Abstract 2510: Hemodialysis Is A Risk Factor For Short Or Long Term Mortality In Ischemic Stroke Patints.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Takashi Shiromoto ◽  
Kensaku Shibazaki ◽  
Yasuyuki Iguchi ◽  
Junya Aoki ◽  
Jyunichi Uemura ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Mortality Rate ◽  
Stroke Onset ◽  
Basilar Artery Occlusion ◽  
Stroke Patients ◽  
Factors Associated ◽  
Long Term Mortality

Background and purpose Hemodialysis(HD) is reported to be a risk factor for cerebrovascular events and poor prognosis. However, it is unclear whether HD is a risk factor for short or long term mortality in ischemic stroke patients. The aim of the present study was to investigate whether a short or long term mortality of stroke patient s receiving HD is higher than those without HD. Methods From April 2007 to May 2010, we retrospectively enrolled ischemic stroke patients within 24h of stroke onset who admitted to our hospital. We divided patients into two groups according to presence and absence of receiving HD(HD group and non-HD group) . We compared clinical characteristics and the mortality rate at discharge and 1year after stroke onset between the two groups. The factors associated with death were investigated by multivariate logistic regression analysis. Results 687 patients (417 males; (61.4%), mean age 72.4 ± 11 years) were enrolled. 29 patients (4.0%) had HD. HD group was younger(69.8±14.2 vs. 73.0±11.9 year,P<0.001), and hypertension(97%vs. 68%, P<0.001) and basilar artery occlusion(10% vs. 2%, P=0.01) were more frequently observed than non-HD group . In-hospital mortality was 6.7% (46/687 patients). HD group was high mortality rate compared with non HD group(21%vs. 6%, P=0.002). Multivariate logistic regression analysis demonstrated that higher NIHSS score on admission, (OR 1.2, 95% CI 1.109-1.207, P <0.001), basilar artery occlusion (OR 3.6, 95% CI 1.031-12.36, P = 0.05), and HD(OR 7.8, 95%CI 2.259-26.79, P = 0.001) were independent factors associated with in-hospital death. Next, after hospital discharge, 14.5% of patients died within 1 year. HD group was high mortality rate compared with non HD group(50%vs. 13%, P<0.001). On multivariate regression analysis, age per 1year increase(OR 1.0, 95%CI 1.015-1.078, P = 0.03), poor functional outcome (modified Ranking Scale (3-5)) at discharge (OR 2.0, 95%CI 1.635-2.599, P <0.001), and HD(OR 26.4, 95%CI 7.532-92.503, P <0.001) were independent factors associated with death within 1year of stroke onset. Therefore, HD was independently associated with short or long term mortality. Conclusions; HD is a risk factor for short or long term mortality in ischemic stroke patients.

Abstract 176: Long Term Mortality in Acute Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation According to Location and Burden of Cerebral Microbleeds

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tae-Jin Song ◽  
Jinkwon Kim ◽  
Dongbeom Song ◽  
Yong-Jae Kim ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Independent Predictor ◽  
Stroke Patients ◽  
Risk Of Death ◽  
Long Term Mortality

Background: Cerebral microbleeds (CMBs) were predictive of mortality in elderly and considered as a putative marker for risk of intracranial hemorrhage. Stroke patients with non valvular atrial fibrillation (NVAF) require anticoagulation, which increases the risk of hemorrhages. We investigated association of CMBs with the long term mortality in acute ischemic stroke patients with NVAF. Methods: During 6 years , consecutive ischemic stroke patients who had NVAF and who had undergone brain MRI with a gradient-recalled echo sequence were enrolled. Long-term mortality and causes of death were identified using data from Korean National Statistical Office. Survival analysis was performed whether the presence, number and location of CMBs were related with all causes, cardiovascular, and cerebrovascular mortality during follow-up. Results: Total 506 patients were enrolled during the study period and were followed up for median 2.5 years. CMBs were found in 30.8% of patients (156/506). Oral anticoagulation with warfarin was prescribed at discharge in 477 (82.7%) patients. During follow up, 177 (35%) patients died and cerebrovascular death was noted in 93 patients (81 ischemic stroke and 12 hemorrhagic stroke). After adjusting age, sex and significant variables in univariate analysis (p<0.1), multiple CMBs (≥5) were the independent predictor for all-cause, cardiovascular and ischemic stroke mortalities. The strictly lobar CMBs were associated with hemorrhagic stroke mortality in multivariate Cox regression analysis (HR 4.776, p=0.032) (Figure 1). Conclusions: Multiple CMBs were the independent predictor for the long term mortality in stroke patients with NVAF. Among them, patients with strictly lobar CMBs had a high risk of death due to hemorrhagic stroke. Our findings suggest that detection of CMBs in stroke patients with NVAF are of clinical relevance for predicting long term outcome and that particular concern is necessary in those with strictly lobar CMBs for their increased risk of death due to hemorrhagic stroke. Figure 1.

Intradialytic Hypotension as an Independent Risk Factor for Long-Term Mortality in Maintaining Hemodialysis Patients: A 5-Year Follow-Up Cohort Study

2018 ◽  
Vol 45 (4) ◽  
pp. 320-326 ◽  
Author(s):  
Jinbo Yu ◽  
Zhonghua Liu ◽  
Bo Shen ◽  
Jie Teng ◽  
Jianzhou Zou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Mortality Rate ◽  
Independent Risk Factor ◽  
Left Ventricular ◽  
Intradialytic Hypotension ◽  
Ultrafiltration Rate ◽  
Long Term Mortality

Aims: This study aimed to assess risk factors of intradialytic hypotension (IDH) and the association of prognosis and IDH among maintenance hemodialysis (MHD) patients. Methods: Among 293 patients, 117 were identified with IDH (more than 4 hypotensive events during 3 months). The association between IDH and survival was evaluated. Results: The incidence of IDH was 39.9%. Age, ultrafiltration rate, N-terminal pro-B-type natriuretic peptide (NT-proBNP), albumin, β2-microglobulin (β2MG), and aortic root inside diameter (AoRD) were independently associated with IDH. During the 5-year follow-up, 84 patients died with a mortality rate 5.2 per 100 person-year. IDH-prone patients had a higher all-cause mortality rate. IDH and left ventricular mass index were independent risk factors for death (HR 1.655, 95% CI 1.061–2.580; HR 1.008, 95% CI 1.001–1.016). Conclusion: IDH is an independent risk factor for long-term mortality in MHD patients. Patients with older age, high ultrafiltration rate, high level of serum NT-proBNP and β2MG, hypoalbuminemia, and shorter AoRD are at high risk of IDH.

Long-term mortality among young ischemic stroke patients in western Norway

2007 ◽  
Vol 116 (3) ◽  
pp. 150-156 ◽  
Author(s):  
U. Waje-Andreassen ◽  
H. Naess ◽  
L. Thomassen ◽  
G. E. Eide ◽  
C. A. Vedeler
Keyword(s):  
Ischemic Stroke ◽  
Stroke Patients ◽  
Western Norway ◽  
Young Ischemic Stroke ◽  
Long Term Mortality

scholarly journals Long term clinical outcomes of patients with ischemic stroke in primary care – a 9-year retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jinghao Han ◽  
Yue Kwan Choi ◽  
Wing Kit Leung ◽  
Ming Tung Hui ◽  
Maria Kwan Wa Leung
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Diastolic Blood Pressure ◽  
Recurrent Stroke ◽  
Stroke Patients ◽  
All Cause Mortality

Abstract Background We aim to document the long-term outcomes of ischemic stroke patients and explore the potential risk factors for recurrent cardiovascular events and all-cause mortality in primary care. Methods A retrospective cohort study performed at two general out-patient clinics (GOPCs) under Hospital Authority (HA) in Hong Kong (HK). Ischemic stroke patients with at least two consecutive follow-up visits during the recruitment period (1/1–30/6/2010) were included. Patients were followed up regularly till the date of recurrent stroke, cardiovascular event, death or 31/12/2018. The primary outcome was the occurrence of recurrent cerebrovascular event including transient ischemic stroke (TIA), ischemic stroke or hemorrhagic stroke. The secondary outcomes were all-cause mortality and coronary artery disease (CAD). We fit cox proportional hazard model adjusting death as competing risk factor to estimate the cause-specific hazard ratio (csHR). Results A total of 466 patients (mean age, 71.5 years) were included. During a median follow-up period of 8.7 years, 158 patients (33.9%) died. Eighty patients (17.2%) had recurrent stroke and 57 (12.2%) patients developed CAD. Age was an independent risk factor for recurrent stroke, CAD and death. Statin therapy at baseline had a protective effect for recurrent stroke (csHR = 0.476; 95% confidence interval [CI] 0.285–0.796, P = 0.005) after adjusting death as a competing risk factor and all-cause mortality (HR = 0.693, 95% CI 0.486–0.968, P = 0.043). In addition, female sex, antiplatelet and a higher diastolic blood pressure (DBP) at baseline were also independent predictors for survival. Conclusions Long term prognosis of ischemic stroke patients in primary care is favorable. Use of statin was associated with a significant decrease in stroke recurrence and mortality. Patients who died had a significant lower DBP at baseline, highlighted the need to consider both systolic and diastolic blood pressure in our daily practice.

scholarly journals One-Year Systolic Blood Pressure Trajectory After Acute Ischemic Stroke

2021 ◽  
Author(s):  
Keon-Joo Lee ◽  
Beom Joon Kim ◽  
Moon-Ku Han ◽  
Joon-Tae Kim ◽  
Kang Ho Choi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Systolic Blood Pressure ◽  
Acute Ischemic Stroke ◽  
Adverse Outcomes ◽  
Stroke Onset ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
One Year

Abstract Although the effect of blood pressure on post-stroke outcome is well-recognized, the long-term trajectory of blood pressure after acute ischemic stroke and its influence on outcomes have not yet been fully elucidated. From a multicenter prospective registry of acute ischemic stroke patients, 5,514 patients with measurements of systolic blood pressure (SBP) at more than 2 of 7 prespecified time-points, up to 1-year after stroke onset, were analyzed. Outcome measures, a composite of stroke recurrence, myocardial infarction and mortality, and each stroke recurrence and mortality, were prospectively collected up to 1-year after stroke onset. The study subjects were categorized into 4 groups according to their SBP trajectories: Low (27.0%), Moderate (59.5%), Persistently high (1.2%), and Slowly dropping (12.4%). After adjustments for pre-determined covariates, the Slowly dropping SBP Group was at higher risk of the composite outcome (hazard ratio, 1.32; 95% confidence interval, 1.05‒1.65), and mortality (1.35; 1.03‒1.78) compared to the Moderate SBP Group. Four main 1-year longitudinal SBP trajectories were identified after acute ischemic stroke. One trajectory, slowly dropping SBP, was particularly prone to adverse outcomes after stroke. These findings provide possible leads for future investigations of SBP control targets after stroke.

scholarly journals Effect of antiplatelet persistence on long-term mortality and predictors of non-persistence in ischemic stroke patients 75 years and older: a nationwide cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Seung Jae Kim ◽  
Oh Deog Kwon ◽  
Ho Chun Choi ◽  
Eung-Joon Lee ◽  
BeLong Cho
Keyword(s):  
Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
National Sample ◽  
Charlson Comorbidity Index Score ◽  
Stroke Patients ◽  
Real World Evidence ◽  
Increased Risk ◽  
Long Term Mortality ◽  
Cvd Mortality

Abstract Background We aimed to provide real-world evidence on the benefit of persistence with antiplatelet therapy (APT) on long-term all-cause mortality (ACM) in ischemic stroke patients aged 75 years and older. Methods Newly diagnosed ischemic stroke patients aged 75 years and older who initiated aspirin or clopidogrel for the first time were chosen from 2003 to 2010 National Health Insurance Service-National Sample Cohort (NHIS-NSC) of Korea (n = 887), a random cohort sample accounting for 2.2% (n = 1,017,468) of total population (n = 46,605,433). Then subjects were divided into persistent (n = 556) and non-persistent (n = 321) groups according to the persistent status at 6 months. Survivor analysis was performed between the two groups and predictors of non-persistence were analyzed by multivariate logistic regression analysis. Patients were followed up until death or December 31, 2013. Results Non-persistence with APT was significantly associated with increased risk of ACM (adjusted hazard ration [aHR] 2.13, 95% confidence interval [CI] 1.72–2.65), cerebro-cardiovascular disease (CVD) mortality (aHR 2.26, 95% CI 1.57–3.24), and non-CVD mortality (aHR 2.06, 95% CI 1.5702.70). More comorbidities (Charlson comorbidity index score ≥ 6) (adjusted odds ratio [aOR], 2.56, 95% CI 1.43–4.55), older age (aOR 1.52, 95% CI 1.11–2.09 for 80–84 years, aOR 1.73, 95% CI 1.17–2.57 for ≥85 years), and less than 4 total prescribed drugs (aOR 1.54, 95% CI 1.08–2.21) were independent predictors of non-persistence. Conclusions Persistent with APT after ischemic stroke featured long-term mortality benefit even in patients aged 75 years and older. Thus, improving APT persistence for ischemic stroke patients in this age group is also recommended by understanding factors associated with non-persistence.

Abstract TP109: Multiplicity of Atherosclerotic Risk Factors Predicts a Risk of Large Arterial Atherosclerosis and Long-term Mortality in Patients with Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sungho Ahn ◽  
Eun-Jae Lee ◽  
Dong-Wha Kang ◽  
Sun U. Kwon ◽  
Jong S. Kim
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Baseline Risk ◽  
Large Artery ◽  
Stroke Patients ◽  
Atherosclerotic Burden ◽  
Point Increase ◽  
Atherosclerotic Risk Factors ◽  
Long Term Mortality

Background: The aim of this study was to investigate clinical significance of multiplicity of atherosclerotic risk factors to determine the type of stroke and long-term mortality in patients with large artery atherosclerotic (LAA) and small vessel occlusive (SVO) stroke. Methods: We retrospectively analyzed medical data of the prospectively registered stroke patients who were diagnosed as LAA and SVO type of ischemic stroke based on diffusion weighted MRI and magnetic resonance angiography between January 2005 and December 2013. Multiplicity of risk factors was defined as numbers of hypertension, diabetes, hyperlipidemia and smoking. Information on mortality as outcome was obtained and reconfirmed from the National Death Certificate system. Results: A total of 4099 patients comprising 2530 LAA stroke and 1569 SVO stroke were studied. After adjustment for differences in baseline risk profiles, multiplicity of risk factors (per 1-point increase, odds ratio [OR] = 1.10, 95% confidence interval [CI] = 1.02-1.18) was significantly associated with the LAA stroke than SVO stroke. Among patients with SVO stroke, patients with a higher multiplicity of risk factors had a higher long-term mortality (OR = 1.34, 95% CI = 1.10-1.65) during 8-year of observation. Conclusions: Atherosclerotic burden defined by multiplicity of risk factors for atherosclerosis could predict the probability of developing LAA stroke compared to the SVO stroke, and long-term mortality particularly in SVO stroke.

Abstract T MP103: Long-Term Outcomes of Elderly Patients with Intracerebral Hemorrhage and Atrial Fibrillation

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Melissa Stamplecoski ◽  
Jiming Fang ◽  
Moira K Kapral ◽  
Frank L Silver
Keyword(s):  
Ischemic Stroke ◽  
Elderly Patients ◽  
Major Bleeding ◽  
Long Term Outcomes ◽  
Short Term ◽  
Term Survival ◽  
Factors Associated ◽  
Short Term Mortality ◽  
Long Term Mortality

Background: There has been limited investigation into the long-term outcomes of elderly patients with intracerebral hemorrhage (ICH) and atrial fibrillation (AF). Although ICH is associated with high short-term mortality, the long-term mortality of those patients with AF who survive a first ICH is unknown, as is the true incidence of recurrent ICH, ischemic stroke and major bleeding. The aims of this study were to examine the long-term outcomes of a cohort of patients with ICH and AF and to identify factors associated with long-term survival. Methods: We used the Ontario Stroke Registry (OSR) to identify a population-based cohort of patients ≥ 65 years of age with ICH and AF who were admitted to one of Ontario’s 150 acute care hospitals between 2002 and 2011. Linkage to health administrative databases was performed to assess mortality at 30 days, 1 year and 2 years as well as rates of recurrent ICH, ischemic stroke and major hemorrhage at 1 year. Prescription drug utilization in the year following hospital discharge was assessed through linkage to the Ontario Drug Benefits (ODB) database. Multivariable logistic regression was used to identify factors associated with long-term survival in these patients. Results: Of the 1,236 elderly patients diagnosed with ICH, 329 (26.6%) had AF. Of those patients discharged alive, 21.1% were prescribed warfarin in the year following discharge. Mortality was 42.6% at 30 days, 58.7% at 1 year and 66.9% at 2 years. The all-cause readmission rate at 1 year was 12.1%, 5.0% for ischemic stroke, 3.5% for recurrent ICH and 7.5% for major bleeding. Multivariable analysis showed that being prescribed an antihypertensive agent (HR 0.151, p<0.0001), a statin (HR 0.463, p=0.0102) or warfarin (HR 0.136, p=0.0056) after ICH was associated with a decreased risk of death at 1 year. Conclusions: In patients with ICH and AF, the incidence of recurrent ICH is lower than the incidence of ischemic stroke or major bleeding at 1 year. Although ICH is associated with high short-term mortality, the 2 year mortality rate for those patients who survive the first 30 days remains stable. Although ICH is often considered a relative contraindication for anticoagulation, this study demonstrates a reduction in long-term mortality in ICH patients treated with warfarin.

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