Abstract TP36: Predictors and Associated Outcomes of Subarachnoid Hemorrhage Following Endovascular Treatment for Acute Ischemic Stroke

Introduction: The rates of occurrence, predictors, and associated outcomes of subarachnoid hemorrhage (SAH) following endovascular treatment are not well studied. Methods: We retrospectively analyzed data from the Interventional Management of Stroke Trial (IMS III). This prospective trial randomized patients to intravenous (IV) rt-PA alone versus IV rt-PA followed by endovascular intervention. All patients underwent computed tomography (CT) at 24 hours post randomization. The scans were assessed by independent reviewers at a core laboratory for the presence, location, and type of intracranial hemorrhage.The primary outcome assessment was by modified Rankin Scale (mRS) score at 3 months. Results: Thirty four out of 434 (7.8%) patients who received endovascular treatment suffered SAH at 24 hours. There were 19 men (55.9%), and 19 patients were older than 70 years.In univariate analysis only pre-existing ischemic heart disease was identified as a predictor of SAH (p=0.03) while patient age was borderline significant (p=0.055). Three-monthmRS score was available for 24/34 patients with SAH and for 318/400 among the other patients. There was no difference in mortality (12.5% vs. 4.1%, p=0.167) or favorable outcome defined as mRS =<2 (41.7% vs. 53.5%, p=0.366). Conclusions: SAH following endovascular intervention for acute stroke is more common among patients with history of ischemic heart disease. It does not impact on functional outcome or mortality at 3 months.

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Association between the level of plasma B-type natriuretic peptide and in-hospital mortality in patients with acute exacerbation of COPD without a history of coronary ischemic heart disease: a retrospective study

10.21203/rs.3.rs-311199/v1 ◽

2021 ◽

Author(s):

Jiyun Cui ◽

Jie Liu ◽

Jing Wang ◽

Meng Lv ◽

Chunyan Xing ◽

...

Keyword(s):

Mechanical Ventilation ◽

Heart Disease ◽

Hospital Mortality ◽

Ischemic Heart Disease ◽

Natriuretic Peptide ◽

Invasive Mechanical Ventilation ◽

Ischemic Heart ◽

Composite Outcome ◽

History Of ◽

Secondary Outcomes

Abstract Background: Previous studies suggested that plasma B-type natriuretic peptide (BNP) level was often elevated in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and was associated with increased mortality. However, most studies did not consider the fact that conditions such as coronary ischemic heart disease can also increase BNP level. Therefore, we aimed to explore the association between BNP level and in-hospital mortality in patients with AECOPD without a history of coronary ischemic heart disease.Methods: In this retrospective cohort study, patients who were diagnosed with AECOPD using International Statistical Classification of Diseases and Related Health Problems, Nineth Revision (ICD-9 codes) between January 2017 and December 2019. All data were obtained from electronic patient files and medical data intelligence platform of Jinan Central Hospital. BNP level was determined within 24 hours after admission, and the value was log2 transformed. The primary outcome was in-hospital mortality, and the secondary outcome was a composite outcome of in-hospital mortality or invasive mechanical ventilation.Results: A total of 300 patients were included in this study. Univariate cox regression analysis showed that the unadjusted HRs of the primary and secondary outcomes were 1.85 (95% CI, 1.39-2.47) and 1.45 (95% CI, 1.20-1.75), respectively. After adjustment for age, sex, past medical history, smoking status, drinking status, CURB65 (Confusion, Urea > 7mmol/L, Respiratory rate≥30/min, Blood pressure systolic < 90 mmHg or diastolic <60 mmHg and age > 65 years), arterial partial pressure of O2(PaO2), the adjusted HRs of the primary and secondary outcomes were 3.65 (95% CI, 2.54-5.26) and 1.43 (95% CI, 1.14-1.97), respectively. The results of subgroup analysis by age, sex, and lung function were robust. This study was retrospective, so there was no clinical trial registration.Conclusions: The plasma log2BNP level was significantly associated with in-hospital mortality and a composite outcome of in-hospital mortality or invasive mechanical ventilation.

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Peanut Consumption and Risk of Stroke and Ischemic Heart Disease in Japanese Men and Women: The JPHC Study

Stroke ◽

10.1161/strokeaha.120.031212 ◽

2021 ◽

Author(s):

Satoyo Ikehara ◽

Hiroyasu Iso ◽

Yoshihiro Kokubo ◽

Kazumasa Yamagishi ◽

Isao Saito ◽

...

Keyword(s):

Public Health ◽

Cardiovascular Disease ◽

Heart Disease ◽

Ischemic Stroke ◽

Ischemic Heart Disease ◽

Ischemic Heart ◽

Japanese Men ◽

Food Frequency ◽

Men And Women ◽

History Of

Background and Purpose: Several prospective cohort studies and a randomized clinical trial have shown the beneficial effects of peanut consumption on cardiovascular disease and its risk factors. We examined the association between peanut consumption and risk of cardiovascular disease in Japanese men and women. Methods: We analyzed data of 74 793 participants aged 45 to 74 years who completed a lifestyle questionnaire including the validated food frequency questionnaire in the Japan Public Health Center–based Prospective Study. They were followed up from 1995 to 2009 for cohort I and from 1998 to 1999 to 2012 for cohort II. Peanut consumption was calculated from the food frequency questionnaire, and the end points were incidence of stroke, ischemic heart disease, and cardiovascular disease (stroke and ischemic heart disease). Results: During a median follow-up of 14.8 years, 3,599 strokes and 849 ischemic heart diseases were reported. Higher peanut consumption was associated with reduced risks of total stroke, ischemic stroke, and cardiovascular disease among men and women. The multivariable hazard ratios (95% CIs) for the highest versus lowest quartiles of peanut consumption after adjustment for age, sex, public health center, smoking, alcohol consumption, perceived stress level, physical activity, vegetable, fruit, fish, soy, sodium and total energy intakes, body mass index, history of hypertension, history of diabetes, and cholesterol-lowering drug were 0.84 (0.77–0.93, P for trend=0.002) for total stroke, 0.80 (0.71–0.90, P for trend=0.002) for ischemic stroke, 0.93 (0.79–1.08, P for trend=0.27) for hemorrhagic stroke, 0.97 (0.80–1.17, P for trend=0.81) for ischemic heart disease and 0.87 (0.80–0.94, P for trend=0.004) for cardiovascular disease, and these associations were similarly observed in both sexes. Conclusions: Higher peanut consumption was associated with reduced risk of stroke, especially ischemic stroke, but not ischemic heart disease in Japanese men and women.

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Initial Invasive Versus Conservative Management of Stable Ischemic Heart Disease in Patients With a History of Heart Failure or Left Ventricular Dysfunction

Circulation ◽

10.1161/circulationaha.120.050304 ◽

2020 ◽

Vol 142 (18) ◽

pp. 1725-1735

Author(s):

Renato D. Lopes ◽

Karen P. Alexander ◽

Susanna R. Stevens ◽

Harmony R. Reynolds ◽

Gregg W. Stone ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Disease ◽

Ischemic Heart Disease ◽

Primary Outcome ◽

Cardiovascular Death ◽

Left Ventricular ◽

Ischemic Heart ◽

Conservative Strategy ◽

Stable Ischemic Heart Disease ◽

History Of

Background: Whether an initial invasive strategy in patients with stable ischemic heart disease and at least moderate ischemia improves outcomes in the setting of a history of heart failure (HF) or left ventricular dysfunction (LVD) when ejection fraction is ≥35% but <45% is unknown. Methods: Among 5179 participants randomized into ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches), all of whom had left ventricular ejection fraction (LVEF) ≥35%, we compared cardiovascular outcomes by treatment strategy in participants with a history of HF/LVD at baseline versus those without HF/LVD. Median follow-up was 3.2 years. Results: There were 398 (7.7%) participants with HF/LVD at baseline, of whom 177 had HF/LVEF >45%, 28 HF/LVEF 35% to 45%, and 193 LVEF 35% to 45% but no history of HF. HF/LVD was associated with more comorbidities at baseline, particularly previous myocardial infarction, stroke, and hypertension. Compared with patients without HF/LVD, participants with HF/LVD were more likely to experience a primary outcome composite of cardiovascular death, nonfatal myocardial infarction, or hospitalization for unstable angina, HF, or resuscitated cardiac arrest (4-year cumulative incidence rate, 22.7% versus 13.8%; cardiovascular death or myocardial infarction, 19.7% versus 12.3%; and all-cause death or HF, 15.0% versus 6.9%). Participants with HF/LVD randomized to the invasive versus conservative strategy had a lower rate of the primary outcome (17.2% versus 29.3%; difference in 4-year event rate, −12.1% [95% CI, −22.6 to −1.6%]), whereas those without HF/LVD did not (13.0% versus 14.6%; difference in 4-year event rate, −1.6% [95% CI, −3.8% to 0.7%]; P interaction = 0.055). A similar differential effect was seen for the primary outcome, all-cause mortality, and cardiovascular mortality when invasive versus conservative strategy–associated outcomes were analyzed with LVEF as a continuous variable for patients with and without previous HF. Conclusions: ISCHEMIA participants with stable ischemic heart disease and at least moderate ischemia with a history of HF or LVD were at increased risk for the primary outcome. In the small, high-risk subgroup with HF and LVEF 35% to 45%, an initial invasive approach was associated with better event-free survival. This result should be considered hypothesis-generating. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01471522.

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