P3557Heart failure patients show increase of white matter lesions in MRI-imaging: LIFE-Adult-Study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Stegmann ◽  
M L Chu ◽  
A Villringer ◽  
U Laufs ◽  
M Loeffler ◽  
...  
Keyword(s):  
Heart Failure ◽  
White Matter ◽  
Troponin T ◽  
Univariate Analysis ◽  
White Matter Lesions ◽  
Future Research ◽  
Cerebral Mri ◽  
History Of ◽  
Study Participants ◽  
Structural Brain

Abstract Background Heart Failure (HF) is a risk factor for stroke and dementia and is associated with cognitive impairment. However, whether or not HF is directly linked to structural brain changes is unknown. White matter lesions (WML) are common structural alterations in the white matter of the brain and their prevalence increases with age. They are associated with cerebral ischemia and cognitive dysfunction. However, there are only a few reports on HF and WML. Purpose We hypothesized that the presence and duration of heart failure are associated with WML. Methods LIFE Adult is a population-based study whose participants are a representative sample of the city of Leipzig, Germany (approximately 580,000 inhabitants). All study participants (18–80 years of age) underwent an extensive core assessment program (5–6 h) including structured medical interviews, medical and psychological questionnaires, physical examination and bio specimen collection. A subgroup of 2490 participants additionally underwent cerebral MRI (cMRI). The Fazekas Score was used for the classification of the WML (none or mild WML versus moderate or severe WML). Raters were blinded to other medical information of study participants. History of HF and other diseases were ascertained as part of the self-reported medical history questionnaire. Results Mean age was 64 years and 46% were female. On univariate analysis age, troponin T, NT-proBNP, body mass index, history of acute myocardial infarction, stroke, HF and diabetes were positively associated with WML. On multivariate analysis, only age, hypertension, stroke and HF were associated with WML. Interestingly, the Odd's ratio (OR) for HF was 2.5 (95% confidence interval (CI) 1.1; 5.6) and numerically higher than the OR for stroke (OR 2.0 (95% CI 1.0; 3.8)). Additionally, the OR increased with longer duration of HF (OR 1.3 for HF-duration <3 years, OR 1.7 for HF 4–6 years duration and OR 2.9 for HF-diagnosis >6 years). Conclusion HF is independently associated with structural brain damage, i. e. WML. Future research is needed to elaborate whether WML could be a therapeutic target for treatment targeting cognitive decline in HF.

scholarly journals Prevalence and Risk Factors of White Matter Lesions in Tibetan Patients Without Acute Stroke

Stroke ◽  
2020 ◽  
Vol 51 (1) ◽  
pp. 149-153 ◽  
Author(s):  
Haiqiang Jin ◽  
Zhijie Ding ◽  
Siqing Lian ◽  
Yuhua Zhao ◽  
Shihua He ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Acute Stroke ◽  
Univariate Analysis ◽  
White Matter Lesions ◽  
Primary Headache ◽  
High Altitudes ◽  
Related Factors ◽  
Logistic Analysis ◽  
History Of

Background and Purpose— Studies on the prevalence and risk factors of white matter lesions (WMLs) in Tibetans living at high altitudes are scarce. We conducted this study to determine the prevalence and risks of WMLs in Tibetan patients without or with nonacute stroke. Methods— We undertook a retrospective analysis of medical records of patients treated at the People’s Hospital of Tibetan Autonomous Region and identified a total of 301 Tibetan patients without acute stroke. WML severity was graded by the Fazekas Scale. We assessed the overall and age-specific prevalence of WMLs and analyzed associations between WMLs and related factors with univariate and multivariate methods. Results— Of the 301 patients, 87 (28.9%) had peripheral vertigo, 83 (27.3%) had primary headache, 52 (17.3%) had a history of stroke, 36 (12.0%) had an anxiety disorder, 29 (9.6%) had epilepsy, 12 (4.0%) had infections of the central nervous system, and 3 (1.0%) had undetermined diseases. WMLs were present in 245 (81.4%) patients, and 54 (17.9%) were younger than 40 years. Univariate analysis showed that age, history of cerebral infarction, hypertension, the thickness of the common carotid artery intima, and plaque within the intracarotid artery were related risks for WMLs. Ordered logistic analysis showed that age, history of cerebral ischemic stroke, hypertension, male sex, and atrial fibrillation were associated with WML severity. Conclusions— Risk factors for WMLs appear similar for Tibetans residing at high altitudes and individuals living in the plains. Further investigations are needed to determine whether Tibetans residing at high altitudes have a higher burden of WMLs than inhabitants of the plains.

373 Historical Use of Substances for Insomnia Impacts Current Beliefs about Hypnotic Medications

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A148-A149
Author(s):  
Jessica Dietch ◽  
Norah Simpson ◽  
Joshua Tutek ◽  
Isabelle Tully ◽  
Elizabeth Rangel ◽  
...  
Keyword(s):  
Prescription Medication ◽  
Stepped Care ◽  
Future Research ◽  
Prescription Medications ◽  
Over The Counter ◽  
Multiple Treatment ◽  
History Of ◽  
Study Participants ◽  
Beliefs About Medications ◽  
The Impact

Abstract Introduction The purpose of the current study was to examine the relationship between current beliefs about hypnotic medications and historical use of prescription hypnotic medications or non-prescription substances for sleep (i.e., over the counter [OTC] medications, alcohol, and cannabis). Methods Participants were 142 middle age and older adults with insomnia (M age = 62.9 [SD = 8.1]; 71.1% female) enrolled in the RCT of the Effectiveness of Stepped-Care Sleep Therapy In General Practice (RESTING) study. Participants reported on history of substances they have tried for insomnia and completed the Beliefs about Medications Questionnaire-Specific with two subscales assessing beliefs about 1) the necessity for hypnotics, and 2) concerns about potential adverse consequences of hypnotics. Participants were grouped based on whether they had used no substances for sleep (No Subs, 11.6%), only prescription medications (Rx Only, 9.5%), only non-prescription substances (NonRx Only, 26.6%), or both prescription and non-prescription substances (Both, 52.3%). Results Sixty-one percent of the sample had used prescription medication for sleep and 79% had used non-prescription substances (74% OTC medication, 23% alcohol, 34% cannabis). The greater number of historical substances endorsed, the stronger the beliefs about necessity of hypnotics, F(1,140)=23.3, p&lt;.001, but not about concerns. Substance groups differed significantly on necessity beliefs, F(3,1)=10.68, p&lt;.001; post-hocs revealed the Both group had stronger beliefs than the No and NonRx Only groups. Substance groups also differed significantly on the concerns subscale, F(3,1)=6.68, p&lt;.001; post-hocs revealed the NonRx Only group had stronger harm beliefs than the other three groups. Conclusion The majority of the sample had used both prescription and non-prescription substances to treat insomnia. Historical use of substances for treating insomnia was associated with current beliefs about hypnotics. Individuals who had used both prescription and non-prescription substances for sleep in the past had stronger beliefs about needing hypnotics to sleep at present, which may reflect a pattern of multiple treatment failures. Individuals who had only tried non-prescription substances for sleep may have specifically sought alternative substances due to concerns about using hypnotics. Future research should seek to understand the impact of treatment history on engagement in and benefit from non-medication-based treatment for insomnia. Support (if any) 1R01AG057500; 2T32MH019938-26A1

Abstract TP201: The Relationship Between Chronic Kidney Diseases and the Presence of Cerebral Small Vessel Disease in Patients With Acute Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kana Ueki ◽  
Asako Nakamura ◽  
Masahiro Yasaka ◽  
Takahiro Kuwashiro ◽  
Seiji Gotoh ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
White Matter Lesion ◽  
Kidney Diseases ◽  
Univariate Analysis ◽  
Small Vessel ◽  
Chronic Kidney Diseases ◽  
History Of ◽  
The Relationship

Introduction: Cerebral small vessel diseases (SVDs) i.e. white matter lesion and cerebral microbleeds (CMBs) are related to the patients with stroke more deeply than those without. In general population, in addition to age, hypertension, diabetes chronic kidney diseases (CKD) is well known to be related to SVDs, but it remains unclear in patients with stroke. We investigated the relationship between CKD and the presence of SVDs in patients with acute ischemic stroke. Methods: We enrolled 493 patients with acute ischemic stroke patients or transient ischemic attack patients (mean age 71; 60% male) who had undergone 1.5T MR imaging within a week of the index events from April 2013 to march 2015. We evaluated kidney function by estimated glomerular filtration rate (eGFR) with the modification of diet in Renal Disease. CKD was defined as an eGFR less than 60mil/min/1.73m 2 . CMBs were defined as focal areas of very low signal intensity smaller than 10mm. White matter lesion as Periventricular hyper intensity (PVH)>grade 2 and Deep and Subcortical White Matter Hyper intensity (DSWMH)> grade 2 were defied as advanced PVH and advanced DSWMH, respectively. We investigated relationship between CKD and CMBs, advanced PVH and advanced DSWMH using a logistic regression analysis. Results: We noted CMBs in 173 patients (35%), PVH in 81 (16%), and DSWMH in 151 (31%). An univariate analysis revealed that the age, CKD, history of stroke, and antiplatelet agents were associated with presence of CMBs, advanced PVH and severe DSWMH . The multivariate analysis revealed that CMBs, advanced PVH and advanced DSWMH were associated with age (CMBs: odds ratio(OR) ; 1.32 ; 95% confidence interval(CI), 1.10-1.60, p=0.004, advanced PVH : OR ; 3.00 ; 95% CI, 2.17-4.26, p<0.01, advanced DSWMH: OR ; 1.94; 95% CI, 1.56-2.45, p<0.01 ), history of stroke(CMBs : OR ; 2.01 ; 95% CI, 1.21-3.34, p=0.007, advanced PVH : OR ; 2.25 ; 95% CI, 1.18-4.27, p=0.01, advanced DSWMH: OR ; 1.78 ; 95% CI, 1.03-3.06, p=0.038). CKD was associated with CMBs (OR ; 1.62 ; 95% CI, 1.04-2.52, p=0.03), but PVH and DSWMH were not. Conclusions: It seems that age and history of stroke are related to CMBs, advanced PVH and advanced DSWMH, and that CKD is associates with CMBs but not with either advanced PVH or advanced DSWMH.

High-sensitivity cardiac troponin T and severity of cerebral white matter lesions in patients with acute ischemic stroke

2018 ◽  
Vol 266 (1) ◽  
pp. 37-45 ◽  
Author(s):  
Regina von Rennenberg ◽  
Bob Siegerink ◽  
Ramanan Ganeshan ◽  
Kersten Villringer ◽  
Wolfram Doehner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
Cardiac Troponin ◽  
Troponin T ◽  
White Matter Lesions ◽  
High Sensitivity ◽  
Cerebral White Matter ◽  
Cardiac Troponin T ◽  
Cerebral White Matter Lesions

Discharge Destination after Elective Femoropopliteal Bypass in Patients without Critical Ischemia

2016 ◽  
Vol 82 (5) ◽  
pp. 462-467 ◽  
Author(s):  
David S. Kauvar ◽  
Candice L. Osborne
Keyword(s):  
Heart Failure ◽  
Cerebrovascular Accident ◽  
Univariate Analysis ◽  
Female Gender ◽  
Femoropopliteal Bypass ◽  
Improvement Program ◽  
Surgical Quality ◽  
Skilled Nursing ◽  
Initial Discharge ◽  
History Of

Femoropopliteal bypass (FPB) remains a widely accepted treatment option for symptomatic leg ischemia, even in patients without features of critical limb ischemia (CLI). These patients are revascularized to improve symptoms of exertional limb pain and the goal of such treatment is to increase their ability to ambulate within the community. Therefore, the anticipated initial discharge disposition for a patient without CLI undergoing FPB is back to their home. This study examined the disposition at initial discharge of such patients. Data from the 2012 National Surgical Quality Improvement Program registry was queried for all elective FPB performed in patients without CLI. Analysis was limited to patients surviving to initial discharge who were living independently at home before surgery. Initial disposition was defined as to HOME or to a FACILITY (either rehabilitation or skilled nursing); these constituting the study groups. Univariate analysis and multivariable logistic regression were performed to identify patient risk factors for failure to discharge to home. In-hospital and postoperative events were also recorded and compared. Significance was defined at P ≤ 0.05. In National Surgical Quality Improvement Program 2012, 1060 cases of elective FPB in patients without CLI were found. The mean6 SD age of the population was 65 ± 9 years; 359 (34%) of patients were female; 198 (19%) had a reported race other than white; and most (893, 84%) had hypertension. 60 (6%) patients failed to discharge to home (26 to rehabilitation, 34 to skilled nursing). On univariate analysis, age (FACILITY 68 ± 11 years vs HOME 65 ± 9 years, P = 0.009), female gender (55% vs 37%, P < 0.001), nonwhite race (30% vs 18%, P = 0.007), and a history of diabetes (48% vs 33%, P = 0.01), dialysis (5% vs 1.3%, P = 0.02) congestive heart failure (5% vs 1.1%, P = 0.01), or a stroke (cerebrovascular accident, 5% vs 2.6%, P = 0.01) were found to predict failure to discharge to home. On multivariate analysis, female gender [odds ratio (OR) = 2.4, 95% confidence interval = 1.4–4.1, P = 0.002], and a history of congestive heart failure (OR = 4.7, 1.2–18, 0.03] or cerebrovascular accident (OR = 3.4, 1.9–9.4, 0.02) independently predicted failure to discharge to home. FACILITY patients had higher rates of infectious complications (8.3% vs 1.4%, P < 0.001), myocardial infarction (3.3% vs 0.8%, P = 0.05), operative transfusion (22% vs 5.8%, P < 0.001), and unplanned reoperation (17% vs 2.4%, P < 0.001) during their initial hospitalization. Elective FPB results in a low but not negligible failure of initial return to the community in patients without CLI. Female gender and serious comorbidities predict initial discharge to a facility, which is associated with a complicated hospital course. Careful patient selection is important to achieve good outcomes in this population and furthermore study into the specific preoperative functional and socioeconomic factors predicting failure of early return to the community is warranted.

scholarly journals A-59 Psychosis and Coma in COVID-19: A Case Report

2021 ◽  
Vol 36 (6) ◽  
pp. 1101-1101
Author(s):  
Parker Kotlarz ◽  
Yasmine B Nabulsi ◽  
Joseph Cahill
Keyword(s):  
African American Male ◽  
Inflammatory Responses ◽  
White Matter Lesions ◽  
Psychiatric Disease ◽  
Future Research ◽  
High Dose ◽  
Local Hospital ◽  
Comatose State ◽  
History Of ◽  
Test Result

Abstract Objective The objective of this case is to spotlight the potential neurological andneuropsychiatric symptoms associated with COVID-19. Method A 55-year-old African American male with a history of schizophrenia, bipolar disorder, obesity, tobacco use, and hypertension voluntarily presented to the local hospital with auditoryhallucinations and delusions. During an inpatient stay, the patient developed symptomsconsistent with COVID-19 and subsequently tested positive for the virus. Thirty-nine days after the initial positive COVID-19 test result, he remained in a coma with retained brainstem responses. An EEG demonstrated encephalopathy and MRI showed multiple, well-circumscribed white matter lesions consistent with acute demyelination (Figure 1). After three days of high-dose steroids and over a month in a coma, the patient began following simple commands. Unfortunately, on hospital day 66, the patient developed sudden hypotension and worsening respiratory status. Results While psychotic episodes in relation to COVID-19 are not widely reported, psychotic episodes are shown in three COVID-19 cases. Other reports have found significant changes in consciousness in COVID-19 patients with delayed awakening from a comatose state. Pre-existing inflammatory responses in those with psychiatric disease may be accelerated by the immune response due to COVID-19. Conclusion Mental status changes in those with psychiatric illness who have COVID-19 are worth exploring. It is unclear whether a history of COVID-19 may accelerate a neuropsychiatric process or other central nervous system diseases. Future research may want to examine the possible interrelationship between pre-existing neurological vulnerabilities and COVID-19. The possibility of high-dose steroid treatment for COVID-19 neuroinflammatory complications should be considered.

scholarly journals Trimethylamine-N-oxide (TMAO) is associated with cardiovascular mortality and vascular brain lesions in patients with atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Luciani ◽  
D Mueller ◽  
C Vanetta ◽  
T Diteepeng ◽  
A Von Eckardstein ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
White Matter ◽  
Cystatin C ◽  
Cardiovascular Mortality ◽  
Brain Mri ◽  
White Matter Lesions ◽  
Brain Lesions ◽  
Mixed Effect ◽  
Mixed Effect Models

Abstract Introduction Trimethylamine-N-oxide (TMAO) is a well characterized pro-atherogenic metabolite derived from the microbial processing of phosphatidylcholine and carnitine (usually present in red meat) and subsequent hepatic oxydation, which promotes endothelial dysfunction, platelet activation and thrombosis initiation. Its role concerning cerebral and cardiovascular adverse events has been assessed in various patient subpopulations but not for long term in patients with atrial fibrillation. Methods Baseline TMAO plasma levels were measured by high-performance liquid chromatography/mass spectrometry in plasmas of 2,379 subjects from our multicentric study. Among them, 1,722 participants at time of recruitment underwent brain MRI. Participants were stratified into TMAO tertiles and Cox PH models, linear mixed effect models or logistic mixed effect models were employed adjusting for several risk factors (age, sex, BMI, active and past smoke habit, cystatin c levels, heart failure, diabetes mellitus, hypertension, coronary artery disease and history of TIA/stroke). Subjects were prospectively followed with a median observation time of 4 years. Results Subjects in the highest tertile of TMAO were older (75.4 vs. 70.6 years in low tertile p&lt;0.001) and had significantly more often comorbidities, (26.9% of subjects were diabetic vs. 9.1% in low tertile p&lt;0.001), with higher BMI (28.1 vs 27.0, p&lt;0.001) and worse renal function as assessed by serum cystatin C (1.46 vs 1.07, mg/dl; p&lt;0.001). Heart failure was present in 37.9% participants in the upper compared to 15.8% in the lower tertile. (p&lt;0.001). As shown in Figure 1, Kaplan Meier estimates showed increased cardiovascular mortality with increasing TMAO tertiles (p&lt;0.0001). After adjustment for the abovementioned factors the upper tertile (T3) had an increased hazard ratio (HR) compared to the lowest one (HR 2.36 95% CI 1.56–3.58 p&lt;0.01). Similar trends for global and ischemic stroke occurrences were not found although TMAO levels positively weakly correlated with NIHSS severity (Spearman's coefficient 0.31 p=0.02). Concerning brain MRI findings, TMAO tertiles identified individuals with different prevalence of small non-cortical infarcts (30.5%, 18.1% and 17.4% in high, middle and low tertiles respectively; p&lt;0.001) and when present, larger white matter lesions volumes (5061 mm3, 4158 mm3 and 2970 mm3; p&lt;0.001). After adjustment, the association with small non-cortical infarcts with TMAO levels remained significant in the highest tertile (T3) (OR 1.48 95% CI 1.07–2.05; p=0.02) and a trend towards larger white matter lesions volumes was observed (estimate 1307 95% CI −90–2705; p=0.07). Conclusions TMAO represents a robust prognostic independent biomarker identifying multimorbid, high risk patients for cardiovascular mortality and brain damage. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Swiss National Science Foundation (SNSF) and Theodor und Ida Herzog-Egli Foundation Figure 1. CV mortality according to TMAO Figure 2. Brain lesions assessment

Vascular White Matter Lesions in Young Adults: A Neurology Outpatient Clinic Registry

2019 ◽  
Vol 82 (1-3) ◽  
pp. 23-31
Author(s):  
Miguel Viana-Baptista ◽  
Vera Cruz-e-Silva ◽  
André Caetano ◽  
João Pedro Marto ◽  
Elsa Azevedo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
White Matter ◽  
Genetic Disorder ◽  
Previous History ◽  
White Matter Lesions ◽  
Vascular Risk Factors ◽  
Outpatient Clinics ◽  
Vascular Risk ◽  
History Of

Introduction: Although frequently assumed to be age-related changes, vascular white matter lesions (WML) are sometimes found in young adults. Etiology is usually attributed to sporadic small vessel disease; nevertheless, genetic disorders may also be implicated. We aimed to characterize the population of young adults with vascular WML in Neurology outpatient clinics. Methods: Neurologists from 12 Portuguese hospitals were invited to include patients aged 18–55 years evaluated in consultation, with vascular WML on MRI, scoring II or III in the Fazekas scale. Central imaging validation was performed by 2 independent, blinded, Neuroradiologists. Demographic and clinical data were collected as well as results of investigations performed. Results: During 2 years, 77 patients were included (mean age 47.7 years). Vascular risk factors were present in 88.3% patients (hypertension in 53.2%) and previous history of stroke in 36.4%. Patients without history of stroke were younger (46.6 ± 7.2 vs. 49.6 ± 3.9 years, p = 0.045) and had fewer vascular risk factors (p < 0.001). They were more frequently females (87.8 vs. 46.4%, p < 0.001), and headache (30.6 vs. 3.6%, p = 0.007), contrary to focal symptoms (16.3 vs. 53.6%, p = 0.001), was the most frequent reason of referral. Etiological investigations performed differed between Neurologists. A genetic disorder was identified in 6 out of 58 patients (CADASIL n = 5; COL4A1 n = 1). Conclusion: Young adults with vascular WML evaluated in Neurology outpatient clinics concentrate in the oldest age groups. Vascular risk factors should be screened carefully in this population. Among patients without history of stroke, females largely outweigh males. Diagnostic investigations performed do not follow a standardized protocol.

Factors associated with symptomatic intracranial haemorrhage after intravenous thrombolysis in severe white matter lesions: a retrospective analysis

2021 ◽  
pp. postgradmedj-2021-140886
Author(s):  
Yu Shen ◽  
DeFu Li ◽  
BoJi Tang ◽  
Qian Cao ◽  
Zhuo Hou ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Retrospective Analysis ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Intravenous Thrombolysis ◽  
White Matter Lesions ◽  
Cerebral Haemorrhage ◽  
Distribution Width ◽  
Nihss Score

Background and purposeWhite matter lesions (WMLs) are thought to cause damage to the blood–brain barrier, thereby aggravating bleeding after intravenous thrombolysis. However, the risk factors for symptomatic cerebral haemorrhage after thrombolysis are still unclear. This study explored the risk factors for bleeding in patients with severe WMLs after intravenous thrombolysis to prevent bleeding as soon as possible.MethodsA large single-centre observational study conducted a retrospective analysis of intravenous thrombolysis in patients with severe WMLs from January 2018 to March 2021. According to whether symptomatic cerebral haemorrhage occurred, the patients were divided into two groups, and then statistical analysis was performed.ResultsAfter a retrospective analysis of the data of nearly 1000 patients with intravenous thrombolysis and excluding invalid information, 146 patients were included, of which 23 (15.8%) patients had symptomatic cerebral haemorrhage. Univariate analysis showed that a history of hypertension (20% vs 4.9%, p=0.024), hyperlipidaemia (38.7% vs 9.6%, p<0.001), the National Institutes of Health Stroke Scale (NIHSS) score before thrombolysis (median 17 vs 6, p<0.001), low-density lipoprotein levels (median 2.98 vs 2.44, p=0.011), cholesterol levels (mean 4.74 vs 4.22, p=0.033), platelet count (median 161 vs 191, p=0.031), platelet distribution width (median 15.2 vs 12.1, p=0.001) and sodium ion levels (median 139.81 vs 138.67, p=0.043) were significantly associated with symptomatic cerebral haemorrhage. Further multivariate logistic regression analysis showed that hyperlipidaemia (OR=9.069; 95% CI 2.57 to 32.07; p=0.001) and the NIHSS score before thrombolysis (OR=1.33; 95% CI 1.16 to 1.52; p<0.001) were comprehensive risk factors for symptomatic cerebral haemorrhage.ConclusionHyperlipidaemia and the NIHSS score before thrombolysis are independent risk factors for bleeding after intravenous thrombolysis in patients with severe WMLs. Delaying the onset of white matter and preventing risk factors for bleeding will help improve the prognosis of cerebral infarction and reduce mortality. These risk factors need to be further evaluated in future studies.

Abstract 337: Prognostic Impact of Cardiac Arrest Among Patients With ST-Elevation Myocardial Infarction

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Anirudh Kumar ◽  
Chetan P Huded ◽  
Michael J Johnson ◽  
Venu Menon ◽  
Stephen G Ellis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiac Arrest ◽  
Troponin T ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Prognostic Impact ◽  
History Of ◽  
St Elevation ◽  
The Impact

Background: ST-elevation myocardial infarction (STEMI) is a potentially fatal condition that may be complicated by cardiac arrest (CA). However, the impact of CA complicating STEMI on prognosis in the contemporary era of rapid primary PCI is uncertain. Methods: We reviewed consecutive cases of STEMI treated with percutaneous coronary intervention (PCI) at our center between January 1, 2011 and December 31, 2016. Baseline clinical characteristics and in-hospital long-term outcomes were compared between patients with and without CA. Results: Among 1,272 patients with STEMI, 148 (11.6%) had CA (30.4% out-of-hospital, 69.6% after ED arrival). Compared to patients without CA, patients with STEMI+CA were more likely to have a history of heart failure, valve surgery, peripheral and cerebrovascular disease, and chronic kidney disease with a trend towards increased prevalence of left main or left anterior descending culprit vessel. Patients with STEMI+CA had greater creatinine (1.28±0.92 vs. 1.07±0.67, p=0.013, infarct size (CK-MB 171.6±131.6 vs. 139.2±117.0 ng/mL, p=0.010; troponin T 6.2±6.2 vs. 5.0±4.8 ng/mL, p=0.024), door-to-balloon-time (118.1±63.6 vs. 106.8±64.0, p=0.045), and incidence of cardiogenic shock (48.0% vs. 5.9%, p<0.0001) and intra-aortic balloon pump need (36.5% vs. 8.3%, p<0.0001). Patients with STEMI+ CA had higher rates of major bleeding (25.0% vs. 9.4%, p<0.0001) and post-PCI heart failure (13.5% vs. 8.1%, p=0.042). Patients with STEMI+CA had significantly greater mortality in-hospital (14.9% vs. 3.6%, p<0.0001) and at 1-year (22.9% vs. 9.3%, p<0.0001) (Figure). Conclusions: CA is a complication in >1 in 10 patients with STEMI and is associated with significantly higher morbidity and mortality compared with STEMI without CA. Strategies to improve the care and outcomes of STEMI patients with CA are needed.

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