Pub Date : 2024-09-24DOI: 10.1016/j.jstrokecerebrovasdis.2024.108026
Yang Du MD , Yijun Lin MD , Anxin Wang PHD , Jia Zhang MD , Ning Li MD , Xiaoli Zhang BS , Xinmin Liu MD , Dandan Wang MD , Wenjuan Wang MD , Xingquan Zhao MD, PHD , Liheng Bian MD
Background
The C-reactive protein-to-albumin ratio (CAR) is a novel prognostic biomarker of systemic inflammation and nutritional status. The association between CAR and the long-term outcome of spontaneous intracerebral hemorrhage (ICH) remains unclear.
Methods
From January 2014 to September 2016, 497 patients with spontaneous ICH were enrolled in our study from 13 hospitals in Beijing. According to the CAR quartiles, patients were classified into four groups (Q1-Q4). Logistic regression was applied to analyze the relationship between different CAR levels and main outcome (90-day and 1-year mRS 4-6). Restricted cubic splines and receiver operating characteristic (ROC) curves of CAR for poor clinical outcomes were assessed.
Results
In the multivariate logistic regression model, compared with the lowest quartile of CAR, the adjusted odds ratios of the Q2, Q3, and Q4 group for 90-day mRS score of 4-6 were 3.64 (1.61–8.23), 3.83 (1.67–8.77), and 8.91 (3.85–20.64). In terms of 1-year mRS score of 4-6, compared with the lowest quartile of CAR, the adjusted odds ratios of the Q3 and Q4 group were 3.31 (1.33–8.22) and 6.87 (2.81–16.78).
Conclusions
A high CAR level was associated with a high risk of long-term adverse prognosis in patients with ICH, and the risk of ICH poor outcome increased steadily with CAR rising in a certain range, and maintained in a high level thereafter.
背景C反应蛋白-白蛋白比值（CAR）是全身炎症和营养状况的新型预后生物标志物。方法从 2014 年 1 月至 2016 年 9 月，我们从北京 13 家医院招募了 497 例自发性 ICH 患者。根据 CAR 四分位数将患者分为四组（Q1-Q4）。应用逻辑回归分析不同 CAR 水平与主要结局（90 天和 1 年 mRS 4-6）之间的关系。结果在多变量逻辑回归模型中，与最低四分位数的 CAR 相比，Q2、Q3 和 Q4 组 90 天 mRS 评分为 4-6 分的调整赔率分别为 3.64（1.61-8.23）、3.83（1.67-8.77）和 8.91（3.85-20.64）。结论高水平的 CAR 与 ICH 患者长期不良预后的高风险相关，ICH 不良预后的风险随着 CAR 在一定范围内的升高而稳步增加，并在此后保持在高水平。
{"title":"Association between the C-reactive protein to albumin ratio and poor clinical outcome in patients with spontaneous intracerebral hemorrhage","authors":"Yang Du MD , Yijun Lin MD , Anxin Wang PHD , Jia Zhang MD , Ning Li MD , Xiaoli Zhang BS , Xinmin Liu MD , Dandan Wang MD , Wenjuan Wang MD , Xingquan Zhao MD, PHD , Liheng Bian MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108026","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108026","url":null,"abstract":"<div><h3>Background</h3><div>The C-reactive protein-to-albumin ratio (CAR) is a novel prognostic biomarker of systemic inflammation and nutritional status. The association between CAR and the long-term outcome of spontaneous intracerebral hemorrhage (ICH) remains unclear.</div></div><div><h3>Methods</h3><div>From January 2014 to September 2016, 497 patients with spontaneous ICH were enrolled in our study from 13 hospitals in Beijing. According to the CAR quartiles, patients were classified into four groups (Q1-Q4). Logistic regression was applied to analyze the relationship between different CAR levels and main outcome (90-day and 1-year mRS 4-6). Restricted cubic splines and receiver operating characteristic (ROC) curves of CAR for poor clinical outcomes were assessed.</div></div><div><h3>Results</h3><div>In the multivariate logistic regression model, compared with the lowest quartile of CAR, the adjusted odds ratios of the Q2, Q3, and Q4 group for 90-day mRS score of 4-6 were 3.64 (1.61–8.23), 3.83 (1.67–8.77), and 8.91 (3.85–20.64). In terms of 1-year mRS score of 4-6, compared with the lowest quartile of CAR, the adjusted odds ratios of the Q3 and Q4 group were 3.31 (1.33–8.22) and 6.87 (2.81–16.78).</div></div><div><h3>Conclusions</h3><div>A high CAR level was associated with a high risk of long-term adverse prognosis in patients with ICH, and the risk of ICH poor outcome increased steadily with CAR rising in a certain range, and maintained in a high level thereafter.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108026"},"PeriodicalIF":2.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-24DOI: 10.1016/j.jstrokecerebrovasdis.2024.108035
Kathryn E. Coté MD, MPH, Megan E. Pudlo MD, Emma Jost-Price BA, Lester Y. Leung MD, MSc
Background
Individual measures of socioeconomic status have been associated with post-stroke disability in patients with ischemic stroke. However, it is not known whether the distribution of income in a community may have an impact on stroke recovery. We hypothesized that increased neighborhood income inequality (as measured by the Gini index) may be associated with a slower recovery after stroke.
Methods
This was a retrospective cohort study of adult patients hospitalized at a comprehensive stroke center with acute ischemic stroke between 1/1/2018-12/31/2019. Individual patient data was abstracted from the EHR, and zip code Gini index was obtained from the US Census Bureau. Binary logistic regression was used to assess the relationship between Gini index and functional independence (modified Rankin scale ≤2) at discharge and first outpatient follow-up. These models controlled for patient demographics, stroke risk factors, stroke severity, and stroke treatment. A second binary regression was also performed using a subset of patients to assess possible predictors of being discharged as recommended (i.e. having a discharge destination that was consistent with the recommendation of the inpatient medical team).
Results
Three hundred and thirty-seven patients were included in this analysis. The median time to first outpatient follow-up was 35 days. Zip code Gini index was not associated with functional independence at discharge but was associated with independence at follow-up (modified Rankin scale ≤2) such that patients from higher inequality neighborhoods had decreased odds of being independent. More specifically, each 1% increase in neighborhood Gini index was associated with 8% decreased odds of independence at follow-up (OR=0.923, 95% CI: 0.863-0.987). Being discharged as recommended was associated with increased odds of independence at follow-up (OR=3.359, 95% CI: 1.055-10.695). Greater income inequality (OR=0.909, 95% CI: 0.841-0.983) and Asian race (OR=0.093, 95% CI: 0.011-0.766) were associated with decreased odds of being discharged as recommended.
Conclusion
Among a cohort of patients with ischemic stroke, increased neighborhood income inequality was associated with decreased odds of achieving functional independence up (modified Rankin scale ≤2) by the time of first outpatient follow-up (at a median of 35 days following discharge). This disparity may be driven by discharge destination and race.
{"title":"Neighborhood income inequality associated with functional independence after ischemic stroke: a cohort study","authors":"Kathryn E. Coté MD, MPH, Megan E. Pudlo MD, Emma Jost-Price BA, Lester Y. Leung MD, MSc","doi":"10.1016/j.jstrokecerebrovasdis.2024.108035","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108035","url":null,"abstract":"<div><h3>Background</h3><div>Individual measures of socioeconomic status have been associated with post-stroke disability in patients with ischemic stroke. However, it is not known whether the distribution of income in a community may have an impact on stroke recovery. We hypothesized that increased neighborhood income inequality (as measured by the Gini index) may be associated with a slower recovery after stroke.</div></div><div><h3>Methods</h3><div>This was a retrospective cohort study of adult patients hospitalized at a comprehensive stroke center with acute ischemic stroke between 1/1/2018-12/31/2019. Individual patient data was abstracted from the EHR, and zip code Gini index was obtained from the US Census Bureau. Binary logistic regression was used to assess the relationship between Gini index and functional independence (modified Rankin scale ≤2) at discharge and first outpatient follow-up. These models controlled for patient demographics, stroke risk factors, stroke severity, and stroke treatment. A second binary regression was also performed using a subset of patients to assess possible predictors of being discharged as recommended (i.e. having a discharge destination that was consistent with the recommendation of the inpatient medical team).</div></div><div><h3>Results</h3><div>Three hundred and thirty-seven patients were included in this analysis. The median time to first outpatient follow-up was 35 days. Zip code Gini index was not associated with functional independence at discharge but was associated with independence at follow-up (modified Rankin scale ≤2) such that patients from higher inequality neighborhoods had decreased odds of being independent. More specifically, each 1% increase in neighborhood Gini index was associated with 8% decreased odds of independence at follow-up (OR=0.923, 95% CI: 0.863-0.987). Being discharged as recommended was associated with increased odds of independence at follow-up (OR=3.359, 95% CI: 1.055-10.695). Greater income inequality (OR=0.909, 95% CI: 0.841-0.983) and Asian race (OR=0.093, 95% CI: 0.011-0.766) were associated with decreased odds of being discharged as recommended.</div></div><div><h3>Conclusion</h3><div>Among a cohort of patients with ischemic stroke, increased neighborhood income inequality was associated with decreased odds of achieving functional independence up (modified Rankin scale ≤2) by the time of first outpatient follow-up (at a median of 35 days following discharge). This disparity may be driven by discharge destination and race.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108035"},"PeriodicalIF":2.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-23DOI: 10.1016/j.jstrokecerebrovasdis.2024.108031
Alison Seitz MD , Alis J. Dicpinigaitis MD , Cenai Zhang MS , Eliza C. Miller MD , Babak B. Navi MD MS , Ava L. Liberman MD
Background
Case reports describe arterial thrombosis including ischemic stroke associated with severe ovarian hyperstimulation syndrome (OHSS), but the prevalence of major ischemic events during or shortly after OHSS is unknown.
Methods
Using publicly available administrative datasets in the United States between 2015 and 2020, we conducted two separate cross-sectional studies of patients with OHSS. We included all patients with OHSS. Our study outcome was any hospitalization for acute ischemic stroke, acute myocardial infarction, cerebral venous sinus thrombosis, pulmonary embolism, or acute deep venous thrombosis during the index hospitalization or within 90 days of OHSS diagnosis.
Results and conclusions
We found very few major ischemic events in patients with OHSS.
{"title":"Ischemic events are infrequent in patients with ovarian hyperstimulation syndrome","authors":"Alison Seitz MD , Alis J. Dicpinigaitis MD , Cenai Zhang MS , Eliza C. Miller MD , Babak B. Navi MD MS , Ava L. Liberman MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108031","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108031","url":null,"abstract":"<div><h3>Background</h3><div>Case reports describe arterial thrombosis including ischemic stroke associated with severe ovarian hyperstimulation syndrome (OHSS), but the prevalence of major ischemic events during or shortly after OHSS is unknown.</div></div><div><h3>Methods</h3><div>Using publicly available administrative datasets in the United States between 2015 and 2020, we conducted two separate cross-sectional studies of patients with OHSS. We included all patients with OHSS. Our study outcome was any hospitalization for acute ischemic stroke, acute myocardial infarction, cerebral venous sinus thrombosis, pulmonary embolism, or acute deep venous thrombosis during the index hospitalization or within 90 days of OHSS diagnosis.</div></div><div><h3>Results and conclusions</h3><div>We found very few major ischemic events in patients with OHSS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 1","pages":"Article 108031"},"PeriodicalIF":2.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-21DOI: 10.1016/j.jstrokecerebrovasdis.2024.108029
Song Pan , Yue-zhou Cao , Wen Sun , Zhenyu Jia , Lin-bo Zhao , Dezhi Liu , Hai-bin Shi , Sheng Liu
Background and purpose
Malnutrition is associated with poor outcomes in different diseases. Our aim was to investigate whether measures of malnutrition could be used to predict 90-day outcomes in patients with vertebrobasilar artery occlusion (VBAO) undergoing endovascular treatment (EVT).
Methods
We retrospectively analyzed patients with VBAO who received EVT at three comprehensive stroke centers. Malnutrition was assessed using the controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI). Primary outcome was good functional outcome defined as modified Rankin Scale (mRS) 0–3 measured at 90 days.
Results
A total of 285 patients were enrolled, of which 260 (91.22 %) met the requirements. According to the CONUT, GNRI, and PNI scores, the proportions of patients classified as moderately or severely malnourished were 7.3 %, 3.08 %, and 35 %, respectively. In the multivariate regression model after adjusting for potential confounders, malnutrition (severe risk versus normal nutritional status) was significantly associated with an increased risk of poor prognosis for CONUT scores (adjusted odds ratio [OR]14.91, 95 %CI, 1.69 - 131.71; P = 0.015), GNRI scores (adjusted [OR] 10.67, 1.17 - 96.93; P = 0.036) and PNI scores (adjusted [OR] 4.61, 2.28 - 9.31; P < 0.001). Similar results were obtained when malnutrition scores were analyzed as continuous variables. Adding the 3 malnutrition measures to the risk reclassification that included traditional risk factors significantly improved the predictive value of 3-month poor prognosis.
Conclusions
Our study showed that malnutrition may be associated with poor prognosis within 3 months of EVT in patients with VBAO.
{"title":"The prognostic impact of malnutrition on the outcomes of patients with vertebrobasilar artery occlusion following endovascular treatment","authors":"Song Pan , Yue-zhou Cao , Wen Sun , Zhenyu Jia , Lin-bo Zhao , Dezhi Liu , Hai-bin Shi , Sheng Liu","doi":"10.1016/j.jstrokecerebrovasdis.2024.108029","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108029","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Malnutrition is associated with poor outcomes in different diseases. Our aim was to investigate whether measures of malnutrition could be used to predict 90-day outcomes in patients with vertebrobasilar artery occlusion (VBAO) undergoing endovascular treatment (EVT).</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients with VBAO who received EVT at three comprehensive stroke centers. Malnutrition was assessed using the controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI). Primary outcome was good functional outcome defined as modified Rankin Scale (mRS) 0–3 measured at 90 days.</div></div><div><h3>Results</h3><div>A total of 285 patients were enrolled, of which 260 (91.22 %) met the requirements. According to the CONUT, GNRI, and PNI scores, the proportions of patients classified as moderately or severely malnourished were 7.3 %, 3.08 %, and 35 %, respectively. In the multivariate regression model after adjusting for potential confounders, malnutrition (severe risk versus normal nutritional status) was significantly associated with an increased risk of poor prognosis for CONUT scores (adjusted odds ratio [OR]14.91, 95 %CI, 1.69 - 131.71; P = 0.015), GNRI scores (adjusted [OR] 10.67, 1.17 - 96.93; P = 0.036) and PNI scores (adjusted [OR] 4.61, 2.28 - 9.31; P < 0.001). Similar results were obtained when malnutrition scores were analyzed as continuous variables. Adding the 3 malnutrition measures to the risk reclassification that included traditional risk factors significantly improved the predictive value of 3-month poor prognosis.</div></div><div><h3>Conclusions</h3><div>Our study showed that malnutrition may be associated with poor prognosis within 3 months of EVT in patients with VBAO.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108029"},"PeriodicalIF":2.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-21DOI: 10.1016/j.jstrokecerebrovasdis.2024.108027
Kriti Bhayana MD , J. Will Handshoe MD , Yadi Li MEd , Nicolas R Thompson MS , Maariyah Kharal BS , Hiba Saleem BS , Ehaab Saleem , Andrew T. Schuster BA , Benjamin Coors MD , Maria Martucci MD , M. Shazam Hussain MD , G. Abbas Kharal MD, MPH
Introduction
Large vessel occlusion-acute ischemic stroke (LVO-AIS) is infrequent in young adults and exhibits distinct stroke mechanisms compared to older adults. This study sought to evaluate the impact of varying stroke etiologies on treatment-related outcomes in young adults with LVO-AIS, an aspect that remains unclear.
Methods
This retrospective cohort study included patients aged 18-50 presenting with AIS from January 2017 to December 2021 within our multi-center stroke network. Patients with LVO on CTA/MRA at presentation were included. We assessed demographics, stroke etiology (TOAST classification), and treatment-related outcomes. Based on intervention received, patients were divided into 5 groups [IV-thrombolysis (IVT) only, Mechanical Thrombectomy (MT) only, IVT+MT, no treatment, unsuccessful MT].
Results
Among 1210 AIS patients, 220 with LVO were included. The median age was 42 (36, 46). 75 (34.1 %) patients underwent successful MT (46.7 % received IVT+MT). 26 (11.8 %) received IVT only, 110 (50 %) received neither intervention, and 9 (4.1 %) underwent unsuccessful MT. Per TOAST, 17.4 % had large artery atherosclerosis (LAA), 19.2 % cardio-embolism, 28.6 % stroke of other etiology, and 34.7 % had undetermined etiology. Favorable thrombectomy outcomes (TICI 2b/2c/3) were observed in 87.2 %. Discharge NIH Stroke Scale (NIHSS) scores improved for patients with IVT+MT in all TOAST categories except LAA.
Conclusions
Young adults with LVO-AIS had good outcomes irrespective of stroke etiology, except LAA, which was associated with a higher discharge NIHSS. Moreover, 50 % of young adults in our study received no intervention, a quarter of those owing to delayed presentation. Further studies are needed to identify barriers in seeking acute treatment in young adults with LVO-AIS.
{"title":"Effect of stroke etiology on treatment-related outcomes in young adults with large vessel occlusion: Results from a retrospective cohort study","authors":"Kriti Bhayana MD , J. Will Handshoe MD , Yadi Li MEd , Nicolas R Thompson MS , Maariyah Kharal BS , Hiba Saleem BS , Ehaab Saleem , Andrew T. Schuster BA , Benjamin Coors MD , Maria Martucci MD , M. Shazam Hussain MD , G. Abbas Kharal MD, MPH","doi":"10.1016/j.jstrokecerebrovasdis.2024.108027","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108027","url":null,"abstract":"<div><h3>Introduction</h3><div>Large vessel occlusion-acute ischemic stroke (LVO-AIS) is infrequent in young adults and exhibits distinct stroke mechanisms compared to older adults. This study sought to evaluate the impact of varying stroke etiologies on treatment-related outcomes in young adults with LVO-AIS, an aspect that remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients aged 18-50 presenting with AIS from January 2017 to December 2021 within our multi-center stroke network. Patients with LVO on CTA/MRA at presentation were included. We assessed demographics, stroke etiology (TOAST classification), and treatment-related outcomes. Based on intervention received, patients were divided into 5 groups [IV-thrombolysis (IVT) only, Mechanical Thrombectomy (MT) only, IVT+MT, no treatment, unsuccessful MT].</div></div><div><h3>Results</h3><div>Among 1210 AIS patients, 220 with LVO were included. The median age was 42 (36, 46). 75 (34.1 %) patients underwent successful MT (46.7 % received IVT+MT). 26 (11.8 %) received IVT only, 110 (50 %) received neither intervention, and 9 (4.1 %) underwent unsuccessful MT. Per TOAST, 17.4 % had large artery atherosclerosis (LAA), 19.2 % cardio-embolism, 28.6 % stroke of other etiology, and 34.7 % had undetermined etiology. Favorable thrombectomy outcomes (TICI 2b/2c/3) were observed in 87.2 %. Discharge NIH Stroke Scale (NIHSS) scores improved for patients with IVT+MT in all TOAST categories except LAA.</div></div><div><h3>Conclusions</h3><div>Young adults with LVO-AIS had good outcomes irrespective of stroke etiology, except LAA, which was associated with a higher discharge NIHSS. Moreover, 50 % of young adults in our study received no intervention, a quarter of those owing to delayed presentation. Further studies are needed to identify barriers in seeking acute treatment in young adults with LVO-AIS.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108027"},"PeriodicalIF":2.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-20DOI: 10.1016/j.jstrokecerebrovasdis.2024.108009
Fengning Guo, Nuan Wang, Chunyu Yu, Youmin Fan, Dan Chen
{"title":"Corrigendum to Genetic association between long non-coding RNA MIAT polymorphism and ischemic stroke susceptibility in the Chinese population","authors":"Fengning Guo, Nuan Wang, Chunyu Yu, Youmin Fan, Dan Chen","doi":"10.1016/j.jstrokecerebrovasdis.2024.108009","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108009","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 11","pages":"Article 108009"},"PeriodicalIF":2.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-20DOI: 10.1016/j.jstrokecerebrovasdis.2024.108013
Gerlinde van der Maten MD, PhD , Xavier G.L.V. Pouwels PhD , Matthijs F.L. Meijs MD, PhD , Clemens von Birgelen MD, PhD , Heleen M. den Hertog MD, PhD , Hendrik Koffijberg PhD , ATTEST investigators
Background
The multicenter ATTEST study recently assessed 1084 patients with ischemic stroke or transient ischemic attack (TIA) of undetermined cause and found that routine transthoracic echocardiography (TTE) detects abnormalities with treatment implications (i.e., major cardiac sources of embolism) in only 1 % of patients, of whom most (91 %) also had major electrocardiographic (ECG)-abnormalities. In this study, we performed a cost-effectiveness analysis of different TTE strategies.
Methods
We compared the cost-effectiveness of three strategies of TTE assessment: (1) TTE in all patients; (2) TTE only in patients with major ECG-abnormalities; and (3) TTE not performed. Input data were derived from ATTEST and systematic literature reviews. A Markov model was developed that simulated recurrent ischemic stroke or TIA and intracranial and gastro-intestinal bleeding complications in patients with ischemic stroke or TIA of undetermined cause. Primary outcome was the additional costs per additional quality-adjusted life-year (QALY) from a Dutch societal perspective.
Results
Performing TTE only in patients with major ECG-abnormalities led to 0.0083 additional QALYs and €108 additional costs per patient as compared with not performing TTE (€12,987/QALY). Performing TTE in all patients resulted in 0.0005 additional QALYs and €422 additional costs per patient as compared with performing TTE only in case of major ECG-abnormalities (€805,336/QALY).
Conclusions
In patients with ischemic stroke or TIA of undetermined cause, a strategy of performing TTE only in patients who also had major ECG-abnormalities resulted in the most favorable ratio of additional costs per additional QALY. This supports performing TTE only in patients, who also have major ECG-abnormalities.
{"title":"Cost-effectiveness analysis of transthoracic echocardiographic assessment in patients with ischemic stroke or TIA of undetermined cause","authors":"Gerlinde van der Maten MD, PhD , Xavier G.L.V. Pouwels PhD , Matthijs F.L. Meijs MD, PhD , Clemens von Birgelen MD, PhD , Heleen M. den Hertog MD, PhD , Hendrik Koffijberg PhD , ATTEST investigators","doi":"10.1016/j.jstrokecerebrovasdis.2024.108013","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108013","url":null,"abstract":"<div><h3>Background</h3><div>The multicenter ATTEST study recently assessed 1084 patients with ischemic stroke or transient ischemic attack (TIA) of undetermined cause and found that routine transthoracic echocardiography (TTE) detects abnormalities with treatment implications (i.e., major cardiac sources of embolism) in only 1 % of patients, of whom most (91 %) also had major electrocardiographic (ECG)-abnormalities. In this study, we performed a cost-effectiveness analysis of different TTE strategies.</div></div><div><h3>Methods</h3><div>We compared the cost-effectiveness of three strategies of TTE assessment: (1) TTE in all patients; (2) TTE only in patients with major ECG-abnormalities; and (3) TTE not performed. Input data were derived from ATTEST and systematic literature reviews. A Markov model was developed that simulated recurrent ischemic stroke or TIA and intracranial and gastro-intestinal bleeding complications in patients with ischemic stroke or TIA of undetermined cause. Primary outcome was the additional costs per additional quality-adjusted life-year (QALY) from a Dutch societal perspective.</div></div><div><h3>Results</h3><div>Performing TTE only in patients with major ECG-abnormalities led to 0.0083 additional QALYs and €108 additional costs per patient as compared with not performing TTE (€12,987/QALY). Performing TTE in all patients resulted in 0.0005 additional QALYs and €422 additional costs per patient as compared with performing TTE only in case of major ECG-abnormalities (€805,336/QALY).</div></div><div><h3>Conclusions</h3><div>In patients with ischemic stroke or TIA of undetermined cause, a strategy of performing TTE only in patients who also had major ECG-abnormalities resulted in the most favorable ratio of additional costs per additional QALY. This supports performing TTE only in patients, who also have major ECG-abnormalities.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108013"},"PeriodicalIF":2.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1016/j.jstrokecerebrovasdis.2024.108017
Tonmoy Alam Shuvo, Asma-Ul- Hosna, Kabir Hossain, Sorif Hossain
Background
Stroke is a major health concern in Bangladesh due to its high incidence and effect on rates of morbidity and death. The morbidity due to stroke in Bangladesh is indeed increasing. This study aimed to find the pooled prevalence of stroke in Bangladesh.
Methods
An extensive search was conducted using PubMed, MEDLINE, and Google Scholar databases. I2 and Q-tests were employed to evaluate the heterogeneity. A random-effects model and subgroup analysis were performed due to the significant heterogeneity. We used Egger's test and funnel plot to look at publication bias. Meta-regression was carried out to analyze how different study variables influenced the effect estimates and to explore sources of heterogeneity across studies. The GRADE approach was used to evaluate the overall quality of the evidence, and the Joanna Briggs Institute tool was used to assess the risk of bias. Sensitivity analysis was conducted to evaluate the robustness of the meta-analysis results. STATA version 17 was used for analysis.
Results
We selected eleven (n = 1577293) studies that met the inclusion criteria for the final synthesis. In Bangladesh, the overall pooled prevalence of stroke was 1.10 % (95 % CI: 0.70–1.51). Subgroup analysis showed that the prevalence of stroke was 1.14 % (95 % CI: 0.58–1.70) from 2005 to 2014 and 1.04 % (95 % CI: 0.40–1.68) from 2015 to 2024.
Conclusion
Stroke prevalence in Bangladesh is significantly high. The country's healthcare system faces adequate stroke prevention and treatment challenges. Improving healthcare services and public health education are crucial to addressing this increasing public health issue.
{"title":"Prevalence of stroke in Bangladesh: A systematic review and meta-analysis","authors":"Tonmoy Alam Shuvo, Asma-Ul- Hosna, Kabir Hossain, Sorif Hossain","doi":"10.1016/j.jstrokecerebrovasdis.2024.108017","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108017","url":null,"abstract":"<div><h3>Background</h3><div>Stroke is a major health concern in Bangladesh due to its high incidence and effect on rates of morbidity and death. The morbidity due to stroke in Bangladesh is indeed increasing. This study aimed to find the pooled prevalence of stroke in Bangladesh.</div></div><div><h3>Methods</h3><div>An extensive search was conducted using PubMed, MEDLINE, and Google Scholar databases. I<sup>2</sup> and Q-tests were employed to evaluate the heterogeneity. A random-effects model and subgroup analysis were performed due to the significant heterogeneity. We used Egger's test and funnel plot to look at publication bias. Meta-regression was carried out to analyze how different study variables influenced the effect estimates and to explore sources of heterogeneity across studies. The GRADE approach was used to evaluate the overall quality of the evidence, and the Joanna Briggs Institute tool was used to assess the risk of bias. Sensitivity analysis was conducted to evaluate the robustness of the meta-analysis results. STATA version 17 was used for analysis.</div></div><div><h3>Results</h3><div>We selected eleven (n = 1577293) studies that met the inclusion criteria for the final synthesis. In Bangladesh, the overall pooled prevalence of stroke was 1.10 % (95 % CI: 0.70–1.51). Subgroup analysis showed that the prevalence of stroke was 1.14 % (95 % CI: 0.58–1.70) from 2005 to 2014 and 1.04 % (95 % CI: 0.40–1.68) from 2015 to 2024.</div></div><div><h3>Conclusion</h3><div>Stroke prevalence in Bangladesh is significantly high. The country's healthcare system faces adequate stroke prevention and treatment challenges. Improving healthcare services and public health education are crucial to addressing this increasing public health issue.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108017"},"PeriodicalIF":2.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1016/j.jstrokecerebrovasdis.2024.108020
Fernando Garagoli MD, Walter Masson MD, Leandro Barbagelata MD
Background
The role of lipoprotein(a) [Lp(a)] as a potential risk factor for atherosclerotic arterial disease has been extensively studied. However, the available data regarding its association with the vulnerability of carotid atherosclerotic plaque is limited. The main objective of the present systematic review was to assess the association between elevated Lp(a) levels and carotid vulnerable plaque features.
Methods
This systematic review adhered to PRISMA guidelines, conducting a comprehensive literature search to identify studies examining the association between Lp(a) levels and vulnerability of carotid atherosclerotic plaque. Experimental or observational studies were eligible, without language, country, or publication type restrictions.
Results
Nine studies including 2058 patients were eligible for this systematic review. Five cross-sectional studies, 3 prospective/retrospective cohorts, and 1 subanalysis of a randomized controlled trial were analyzed. Two cross-sectional studies that compared Lp(a) levels between patients with and without vulnerable carotid plaque showed discordant results. Nevertheless, all the studies that evaluated the prevalence or incidence of vulnerable carotid plaque according to Lp(a) levels showed a positive association. Similarly, one study found a significant correlation between vulnerability of carotid plaque and Lp(a) levels.
Conclusion
Almost all studies analyzed in the present review showed a positive association between elevated Lp(a) levels and carotid vulnerable plaque features. However, further research is needed to clarify this issue.
{"title":"Association between elevated lipoprotein(a) levels and vulnerability of carotid atherosclerotic plaque: A systematic review","authors":"Fernando Garagoli MD, Walter Masson MD, Leandro Barbagelata MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108020","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108020","url":null,"abstract":"<div><h3>Background</h3><div>The role of lipoprotein(a) [Lp(a)] as a potential risk factor for atherosclerotic arterial disease has been extensively studied. However, the available data regarding its association with the vulnerability of carotid atherosclerotic plaque is limited. The main objective of the present systematic review was to assess the association between elevated Lp(a) levels and carotid vulnerable plaque features.</div></div><div><h3>Methods</h3><div>This systematic review adhered to PRISMA guidelines, conducting a comprehensive literature search to identify studies examining the association between Lp(a) levels and vulnerability of carotid atherosclerotic plaque. Experimental or observational studies were eligible, without language, country, or publication type restrictions.</div></div><div><h3>Results</h3><div>Nine studies including 2058 patients were eligible for this systematic review. Five cross-sectional studies, 3 prospective/retrospective cohorts, and 1 subanalysis of a randomized controlled trial were analyzed. Two cross-sectional studies that compared Lp(a) levels between patients with and without vulnerable carotid plaque showed discordant results. Nevertheless, all the studies that evaluated the prevalence or incidence of vulnerable carotid plaque according to Lp(a) levels showed a positive association. Similarly, one study found a significant correlation between vulnerability of carotid plaque and Lp(a) levels.</div></div><div><h3>Conclusion</h3><div>Almost all studies analyzed in the present review showed a positive association between elevated Lp(a) levels and carotid vulnerable plaque features. However, further research is needed to clarify this issue.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108020"},"PeriodicalIF":2.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-19DOI: 10.1016/j.jstrokecerebrovasdis.2024.108022
A.Z. Siddiqi , N. Kashani , Adam A. Dmytriw , D. Yavagal , G. Saposnik , M. Tymianski , C. Adams , M.D. Hill , Dar Dowlatshahi , Aristeidis H Katsanos , B.K. Menon , A. Ganesh , N. Singh
Background
A recently published individual participant-level meta-analysis found that EVT alone was not non-inferior to combined intravenous thrombolysis (IVT) and EVT. Our aim was to determine factors that influence physicians’ treatment choice of IVT-alone versus EVT-alone versus a combined approach.
Methods
We performed an international, structured, invite-only survey among physicians treating patients presenting with AIS. Respondents were asked 16 multiple choice questions. Fourteen questions involved the respondent being provided with a clinical scenario. In each scenario, a patient was presenting with an AIS with LVO, varying a single clinical or imaging feature.
Results
A total of 282 stroke physicians (mean age 46 years, 75 % males) participated in the survey. In LVO stroke, eligible for both IVT and EVT, without other qualifiers, 220 (85.9 %) respondents chose to pursue a combined approach. For age over 80 years, 191 (74 %) participants opted for combined approach, which decreased to 121 (48.2 %) with dementia and 148 (57.4 %) if the patient was on dual anti-platelet therapy (DAPT). Of respondents choosing combination therapy in a patient above the age of 80, only 105 (56.8 %) would pursue the same in a patient with dementia. For imaging factors, 177 (72.8 %) opted for a combined approach for intracranial carotid occlusion, which decreased to 160 (65.3 %) in tandem occlusions. Overall, 88 (38 %) respondents agreed to the statement “I am uncomfortable with uncertainty in patient care”.
Conclusions
In a typical patient with AIS due to LVO, most respondents still choose a combined revascularization approach but discrepancy in decision-making increases in complex scenarios.
{"title":"Understanding physician preferences about combined thrombolysis and thrombectomy in patients with large vessel occlusion: An international cross-sectional survey","authors":"A.Z. Siddiqi , N. Kashani , Adam A. Dmytriw , D. Yavagal , G. Saposnik , M. Tymianski , C. Adams , M.D. Hill , Dar Dowlatshahi , Aristeidis H Katsanos , B.K. Menon , A. Ganesh , N. Singh","doi":"10.1016/j.jstrokecerebrovasdis.2024.108022","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108022","url":null,"abstract":"<div><h3>Background</h3><div>A recently published individual participant-level meta-analysis found that EVT alone was not non-inferior to combined intravenous thrombolysis (IVT) and EVT. Our aim was to determine factors that influence physicians’ treatment choice of IVT-alone versus EVT-alone versus a combined approach.</div></div><div><h3>Methods</h3><div>We performed an international, structured, invite-only survey among physicians treating patients presenting with AIS. Respondents were asked 16 multiple choice questions. Fourteen questions involved the respondent being provided with a clinical scenario. In each scenario, a patient was presenting with an AIS with LVO, varying a single clinical or imaging feature.</div></div><div><h3>Results</h3><div>A total of 282 stroke physicians (mean age 46 years, 75 % males) participated in the survey. In LVO stroke, eligible for both IVT and EVT, without other qualifiers, 220 (85.9 %) respondents chose to pursue a combined approach. For age over 80 years, 191 (74 %) participants opted for combined approach, which decreased to 121 (48.2 %) with dementia and 148 (57.4 %) if the patient was on dual anti-platelet therapy (DAPT). Of respondents choosing combination therapy in a patient above the age of 80, only 105 (56.8 %) would pursue the same in a patient with dementia. For imaging factors, 177 (72.8 %) opted for a combined approach for intracranial carotid occlusion, which decreased to 160 (65.3 %) in tandem occlusions. Overall, 88 (38 %) respondents agreed to the statement “I am uncomfortable with uncertainty in patient care”.</div></div><div><h3>Conclusions</h3><div>In a typical patient with AIS due to LVO, most respondents still choose a combined revascularization approach but discrepancy in decision-making increases in complex scenarios.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108022"},"PeriodicalIF":2.0,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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