, 47 (61.8%), and 26 (34.2%). On multivariable analysis, left ventricular hypertrophy was independently associated with not being on anti-hypertensive medications among hypertensives participants {adjusted risk ratio 1.4 (95%CI:1.04-1.94). The mean National Institute of Health Stroke score was 18 and 30-day mortality was 42 (43.3%). The sensitivity and specificity for Sokolow-Lyon in detecting left ventricular hypertrophy was 27% and 78%, and for Cornell was 32% and 52% respectively. CONCLUSIONS We identified a high proportion of left ventricular hypertrophy in young adults with stroke associated with chronic undertreated hypertension. While the study methodology does not allow us to determine causation, this association and knowledge of pathophysiological processes supports the notion that chronic hypertension is a major risk factor for young strokes associated with high mortality. Our findings did not support the use of the electrical voltage criteria for detecting left ventricular hypertrophy. We recommend low cost interventions like blood pressure screening and treatment to reduce this burden.
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Affiliation(s)
- Sarah Shali Matuja
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, P.O Box 1464, Mwanza, Tanzania.
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Candida Moshiro
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Khuzeima Khanbhai
- Department of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania
| | - Karim Mahawish
- Department of Internal Medicine, Midcentral District Health Board, Palmerston North, New Zealand
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Rossi C, Berta P, Curello S, Lovaglio PG, Magoni M, Metra M, Roccaro AM, Verzillo S, Vittadini G. The impact of COVID-19 pandemic on AMI and stroke mortality in Lombardy: Evidence from the epicenter of the pandemic. PLoS One 2021; 16:e0257910. [PMID: 34597292 PMCID: PMC8486095 DOI: 10.1371/journal.pone.0257910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The first Covid-19 epidemic outbreak has enormously impacted the delivery of clinical healthcare and hospital management practices in most of the hospitals around the world. In this context, it is important to assess whether the clinical management of non-Covid patients has not been compromised. Among non-Covid cases, patients with Acute Myocardial Infarction (AMI) and stroke need non-deferrable emergency care and are the natural candidates to be studied. Preliminary evidence suggests that the time from onset of symptoms to emergency department (ED) presentation has significantly increased in Covid-19 times as well as the 30-day mortality and in-hospital mortality. METHODS We check, in a causal inference framework, the causal effect of the hospital's stress generated by Covid-19 pandemic on in-hospital mortality rates (primary end-point of the study) of AMI and stroke over several time-windows of 15-days around the implementation date of the State of Emergency restrictions for COVID-19 (March, 9th 2020) using two quasi-experimental approaches, regression-discontinuity design (RDD) and difference-in-regression-discontinuity (DRD) designs. Data are drawn from Spedali Civili of Brescia, one of the most hit provinces in Italy by Covid-19 during March and May 2020. FINDINGS Despite the potential adverse effects on expected mortality due to a longer time to hospitalization and staff extra-burden generated by the first wave of Covid-19, the AMI and stroke mortality rates are overall not statistically different during the first wave of Covid-19 than before the first peak. The obtained results provided by RDD models are robust also when we account for seasonality and unobserved factors with DRD models. INTERPRETATION The non-statistically significant impact on mortality rates for AMI and stroke patients provides evidence of the hospital ability to manage -with the implementation of a dual track organization- the simultaneous delivery of high-quality cares to both Covid and non-Covid patients.
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Affiliation(s)
| | - Paolo Berta
- Department of Statistics and Quantitative Methods and CRISP, University of Milan-Bicocca, Milan, Italy
| | | | - Pietro Giorgio Lovaglio
- Department of Statistics and Quantitative Methods and CRISP, University of Milan-Bicocca, Milan, Italy
| | | | - Marco Metra
- ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Stefano Verzillo
- European Commission, Joint Research Centre (JRC), Ispra, Italy
- * E-mail:
| | - Giorgio Vittadini
- Department of Statistics and Quantitative Methods and CRISP, University of Milan-Bicocca, Milan, Italy
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Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, Abbasifard M, Abbasi-Kangevari M, Abd-Allah F, Abedi V, Abualhasan A, Abu-Rmeileh NME, Abushouk AI, Adebayo OM, Agarwal G, Agasthi P, Ahinkorah BO, Ahmad S, Ahmadi S, Ahmed Salih Y, Aji B, Akbarpour S, Akinyemi RO, Al Hamad H, Alahdab F, Alif SM, Alipour V, Aljunid SM, Almustanyir S, Al-Raddadi RM, Al-Shahi Salman R, Alvis-Guzman N, Ancuceanu R, Anderlini D, Anderson JA, Ansar A, Antonazzo IC, Arabloo J, Ärnlöv J, Artanti KD, Aryan Z, Asgari S, Ashraf T, Athar M, Atreya A, Ausloos M, Baig AA, Baltatu OC, Banach M, Barboza MA, Barker-Collo SL, Bärnighausen TW, Barone MTU, Basu S, Bazmandegan G, Beghi E, Beheshti M, Béjot Y, Bell AW, Bennett DA, Bensenor IM, Bezabhe WM, Bezabih YM, Bhagavathula AS, Bhardwaj P, Bhattacharyya K, Bijani A, Bikbov B, Birhanu MM, Boloor A, Bonny A, Brauer M, Brenner H, Bryazka D, Butt ZA, Caetano dos Santos FL, Campos-Nonato IR, Cantu-Brito C, Carrero JJ, Castañeda-Orjuela CA, Catapano AL, Chakraborty PA, Charan J, Choudhari SG, Chowdhury EK, Chu DT, Chung SC, Colozza D, Costa VM, Costanzo S, Criqui MH, Dadras O, Dagnew B, Dai X, Dalal K, Damasceno AAM, D'Amico E, Dandona L, Dandona R, Darega Gela J, Davletov K, De la Cruz-Góngora V, Desai R, Dhamnetiya D, Dharmaratne SD, Dhimal ML, Dhimal M, Diaz D, Dichgans M, Dokova K, Doshi R, Douiri A, Duncan BB, Eftekharzadeh S, Ekholuenetale M, El Nahas N, Elgendy IY, Elhadi M, El-Jaafary SI, Endres M, Endries AY, Erku DA, Faraon EJA, Farooque U, Farzadfar F, Feroze AH, Filip I, Fischer F, Flood D, Gad MM, Gaidhane S, Ghanei Gheshlagh R, Ghashghaee A, Ghith N, Ghozali G, Ghozy S, Gialluisi A, Giampaoli S, Gilani SA, Gill PS, Gnedovskaya EV, Golechha M, Goulart AC, Guo Y, Gupta R, Gupta VB, Gupta VK, Gyanwali P, Hafezi-Nejad N, Hamidi S, Hanif A, Hankey GJ, Hargono A, Hashi A, Hassan TS, Hassen HY, Havmoeller RJ, Hay SI, Hayat K, Hegazy MI, Herteliu C, Holla R, Hostiuc S, Househ M, Huang J, Humayun A, Hwang BF, Iacoviello L, Iavicoli I, Ibitoye SE, Ilesanmi OS, Ilic IM, Ilic MD, Iqbal U, Irvani SSN, Islam SMS, Ismail NE, Iso H, Isola G, Iwagami M, Jacob L, Jain V, Jang SI, Jayapal SK, Jayaram S, Jayawardena R, Jeemon P, Jha RP, Johnson WD, Jonas JB, Joseph N, Jozwiak JJ, Jürisson M, Kalani R, Kalhor R, Kalkonde Y, Kamath A, Kamiab Z, Kanchan T, Kandel H, Karch A, Katoto PDMC, Kayode GA, Keshavarz P, Khader YS, Khan EA, Khan IA, Khan M, Khan MAB, Khatib MN, Khubchandani J, Kim GR, Kim MS, Kim YJ, Kisa A, Kisa S, Kivimäki M, Kolte D, Koolivand A, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Krishnamoorthy V, Krishnamurthi RV, Kumar GA, Kusuma D, La Vecchia C, Lacey B, Lak HM, Lallukka T, Lasrado S, Lavados PM, Leonardi M, Li B, Li S, Lin H, Lin RT, Liu X, Lo WD, Lorkowski S, Lucchetti G, Lutzky Saute R, Magdy Abd El Razek H, Magnani FG, Mahajan PB, Majeed A, Makki A, Malekzadeh R, Malik AA, Manafi N, Mansournia MA, Mantovani LG, Martini S, Mazzaglia G, Mehndiratta MM, Menezes RG, Meretoja A, Mersha AG, Miao Jonasson J, Miazgowski B, Miazgowski T, Michalek IM, Mirrakhimov EM, Mohammad Y, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Mokhayeri Y, Molokhia M, Moni MA, Montasir AA, Moradzadeh R, Morawska L, Morze J, Muruet W, Musa KI, Nagarajan AJ, Naghavi M, Narasimha Swamy S, Nascimento BR, Negoi RI, Neupane Kandel S, Nguyen TH, Norrving B, Noubiap JJ, Nwatah VE, Oancea B, Odukoya OO, Olagunju AT, Orru H, Owolabi MO, Padubidri JR, Pana A, Parekh T, Park EC, Pashazadeh Kan F, Pathak M, Peres MFP, Perianayagam A, Pham TM, Piradov MA, Podder V, Polinder S, Postma MJ, Pourshams A, Radfar A, Rafiei A, Raggi A, Rahim F, Rahimi-Movaghar V, Rahman M, Rahman MA, Rahmani AM, Rajai N, Ranasinghe P, Rao CR, Rao SJ, Rathi P, Rawaf DL, Rawaf S, Reitsma MB, Renjith V, Renzaho AMN, Rezapour A, Rodriguez JAB, Roever L, Romoli M, Rynkiewicz A, Sacco S, Sadeghi M, Saeedi Moghaddam S, Sahebkar A, Saif-Ur-Rahman KM, Salah R, Samaei M, Samy AM, Santos IS, Santric-Milicevic MM, Sarrafzadegan N, Sathian B, Sattin D, Schiavolin S, Schlaich MP, Schmidt MI, Schutte AE, Sepanlou SG, Seylani A, Sha F, Shahabi S, Shaikh MA, Shannawaz M, Shawon MSR, Sheikh A, Sheikhbahaei S, Shibuya K, Siabani S, Silva DAS, Singh JA, Singh JK, Skryabin VY, Skryabina AA, Sobaih BH, Stortecky S, Stranges S, Tadesse EG, Tarigan IU, Temsah MH, Teuschl Y, Thrift AG, Tonelli M, Tovani-Palone MR, Tran BX, Tripathi M, Tsegaye GW, Ullah A, Unim B, Unnikrishnan B, Vakilian A, Valadan Tahbaz S, Vasankari TJ, Venketasubramanian N, Vervoort D, Vo B, Volovici V, Vosoughi K, Vu GT, Vu LG, Wafa HA, Waheed Y, Wang Y, Wijeratne T, Winkler AS, Wolfe CDA, Woodward M, Wu JH, Wulf Hanson S, Xu X, Yadav L, Yadollahpour A, Yahyazadeh Jabbari SH, Yamagishi K, Yatsuya H, Yonemoto N, Yu C, Yunusa I, Zaman MS, Zaman SB, Zamanian M, Zand R, Zandifar A, Zastrozhin MS, Zastrozhina A, Zhang Y, Zhang ZJ, Zhong C, Zuniga YMH, Murray CJL. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20:795-820. [PMID: 34487721 PMCID: PMC8443449 DOI: 10.1016/s1474-4422(21)00252-0] [Citation(s) in RCA: 1651] [Impact Index Per Article: 550.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. METHODS We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. FINDINGS In 2019, there were 12·2 million (95% UI 11·0-13·6) incident cases of stroke, 101 million (93·2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6·55 million (6·00-7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8-12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1-6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0-73·0), prevalent strokes increased by 85·0% (83·0-88·0), deaths from stroke increased by 43·0% (31·0-55·0), and DALYs due to stroke increased by 32·0% (22·0-42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0-18·0), mortality decreased by 36·0% (31·0-42·0), prevalence decreased by 6·0% (5·0-7·0), and DALYs decreased by 36·0% (31·0-42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0-24·0) and incidence rates increased by 15·0% (12·0-18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5-3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5-3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57-8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97-3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01-1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7-90·8] DALYs or 55·5% [48·2-62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3-48·6] DALYs or 24·3% [15·7-33·2]), high fasting plasma glucose (28·9 million [19·8-41·5] DALYs or 20·2% [13·8-29·1]), ambient particulate matter pollution (28·7 million [23·4-33·4] DALYs or 20·1% [16·6-23·0]), and smoking (25·3 million [22·6-28·2] DALYs or 17·6% [16·4-19·0]). INTERPRETATION The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. FUNDING Bill & Melinda Gates Foundation.
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Cao J, Eshak ES, Liu K, Arafa A, Sheerah HA, Yu C. Age-period-cohort analysis of stroke mortality attributable to high systolic blood pressure in China and Japan. Sci Rep 2021; 11:19083. [PMID: 34580315 PMCID: PMC8476589 DOI: 10.1038/s41598-021-98072-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 08/25/2021] [Indexed: 11/20/2022] Open
Abstract
Stroke is a principal cause of mortality in China and Japan. High systolic blood pressure (SBP) was considered a chief risk factor for stroke mortality. Herein, we evaluated temporal trends of high SBP-attributable stroke mortality in China and Japan between 1990 and 2017. Data on stroke mortality were retrieved from the Global Burden of Disease Study 2017 (GBD 2017). Using the age-period-cohort method, we computed overall net drifts, local drifts, longitudinal age curves, and cohort/period rate ratios (RRs) for high SBP-attributable stroke mortality. The age-standardized mortality rates (ASMRs) displayed decreasing trends for high SBP-attributable stroke mortality. The annual net drift values were - 1.4% and - 3.5% in Chinese men and women versus - 3.1% and - 4.9% in Japanese men and women. The local drift values in both countries were < 0 among all age groups but were lower in women than in men. The longitudinal age curves showed a greater high SBP-attributable stroke mortality in men than in women across all age groups. Similar decreasing patterns were shown in the period and cohort RRs in both sexes with women having a quicker decline than men. In China and Japan, the ASMRs, as well as the period and cohort RRs of high SBP-attributable stroke mortality, decreased between 1990 and 2017 in both sexes and across all age groups. Yet, the prevalence of high SBP remained worrisome in both countries. Thus, SBP control should be encouraged to prevent stroke mortality.
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Affiliation(s)
- Jinhong Cao
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, 185 Donghu Rd, Wuhan, 430071, Hubei, China
| | - Ehab S Eshak
- Department of Public Health, Community and Preventive Medicine, Faculty of Medicine, Minia University, Minia, Egypt
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Keyang Liu
- Department of Public Health, Community and Preventive Medicine, Faculty of Medicine, Minia University, Minia, Egypt
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Ahmed Arafa
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Public Health, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Haytham A Sheerah
- Department of Public Health, Community and Preventive Medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, 185 Donghu Rd, Wuhan, 430071, Hubei, China.
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Tang J, Dong JY, Eshak ES, Cui R, Shirai K, Liu K, Sakaniwa R, Tamakoshi A, Iso H. Supper Timing and Cardiovascular Mortality: The Japan Collaborative Cohort Study. Nutrients 2021; 13:nu13103389. [PMID: 34684390 PMCID: PMC8541292 DOI: 10.3390/nu13103389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/12/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
Evidence on the role of supper timing in the development of cardiovascular disease (CVD) is limited. In this study, we examined the associations between supper timing and risks of mortality from stroke, coronary heart disease (CHD), and total CVD. A total of 28,625 males and 43,213 females, aged 40 to 79 years, free from CVD and cancers at baseline were involved in this study. Participants were divided into three groups: the early supper group (before 8:00 p.m.), the irregular supper group (time irregular), and the late supper group (after 8:00 p.m.). Cox proportional hazards regression models were used to calculate hazard ratios (HRs) for stroke, CHD, and total CVD according to the supper time groups. During the 19-year follow-up, we identified 4706 deaths from total CVD. Compared with the early supper group, the multivariable HR of hemorrhagic stroke mortality for the irregular supper group was 1.44 (95% confidence interval [CI]: 1.05–1.97). There was no significant association between supper timing and the risk of mortality from other types of stroke, CHD, and CVD. We found that adopting an irregular supper timing compared with having dinner before 8:00 p.m. was associated with an increased risk of hemorrhagic stroke mortality.
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Affiliation(s)
- Jingyun Tang
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi 565-0871, Japan; (J.T.); (E.S.E.); (K.S.); (K.L.); (R.S.)
| | - Jia-Yi Dong
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi 565-0871, Japan; (J.T.); (E.S.E.); (K.S.); (K.L.); (R.S.)
- Correspondence: (J.-Y.D.); (H.I.); Tel.: +81-6-6879-3911 (J.-Y.D. & H.I.); Fax: +81-6-6879-3919 (J.-Y.D. & H.I.)
| | - Ehab S. Eshak
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi 565-0871, Japan; (J.T.); (E.S.E.); (K.S.); (K.L.); (R.S.)
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Minia University, Minia 61511, Egypt
| | - Renzhe Cui
- Department of Internal Medicine, Okanami General Hospital, 1734 Uenokuwachi, Iga-shi 518-0842, Japan;
| | - Kokoro Shirai
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi 565-0871, Japan; (J.T.); (E.S.E.); (K.S.); (K.L.); (R.S.)
| | - Keyang Liu
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi 565-0871, Japan; (J.T.); (E.S.E.); (K.S.); (K.L.); (R.S.)
| | - Ryoto Sakaniwa
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi 565-0871, Japan; (J.T.); (E.S.E.); (K.S.); (K.L.); (R.S.)
| | - Akiko Tamakoshi
- Department of Public Health, Graduate School of Medicine, Hokkaido University, Kita 15 Jo Nishi 7 Chome, Sapporo-shi 060-8638, Japan;
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi 565-0871, Japan; (J.T.); (E.S.E.); (K.S.); (K.L.); (R.S.)
- Correspondence: (J.-Y.D.); (H.I.); Tel.: +81-6-6879-3911 (J.-Y.D. & H.I.); Fax: +81-6-6879-3919 (J.-Y.D. & H.I.)
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Halliday A, Bulbulia R, Bonati LH, Chester J, Cradduck-Bamford A, Peto R, Pan H. Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy. Lancet 2021; 398:1065-1073. [PMID: 34469763 PMCID: PMC8473558 DOI: 10.1016/s0140-6736(21)01910-3] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. METHODS ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. FINDINGS Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91-1·32; p=0·21). INTERPRETATION Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable. FUNDING UK Medical Research Council and Health Technology Assessment Programme.
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Affiliation(s)
- Alison Halliday
- Nuffield Department of Population Health, University of Oxford, Oxford, UK; Nuffield Department of Surgery, University of Oxford, Oxford, UK.
| | - Richard Bulbulia
- Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Leo H Bonati
- Department of Neurology, University Hospital, Basel, Switzerland
| | - Johanna Chester
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Richard Peto
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Hongchao Pan
- Nuffield Department of Population Health, University of Oxford, Oxford, UK; Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Rahimi K, Bidel Z, Nazarzadeh M, Copland E, Canoy D, Wamil M, Majert J, McManus R, Adler A, Agodoa L, Algra A, Asselbergs FW, Beckett NS, Berge E, Black H, Boersma E, Brouwers FPJ, Brown M, Brugts JJ, Bulpitt CJ, Byington RP, Cushman WC, Cutler J, Devereaux RB, Dwyer JP, Estacio R, Fagard R, Fox K, Fukui T, Gupta AK, Holman RR, Imai Y, Ishii M, Julius S, Kanno Y, Kjeldsen SE, Kostis J, Kuramoto K, Lanke J, Lewis E, Lewis JB, Lievre M, Lindholm LH, Lueders S, MacMahon S, Mancia G, Matsuzaki M, Mehlum MH, Nissen S, Ogawa H, Ogihara T, Ohkubo T, Palmer CR, Patel A, Pfeffer MA, Pitt B, Poulter NR, Rakugi H, Reboldi G, Reid C, Remuzzi G, Ruggenenti P, Saruta T, Schrader J, Schrier R, Sever P, Sleight P, Staessen JA, Suzuki H, Thijs L, Ueshima K, Umemoto S, van Gilst WH, Verdecchia P, Wachtell K, Whelton P, Wing L, Woodward M, Yui Y, Yusuf S, Zanchetti A, Zhang ZY, Anderson C, Baigent C, Brenner BM, Collins R, de Zeeuw D, Lubsen J, Malacco E, Neal B, Perkovic V, Rodgers A, Rothwell P, Salimi-Khorshidi G, Sundström J, Turnbull F, Viberti G, Wang J, Chalmers J, Davis BR, Pepine CJ, Teo KK. Age-stratified and blood-pressure-stratified effects of blood-pressure-lowering pharmacotherapy for the prevention of cardiovascular disease and death: an individual participant-level data meta-analysis. Lancet 2021; 398:1053-1064. [PMID: 34461040 PMCID: PMC8473559 DOI: 10.1016/s0140-6736(21)01921-8] [Citation(s) in RCA: 100] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/06/2021] [Accepted: 08/06/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The effects of pharmacological blood-pressure-lowering on cardiovascular outcomes in individuals aged 70 years and older, particularly when blood pressure is not substantially increased, is uncertain. We compared the effects of blood-pressure-lowering treatment on the risk of major cardiovascular events in groups of patients stratified by age and blood pressure at baseline. METHODS We did a meta-analysis using individual participant-level data from randomised controlled trials of pharmacological blood-pressure-lowering versus placebo or other classes of blood-pressure-lowering medications, or between more versus less intensive treatment strategies, which had at least 1000 persons-years of follow-up in each treatment group. Participants with previous history of heart failure were excluded. Data were obtained from the Blood Pressure Lowering Treatment Triallists' Collaboration. We pooled the data and categorised participants into baseline age groups (<55 years, 55-64 years, 65-74 years, 75-84 years, and ≥85 years) and blood pressure categories (in 10 mm Hg increments from <120 mm Hg to ≥170 mm Hg systolic blood pressure and from <70 mm Hg to ≥110 mm Hg diastolic). We used a fixed effects one-stage approach and applied Cox proportional hazard models, stratified by trial, to analyse the data. The primary outcome was defined as either a composite of fatal or non-fatal stroke, fatal or non-fatal myocardial infarction or ischaemic heart disease, or heart failure causing death or requiring hospital admission. FINDINGS We included data from 358 707 participants from 51 randomised clinical trials. The age of participants at randomisation ranged from 21 years to 105 years (median 65 years [IQR 59-75]), with 42 960 (12·0%) participants younger than 55 years, 128 437 (35·8%) aged 55-64 years, 128 506 (35·8%) 65-74 years, 54 016 (15·1%) 75-84 years, and 4788 (1·3%) 85 years and older. The hazard ratios for the risk of major cardiovascular events per 5 mm Hg reduction in systolic blood pressure for each age group were 0·82 (95% CI 0·76-0·88) in individuals younger than 55 years, 0·91 (0·88-0·95) in those aged 55-64 years, 0·91 (0·88-0·95) in those aged 65-74 years, 0·91 (0·87-0·96) in those aged 75-84 years, and 0·99 (0·87-1·12) in those aged 85 years and older (adjusted pinteraction=0·050). Similar patterns of proportional risk reductions were observed for a 3 mm Hg reduction in diastolic blood pressure. Absolute risk reductions for major cardiovascular events varied by age and were larger in older groups (adjusted pinteraction=0·024). We did not find evidence for any clinically meaningful heterogeneity of relative treatment effects across different baseline blood pressure categories in any age group. INTERPRETATION Pharmacological blood pressure reduction is effective into old age, with no evidence that relative risk reductions for prevention of major cardiovascular events vary by systolic or diastolic blood pressure levels at randomisation, down to less than 120/70 mm Hg. Pharmacological blood pressure reduction should, therefore, be considered an important treatment option regardless of age, with the removal of age-related blood-pressure thresholds from international guidelines. FUNDING British Heart Foundation, National Institute of Health Research Oxford Biomedical Research Centre, Oxford Martin School.
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Moreira PVL, de Arruda Neta ADCP, Ferreira SS, Ferreira FELL, de Lima RLFC, de Toledo Vianna RP, de Araújo JM, de Alencar Rodrigues RE, da Silva Neto JM, O’Flaherty M. Coronary heart disease and stroke mortality trends in Brazil 2000-2018. PLoS One 2021; 16:e0253639. [PMID: 34473712 PMCID: PMC8412280 DOI: 10.1371/journal.pone.0253639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/09/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To analyse the mortality rate trend due to coronary heart disease (CHD) and stroke in the adult population in Brazil. METHODS From 2000 to 2018, a time trend study with joinpoint regression was conducted among Brazilian men and women aged 35 years and over. Age-adjusted and age, sex specific CHD and stroke trend rate mortality were measured. RESULTS Crude mortality rates from CHD decreased in both sexes and in all age groups, except for males over 85 years old with an increase of 1.78%. The most accentuated declining occurred for age range 35 to 44 years for both men (52.1%) and women (53.2%) due to stroke and in men (33%) due to CHD, and among women (32%) aged 65 to 74 years due to CHD. Age-adjusted mortality rates for CHD and stroke decreased in both sexes, in the period from 2000 to 2018. The average annual rate for CHD went from 97.09 during 2000-2008 to 78.75 during 2016-2018, whereas the highest percentage of change was observed during 2008 to 2013 (APC -2.5%; 95% CI). The average annual rate for stroke decreased from 104.96 to 69.93, between 2000-2008 and 2016-2018, and the highest percentage of change occurred during the periods from 2008 to 2013 and 2016 to 2018 (APC 4.7%; 95% CI). CONCLUSION The downward trend CHD and stroke mortality rates is continuing. Policy intervention directed to strengthen care provision and improve population diets and lifestyles might explain the continued progress, but there is no room for complacency.
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Affiliation(s)
| | | | - Sara Silva Ferreira
- Department of Nutrition, Federal University of Paraiba, João Pessoa, Paraíba, Brazil
| | | | | | | | | | | | | | - Martin O’Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, Merseyside, United Kingdom
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Berni TR, Morgan CL, Rees DA. Women With Polycystic Ovary Syndrome Have an Increased Risk of Major Cardiovascular Events: a Population Study. J Clin Endocrinol Metab 2021; 106:e3369-e3380. [PMID: 34061968 PMCID: PMC8372630 DOI: 10.1210/clinem/dgab392] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Indexed: 01/02/2023]
Abstract
CONTEXT The effects of polycystic ovary syndrome (PCOS) on cardiovascular morbidity and mortality are unclear. OBJECTIVE This work aims to establish the relative risk of myocardial infarction (MI), stroke, angina, revascularization, and cardiovascular mortality for women with PCOS. METHODS Data were extracted from the Clinical Practice Research Datalink Aurum database. Patients with PCOS were matched to controls (1:1) by age, body mass index (BMI) category, and primary care practice. The primary outcome was the time to major adverse cardiovascular event (MACE); a composite end point incorporating MI, stroke, angina, revascularization and cardiovascular mortality. Secondary outcomes were the individual MACE end points. RESULTS Of 219 034 individuals with a diagnosis of PCOS, 174 660 (79.7%) met the eligibility criteria and were matched. Crude rates of the composite end point, MI, stroke, angina, revascularization, and cardiovascular mortality were respectively 82.7, 22.7, 27.4, 32.8, 10.5, and 6.97 per 100 000 patient-years for cases, and 64.3, 15.9, 25.7, 19.8, 7.13, and 7.75 per 100 000 patient-years for controls. In adjusted Cox proportional hazard models (CPHMs), the hazard ratios (HRs) were 1.26 (95% CI, 1.13-1.41), 1.38 (95% CI, 1.11-1.72), 1.60 (95% CI, 1.32-1.94), and 1.50 (95% CI, 1.08-2.07) for the composite outcome, MI, angina, and revascularization, respectively. In a time-dependent CPHM, weight gain (HR 1.01; 1.00-1.01), prior type 2 diabetes mellitus (T2DM) (HR 2.40; 1.76-3.30), and social deprivation (HR 1.53; 1.11-2.11) increased risk of progression to the composite end point. CONCLUSION The risk of incident MI, angina, and revascularization is increased in young women with PCOS. Weight and T2DM are potentially modifiable risk factors amenable to intervention.
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Affiliation(s)
| | | | - D Aled Rees
- Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Cardiff CF24 4HQ, UK
- Correspondence: D. Aled Rees, MB BCh, PhD, Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, Heath Park, Cardiff CF24 4HQ, UK.
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Lin YT, Liu YH, Hsiao YL, Chiang HY, Chen PS, Chang SN, Tsai HC, Chen CH, Kuo CC. Pharmacological blood pressure control and outcomes in patients with hypertensive crisis discharged from the emergency department. PLoS One 2021; 16:e0251311. [PMID: 34403407 PMCID: PMC8370605 DOI: 10.1371/journal.pone.0251311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/24/2021] [Indexed: 11/18/2022] Open
Abstract
Pharmacological blood pressure (BP) intervention for high blood pressure is controversial for a wide spectrum of hypertensive crisis in the emergency department (ED). We evaluated whether medical control of BP altered the short- and long-term outcomes among patients with hypertensive crisis who were discharged from the ED under universal health care. This retrospective cohort comprised 22 906 adults discharged from the ED of a tertiary hospital with initial systolic BP ≥ 180 mmHg or diastolic BP ≥ 120 mmHg between 2010 and 2016. The main exposure was the use of antihypertensive medication during the ED stay. Clinical endpoints were revisits to the ED or inpatient admission (at 7, 30, and 60 days), cardiovascular mortality (at 1, 3, and 5 years), and incident stroke (at 1, 3, and 5 years). The associations between pharmacological intervention for BP and outcomes were evaluated using multivariable Cox proportional-hazards models. Of the patient data analyzed, 72.2% were not treated pharmacologically and 68.4% underwent evaluation of end-organ damage. Pharmacological intervention for BP was significantly associated with a 11% and 11% reduced risk of hospital revisits within 30 or 60 days of discharge from ED, respectively, particularly among patients with polypharmacy. No association between pharmacological intervention for BP and incident stroke and cardiovascular mortality was observed. A revision of diagnostic criteria for hypertensive crisis is essential. Although pharmacological intervention for BP may not alter the long-term risk of cardiovascular mortality, it significantly reduces short-term health care utilization.
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Affiliation(s)
- Yu-Ting Lin
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Yen-Hung Liu
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ya-Luan Hsiao
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Shan Chen
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Shih-Ni Chang
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Hsiu-Chen Tsai
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Hung Chen
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chin-Chi Kuo
- Big Data Center, China Medical University Hospital, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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Gu HQ, Yang X, Wang CJ, Zhao XQ, Wang YL, Liu LP, Meng X, Jiang Y, Li H, Liu C, Wangqin R, Fonarow GC, Schwamm LH, Xian Y, Li ZX, Wang YJ. Clinical Characteristics, Management, and In-Hospital Outcomes in Patients With Stroke or Transient Ischemic Attack in China. JAMA Netw Open 2021; 4:e2120745. [PMID: 34387677 PMCID: PMC8363916 DOI: 10.1001/jamanetworkopen.2021.20745] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Stroke represents a significant burden on the health care system of China. The Chinese Stroke Center Alliance was launched in 2015 to monitor and improve care quality and outcomes for patients with acute stroke and transient ischemic attack (TIA). OBJECTIVE To evaluate the clinical characteristics, management, and in-hospital clinical outcomes and complications among patients with stroke or TIA in China. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study assessed stroke or TIA admissions to 1476 participating hospitals in the Chinese Stroke Center Alliance between August 1, 2015, and July 31, 2019. EXPOSURES Stroke types and calendar year. MAIN OUTCOMES AND MEASURES Eleven guideline-based admission or discharge management measures and 2 summary measures: an all-or-none binary outcome and a composite score (range, 0 [nonadherence] to 1 [perfect adherence]) for adherence to evidence-based stroke and TIA care and in-hospital clinical outcomes, including death or discharge against medical advice (DAMA), major adverse cardiovascular events (MACEs), including ischemic stroke, hemorrhagic stroke, TIA, or myocardial infarction; and in-hospital complications. RESULTS Of 1 006 798 patients with stroke or TIA (mean [SD] age, 65.7 [12.2] years; 383 500 [38.1%] female), 838 229 (83.3%) had an ischemic stroke, 64 929 (6.4%) had TIA, 85 705 (8.5%) had intracerebral hemorrhage (ICH), and 11 241 (1.1%) had subarachnoid hemorrhage (SAH). Management measures varied by cerebrovascular event type, with the mean (SD) composite score ranging from 0.57 (0.31) in SAH to 0.83 (0.24) in TIA. Poor outcomes and complications were highest among patients with SAH (21.9%; 95% CI, 21.0%-22.8% in-hospital death or DAMA; 9.6%; 95% CI, 9.1%-10.2% MACEs; and 31.4%; 95% CI, 30.6%-32.3% in-hospital complications) and patients with ICH (17.2%; 95% CI, 16.9%-17.5% in-hospital death or DAMA; 9.3%; 95% CI, 9.1%-9.5% MACEs; and 31.3%; 95% CI, 31.0%-31.6% in-hospital complications), followed by patients with ischemic stroke (6.1%; 95% CI, 6.0%-6.1% in-hospital death or DAMA; 6.3%; 95% CI, 6.3%-6.4% MACEs; and 12.8%; 95% CI, 12.7%-12.9% in-hospital complications), and lowest in patients with TIA (5.0%; 95% CI, 4.8%-5.2% in-hospital death or DAMA; 2.4%; 95% CI, 2.3%-2.5% MACEs; and 0.8%; 95% CI, 0.7%-0.8% in-hospital complications). Temporal improvements in management measures were observed from 2015 to 2019, especially in administration of intravenous recombinant tissue plasminogen activator (+60.3% relatively; 95% CI, 52.9%-70.5%), dysphagia screening (+14.7% relatively; 95% CI, 14.0%-15.6%), and use of anticoagulants for atrial fibrillation (+31.4% relatively; 95% CI, 25.7%-37.3%). Temporal improvements in in-hospital death or DAMA (-9.7% relatively; 95% CI, -9.6% to -8.5%) and complications (-27.1% relatively; 95% CI, -28.6% to -25.3) were also observed. CONCLUSIONS AND RELEVANCE In this quality improvement study, performance measure adherence and poor outcomes and complications varied by cerebrovascular event type; although there were substantial improvements over time, these results suggest that support for the use of evidence-based practices is needed.
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Affiliation(s)
- Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing-Quan Zhao
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yi-Long Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Liu
- Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chelsea Liu
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Runqi Wangqin
- Department of Neurology, Duke University Medical Center, Durham, North Carolina
| | - Gregg C. Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan–UCLA Medical Center, Los Angeles, California
- Associate Editor for Health Care Quality and Guidelines, JAMA Cardiology
| | - Lee H. Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Ying Xian
- Department of Neurology, Duke University Medical Center, Durham, North Carolina
| | - Zi-Xiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
| | - Yong-Jun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Pedapati R, Bhatia R, Shakywar M, Gupta A, Vishnubhatla S, Srivastava MVP, Tripathi M, Singh MB, Singh RK, Y VV, Rajan R, Gupta A, Aggarwal R, Prasad K. Educating Caregivers to Reduce Complications and Improve Outcomes of Stroke Patients (ECCOS) - A Cluster-Randomized Trial. J Stroke Cerebrovasc Dis 2021; 30:105966. [PMID: 34271274 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Stroke constitutes a significant public health problem in developing countries. Caregivers provide an important support system for patient care but usually lack knowledge and skill to attend their stroke patients. We assessed whether a caregiver-directed educational intervention would reduce hospital-acquired complications and improve stroke patients' outcomes. MATERIALS AND METHODS We randomly assigned two Neurology inpatient wards to receive either standard care or an educational intervention. The coprimary outcomes included incidence of hospital-acquired complications and in-hospital mortality. Secondary outcomes included the modified Rankin Scale and mortality at three months. RESULTS Among 164 patients recruited, 82 received intervention, and standard care each. The mean (Standard deviation) Glasgow coma scale of patients was 11.01 (3.4), and National Institute of Health Stroke Scale was 19.17 (8.54). The incidence of complications (72 in the intervention versus 81 in the control group; p=0.56) was not different. Ten patients (12.2%) in the intervention group and 16 (19.5%) in the control group (p=0.20) died in-hospital. Twenty patients (27.8%) in the intervention and twelve (18.2%) in the control group attained modified Rankin Scale 0-2 at three months (p=0.12). The mortality at three months (20 [24.4%] in the intervention versus 25 [30.5%] in the control group) was not different (p=0.38). The intervention group had fewer complications (42 versus 68 in the control group; p=0.01) during the initial ten days of hospital stay, but adjusted analysis revealed no difference. CONCLUSION A structured educational intervention did not reduce the incidence of hospital-acquired complications, mortality, or morbidity. However, there was a trend towards fewer complications in the initial days of hospital stay. Extended hospital stay, caregiver fatigue, and dilution of the intervention over time might be reasons for the apparent lack of effect. CLINICAL TRIAL REGISTRATION-URL: http://www.ctri.nic.in. Unique identifier: CTRI/2018/11/016312.
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Affiliation(s)
- Radhakrishna Pedapati
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Maneesh Shakywar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Akash Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Sreenivas Vishnubhatla
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Rajesh Kumar Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Vishnu V Y
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Rajeev Aggarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
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Khan SU, Kalra A, Yedlapati SH, Dani SS, Shapiro MD, Nasir K, Virani SS, Michos ED, Alkhouli M. Stroke-Related Mortality in the United States-Mexico Border Area of the United States, 1999 to 2018. J Am Heart Assoc 2021; 10:e019993. [PMID: 34212760 PMCID: PMC8403284 DOI: 10.1161/jaha.120.019993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 05/07/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The United States (US)-Mexico border is a socioeconomically underserved area. We sought to investigate whether stroke-related mortality varies between the US border and nonborder counties. METHODS AND RESULTS We used death certificates from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database to examine stroke-related mortality in border versus nonborder counties in California, Texas, New Mexico, and Arizona. We measured average annual percent changes (AAPCs) in age-adjusted mortality rates (AAMRs) per 100 000 between 1999 and 2018. Overall, AAMRs were higher for nonborder counties, older adults, men, and non-Hispanic Black adults than their counterparts. Between 1999 and 2018, AAMRs reduced from 55.8 per 100 000 to 34.4 per 100 000 in the border counties (AAPC, -2.70) and 64.5 per 100 000 to 37.6 per 100 000 in nonborder counties (AAPC, -2.92). The annual percent change in AAMR initially decreased, followed by stagnation in both border and nonborder counties since 2012. The AAPC in AAMR decreased in all 4 states; however, AAMR increased in California's border counties since 2012 (annual percent change, 3.9). The annual percent change in AAMR decreased for older adults between 1999 and 2012 for the border (-5.10) and nonborder counties (-5.01), followed by a rise in border counties and stalling in nonborder counties. Although the AAPC in AAMR decreased for both sexes, the AAPC in AAMR differed significantly for non-Hispanic White adults in border (-2.69) and nonborder counties (-2.86). The mortality decreased consistently for all other ethnicities/races in both border and nonborder counties. CONCLUSIONS Stroke-related mortality varied between the border and nonborder counties. Given the substantial public health implications, targeted interventions aimed at vulnerable populations are required to improve stroke-related outcomes in the US-Mexico border area.
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Affiliation(s)
- Safi U. Khan
- Department of MedicineWest Virginia UniversityMorgantownWV
| | - Ankur Kalra
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
- Regional Section of Interventional CardiologyCardiovascular ResearchCleveland Clinic Akron GeneralAkronOH
| | | | - Sourbha S. Dani
- Department of CardiologyLahey Hospital & Medical CenterBurlingtonMA
| | - Michael D. Shapiro
- Section on Cardiovascular MedicineWake Forest University School of MedicineWinston‐SalemNC
| | - Khurram Nasir
- Department of CardiologyHouston Methodist DeBakey Heart & Vascular CenterHoustonTX
| | - Salim S. Virani
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular ResearchDepartment of MedicineBaylor College of MedicineHoustonTX
| | - Erin D. Michos
- Division of CardiologyJohns Hopkins University School of MedicineBaltimoreMD
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Cui C, Zhou M, Cheng L, Ye T, Zhang Y, Zhu F, Li S, Jiang X, Chen Q, Qi L, Chen X, Yang S, Cai L. Admission hyperglycemia as an independent predictor of long-term prognosis in acute myocardial infarction patients without diabetes: A retrospective study. J Diabetes Investig 2021; 12:1244-1251. [PMID: 33249775 PMCID: PMC8264390 DOI: 10.1111/jdi.13468] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/23/2020] [Accepted: 11/21/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS/INTRODUCTION The predictive value of admission hyperglycemia in the long-term prognosis of acute myocardial infarction patients is still controversial. We aimed to investigate this value based on the diabetes status. MATERIALS AND METHODS We carried out a multicenter, retrospective study of 1,288 acute myocardial infarction patients enrolled in 11 hospitals between March 2014 and June 2019 in Chengdu, China. The patients were classified into those with diabetes and those without diabetes, each was further divided into: hyperglycemia and non-hyperglycemia subgroups, according to the optimal cut-off value of the blood glucose to predict all-cause mortality during follow up. The end-points were all-cause death and major adverse cardiovascular and cerebrovascular events, including all-cause death, non-fatal myocardial infarction, vessel revascularization and non-fatal stroke. RESULTS In the follow-up period of 15 months, we observed 210 (16.3%), 6 (0.5%), 57 (4.4%) and 34 (2.6%) cases of death, non-fatal myocardial infarction, revascularization and non-fatal stroke, respectively. The optimal cut-off values of admission blood glucose for patients with diabetes and patients without diabetes to predict all-cause mortality during follow up were 14.80 and 6.77 mmol/L, respectively. We divided patients with diabetes (n = 331) into hyperglycemia (n = 92) and non-hyperglycemia (n = 239), and patients without diabetes (n = 897) into hyperglycemia (n = 425) and non-hyperglycemia (n = 472). The cumulative rates of all-cause death and major adverse cardiovascular and cerebrovascular events among the patients in each hyperglycemia group was higher than that in the corresponding non-hyperglycemia group (P < 0.001). In patients without diabetes, admission hyperglycemia was an independent predictor of all-cause mortality and major adverse cardiovascular and cerebrovascular events. CONCLUSION Admission hyperglycemia was an independent predictor for long-term prognosis in acute myocardial infarction patients without diabetes.
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Affiliation(s)
- Cai‐yan Cui
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Ming‐gang Zhou
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Lian‐chao Cheng
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Tao Ye
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Yu‐mei Zhang
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Feng Zhu
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Si‐yi Li
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Xing‐lin Jiang
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Qiang Chen
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Ling‐yao Qi
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Xu Chen
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Si‐qi Yang
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
| | - Lin Cai
- Department of CardiologyThe Third People’s Hospital of ChengduAffiliated Hospital of Southwest Jiaotong UniversityChengduSichuanChina
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