Abstract TP336: Characteristics and Outcome of Patients With Acute Intracerebral Hemorrhage Who Overuse Alcohol

Background: Alcohol overuse (AO) is considered a cause of spontaneous intracerebral hemorrhage (ICH), but the clinical and outcome characteristics of these patients (AO+ICH) are not well known. Methods: All patients with ICH admitted from January 2005 to June 2015 to a single university tertiary stroke center were prospectively studied and followed up during 5 years. Demographic features, radiological characteristics, and clinical outcome of patients with acute ICH and previous heavy alcohol intake (>40 gr/day or >300 gr/week) were analyzed. Results: During the study period, 609 patients with ICH were admitted. Nineteen patients were excluded because data on alcohol intake was not available. At admission, 83 patients (13.6%) were identified with AO (22.7% of men vs 2.9% of women; p< 0.0001) and was more frequent in younger patients (mean age, 63.11 years, compared to 72.7 years overall; p< 0.0001). Smoking was associated with AO (63,9% vs 13,8% non-AO; p< 0.0001) but not significant differences were found according with cardiovascular risk factors (dyslipidemia, diabetes and hypertension). ICH score was lower in the AO group (1.3 vs 1.8, p= 0.009) and deep ICH were more frequent (p= 0.036), compared to non-AO. Adjusted by sex, age, and high blood pressure, a trend in favor of increased deep ICH in AO patients remained (HR: 1.68 [95% CI: 0.92-3.05], p= 0.086). Adjusted mortality at 3-month, 12-month, and 5-year follow-up was similar in both groups. Conclusions: AO was present in 13.6% of ICH patients. These patients were an average of 11.5 years younger, predominantly men, and smokers, compared to the non-AO group. Adjusted short-term and long-term mortality was similar in AO and non-AO groups.

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Abstract TP366: National Institutes of Health Stroke Scale (NIHSS) is a Potent Predictor of Outcome in Acute Intracerebral Hemorrhage

Stroke ◽

10.1161/str.47.suppl_1.tp366 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Suzie Kazaryan ◽

Nerses Sanossian ◽

David S Liebeskind ◽

Sidney Starkman ◽

Marc Eckstein ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Strong Predictor ◽

Final Diagnosis ◽

Term Outcome ◽

Long Term Outcome ◽

Acute Cerebral Ischemia ◽

History Of ◽

Acute Intracerebral Hemorrhage ◽

Ich Score

Background: Although the NIHSS is a well-validated tool in assessing neurological deficit and predicting long-term outcome in acute cerebral ischemia, its utility in ICH has not been extensively studied. As NIHSS is routinely obtained in cases of stroke prior to imaging, it is often available in ICH patients to potentially assist physicians in triage, prognostication, and risk-adjustment. Methods: We analyzed consecutive patients enrolled in the NIH Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 trial whose final diagnosis was ICH. Trained study nurses performed the NIHSS in the Emergency Department (ED) shortly after arrival and the modified Rankin Scale (mRS) at 90 days. Primary outcomes were disability or death (mRS 3-6) and mortality. Candidate potential predictor variables, including NIHSS, ICH Score, and GCS, those with threshold of p<0.10 were candidate parameters for backward selection logistic regression to determine independent predictors of disability or death and of mortality. Results: Among the 384 ICH patients, age was mean 65 (±13); female 34%; race white 78%, black 10%, Asian 10%; Hispanic ethnicity 33%; and history of hypertension 78%. The ED NIHSS and GCS was performed a median 148 minutes (IQR 121-180) after last known well. Initial NIHSS was median 16 (IQR 9-16), GCS 15 (IQR 10-15), and ICH Score 1(IQR 0-2). NIHSS correlated with ICH Score (r=0.780) and GCS (r=0.860). At 90 days, median mRS was 4 (IQR 2-6), disability or death (mRS 3-6) was present in 70%, and mortality occurred in 26%. In predicting disability or death at 90 days, c statistics were: NIHSS 0.81, ICH Score 0.81, and GCS 0.72. NIHSS≥14 showed 72% sensitivity and 75% specificity. For mortality by 90 days, c statistics were: NIHSS 0.78, ICH Score 0.80, and GCS 0.73. NIHSS≥19 had 80% sensitivity and 70% specificity. On multivariate analysis age (OR 1.07, 95%CI 1.04-2.0) and NIHSS (OR 1.18, 95%CI 1.13-1.23) were independent predictors of disability and death. Conclusions: The initial NIHSS is a strong predictor of disability and death and good predictor of mortality after intracerebral hemorrhage, performing as well as the ICH Score and better than the GCS. Consideration should be given to routine performance and documentation of the NIHSS in ICH patients.

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P1520Management and outcome of women with NSTEMI. Have there been any changes in recent years?

European Heart Journal ◽

10.1093/eurheartj/ehz748.0282 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Cacho ◽

T Gonzalez Ferrero ◽

A Torrelles Fortuny ◽

M Perez Dominguez ◽

C Abbou Johk ◽

...

Keyword(s):

P Value ◽

Evidence Based ◽

Short Term ◽

Killip Class ◽

Hospitalization Period ◽

Short Term Mortality ◽

Baseline Characteristics ◽

Long Term Mortality

Abstract Introduction Women have been less represented in every NSTEMI clinical trial. Moreover, it has been observed that this group of patients have usually received less revascularization and evidence based treatment, therefore presenting with a greater long and short-term mortality. Purpose The purpose of our study is to analyze the presence of differences in baseline characteristics, management and outcome of women with NSTEMI during the last decade. Methods and results Retrospective study including 861 women admitted for NSTEMI between 2003 and 2015 in our center. We divided 2 groups according to hospitalization period (2003–2008 and 2009–2015) with a medium follow up of 4.5±2.9 years. Baseline characteristics and treatment at discharge are described on table 1. We noticed a greater use of statins and ACEI/ARB on the second period as well as a greater percentage of patients receiving early revascularization. It is remarkable on women a non-significant reduction of heart failure hospitalization at follow up (6.8% vs 4.5%; p=0.091), neither differences on 30-day mortality (1.3% vs 0,4%) or 1-year mortality (7.1% vs 5.8%). However, long-term mortality for the second group is reduced (HR 0.69; CI 95% 0.52–0.89), even after performing a multivariate analysis (HR 0.64; CI 95% 0.48–0.85). Characteristic Population (n=861) 2003–2008 (n=395) 2009–2015 (n=466) p-value Age (years) 73±12 73±12 72±12 0.316 Hypertension 629 (73.1%) 285 (72.2%) 344 (73.8%) 0.318 Hypercholesterolemia 414 (48.1%) 190 (48.1%) 224 (48.1%) 0.523 Killip class 0.292 I 664 (77.1%) 299 (75.7%) 365 (78.3%) II 143 (16.6%) 74 (18.7%) 69 (14.8%) III 47 (5.5%) 20 (5.1%) 27 (5.8%) IV 4 (0.5%) 2 (0.5%) 2 (0.4) GRACE score 129±32 130±37 128±33 0.897 Early PCI 249 (29.3%) 76 (19.2%) 173 (38.0%) <0.005 Treatment at discharge AAS 698 (81.1%) 313 (79.2%) 385 (82.6%) 0.120 Clopidogrel 465 (54.0%) 221 (55.9%) 244 (52.4%) 0.162 ACEI/ARB 466 (54.1%) 191 (48.4%) 275 (59.0%) 0.001 Beta-blocker 509 (59.1%) 238 (60.3%) 271 (58.2%) 0.290 Statins 643 (74.7%) 275 (69.6%) 368 (79.0%) 0.001 Conclusions In recent years, early interventionist management and greater use of evidence-based therapies have been observed in women with NSTEMI. This has been associated with a lesser long-term mortality, although short-term events have remained the same.

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Long-term mortality in survivors of spontaneous intracerebral hemorrhage

International Journal of Stroke ◽

10.1177/1747493020954946 ◽

2020 ◽

pp. 174749302095494

Author(s):

Marco Pasi ◽

Barbara Casolla ◽

Maéva Kyheng ◽

Grégoire Boulouis ◽

Grégory Kuchcinski ◽

...

Keyword(s):

Brain Injury ◽

Intracerebral Hemorrhage ◽

Cerebral Atrophy ◽

Clinical Severity ◽

Clinical Event ◽

Spontaneous Intracerebral Hemorrhage ◽

Point Increase ◽

Long Term Mortality

Background Factors associated with long-term mortality after spontaneous intracerebral hemorrhage (ICH) have been poorly investigated. Aim Our objective was to identify variables associated with long-term mortality in a prospective cohort of 30-day ICH survivors. Methods We prospectively included consecutive 30-day spontaneous ICH survivors. We evaluated baseline and follow-up clinical characteristics and magnetic resonance imaging (MRI) markers of chronic brain injury as variables associated with long-term mortality using univariate and multivariable Cox proportional hazard regression models. Results Of 560 patients with spontaneous ICH, 304 (54.2%) survived more than 30 days and consented for follow-up. During a median follow-up of 10 years (interquartile range: 8.0–10.5), 176 patients died. The cumulative survival rate at 10 years was 38%. In multivariable analysis, variables independently associated with long-term mortality were age (hazard ratio (HR) per 10-year increase: 1.68, 95% confidence interval (CI): 1.45–1.95), male gender (HR: 1.41, CI: 1.02–1.95), prestroke dependency (HR: 1.66, CI: 1.15–2.39), National Institutes of Health Stroke Scale score (HR per 1-point increase: 1.03, CI: 1.01–1.04), occurrence of any stroke (HR: 2.24, CI: 1.39–3.60), and dementia (HR: 1.51, CI: 1.06–2.16) during follow-up. Among MRI markers, only cerebral atrophy (HR per 1-point increase: 1.50, CI: 1.13–2.00) was independently associated with long-term mortality. Conclusions Preexisting comorbidities, clinical severity at presentation, and significant clinical event during follow-up are associated with long-term mortality. Among MRI markers of chronic brain injury, only cerebral atrophy is associated with long-term mortality.

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Comparison of surgical indications and short- and long-term complications in 56 cats undergoing perineal, transpelvic or prepubic urethrostomy

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x20959032 ◽

2020 ◽

pp. 1098612X2095903

Author(s):

Maheeka Seneviratne ◽

Polina Stamenova ◽

Karla Lee

Keyword(s):

Short Term ◽

Short Term Mortality ◽

Short And Long Term ◽

Urethral Lesion ◽

Urethral Rupture ◽

Complications And Mortality ◽

Long Term Mortality

Objectives The aim of this study was to compare indications, complications and mortality rates for perineal urethrostomy (PU), transpelvic urethrostomy (TPU) and prepubic urethrostomy (PPU). Methods A retrospective review of, and follow-up owner questionnaire for, cats undergoing urethrostomy between 2008 and 2018, at a single referral hospital, were performed. Results Fifty-six cats underwent urethrostomy (PU, n = 37; TPU, n = 8; PPU, n = 11). The presenting problem was significantly associated with urethrostomy technique ( P <0.001). For PU cats, feline idiopathic cystitis (FIC; n = 21 [56.7%]) was the most common problem, whereas for PPU cats, trauma (n = 9 [81.8%]) was most common ( P <0.001). Urethrostomy technique was associated with imaging diagnosis ( P <0.001) of the urethral lesion. Most PU cats had no diagnostic imaging lesion (n = 15 [40.5%]) or obstructive calculi or clots (n = 10 [27.0%]), and all PPU cats had urethral rupture. Ten (90.9%) PPU cats had a pelvic lesion, while 21 (56.7%) PU cats had a penile lesion. TPU cats had a range of presenting problems and imaging diagnoses. Short- and long-term complications were reported in 33/55 (60.0%) and 11/30 (36.7%) cats, respectively. The number of cats with long-term complications was greater among PPU cats ( P = 0.02). Short-term dermatitis ( P = 0.019) and long-term incontinence ( P = 0.01) were associated with PPU. Short-term mortality was 5.6% and long-term mortality was 13.3%; both were independent of urethrostomy technique. Quality of life post-urethrostomy, across all techniques, was graded as good by 93% of owners. Conclusions and relevance In this study, PU was the most common feline urethrostomy technique indicated for FIC. Short-term urethrostomy complications are common, irrespective of urethrostomy technique. Long-term complications are less frequent but more common with PPU.

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Left Ventricle Hypertrophy is Common in Patients with Cerebral Amyloid Angiopathy-Related Intracerebral Hemorrhage and Is Independently Associated with Long-Term Mortality.

Stroke ◽

10.1161/str.44.suppl_1.awp300 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Octavio M Pontes-Neto ◽

Sergi Martinez-Ramirez ◽

Anand Viswanathan ◽

Eitan Auriel ◽

Kristen M Schwab ◽

...

Keyword(s):

Left Ventricle ◽

Intracerebral Hemorrhage ◽

Cerebral Amyloid Angiopathy ◽

Amyloid Angiopathy ◽

Lv Mass ◽

The Mean ◽

Cerebral Amyloid ◽

Long Term Mortality

Background: A post-hoc analysis of the PROGRESS trial suggested that long-term anti-hypertensive therapy prevents intracerebral hemorrhage (ICH) in patients with cerebral amyloid angiopathy (CAA). However, the burden of underlying hypertension in patients with CAA is unclear, and it is also unclear whether this hypertensive burden contributes to long-term outcome in survivors of CAA-related ICH. Left ventricle (LV) hypertrophy is a measure of the chronicity and severity of hypertension and could be used to assess hypertensive end-organ damage in patients with CAA. Objective: To test the hypothesis that LV hypertrophy is common in patients with CAA-related ICH and is associated with increased long-term mortality and shorter survival in those patients. Methods: This was a retrospective analysis of a prospectively collected cohort of consecutive patients with primary ICH presenting to a single academic center. We included patients presenting between January/2000 to December/2010, age > 55 years, who received a transthoracic echocardiogram (echo) during follow-up and were diagnosed with definitive, probable or possible CAA according to the Boston criteria. LV mass index (10g/m2) was calculated according to Penn convention. Ninety-day survivors were followed prospectively for long-term mortality or censoring at January/2012. Cox proportional hazards models were used to identify predictors of mortality as time-dependent variables adjusting for potential confounders. Results: Among 211 patients who met inclusion criteria, the mean time to follow-up was 4.28 ± 2.7 years; the median time to echocardiogram was 3 days (IQR:49). The mean age was 75.7 ± 9.1 years; 103 (49%) were male. LV hypertrophy was present in 55 (31.8%) patients and 152 (72%) patients survived more than 90 days. In multivariate analysis, after adjusting for baseline characteristics, LV mass index (10g/m2) was associated with higher long-term mortality (HR: 1.20; 95%CI: 1.01-1.4; p=0.039). On Cox-regression, LV hypertrophy was independently associated with shorter long-term survival (HR 1.91; 95%CI 1.05-3.47; p=0.034). Conclusions: LV hypertrophy is common in patients with CAA-related ICH and is associated with increased risk of subsequent mortality among 90-day survivors.

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Early-onset delirium after spontaneous intracerebral hemorrhage

International Journal of Stroke ◽

10.1177/17474930211059636 ◽

2021 ◽

pp. 174749302110596

Author(s):

Federico Marrama ◽

Maéva Kyheng ◽

Marco Pasi ◽

Matthieu Pierre Rutgers ◽

Solène Moulin ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Incidence Rate ◽

Mortality Risk ◽

Early Onset ◽

Gray Model ◽

Spontaneous Intracerebral Hemorrhage ◽

Long Term Mortality ◽

New Onset

Objective This study aimed at identifying the incidence, predictors, and impact on long-term mortality and dementia of early-onset delirium in a cohort of patients with spontaneous intracerebral hemorrhage. Methods We prospectively recruited consecutive patients in the Prognosis of InTra-Cerebral Hemorrhage (PITCH) cohort and analyzed incidence rate of early-onset delirium (i.e. during the first seven days after intracerebral hemorrhage onset) with a competing risk model. We used a multivariable Fine-Gray model to identify baseline predictors, a Cox regression model to study its impact on the long-term mortality risk, and a Fine-Gray model adjusted for pre-specified confounders to analyze its impact on new-onset dementia. Results The study population consisted of 248 patients (mean age 70 years, 54% males). Early-onset delirium incidence rate was 29.8% (95% confidence interval (CI) 24.3–35.6). Multivariate analysis showed that pre-existing dementia (subhazard ratio (SHR) 2.08, 95%CI 1.32–3.32, p = 0.002), heavy alcohol intake (SHR 1.79, 95%CI 1.13–2.82, p = 0.013), and intracerebral hemorrhage lobar location (SHR 1.56, 95%CI 1.01–2.42, p = 0.049) independently predicted early-onset delirium. Median follow-up was 9.5 years. Early-onset delirium was associated with higher mortality rates during the first five years of follow-up (HR 1.52, 95%CI 1.00–2.31, p = 0.049), but did not predict new-onset dementia (SHR 1.31, 95%CI 0.60–2.87). Conclusion Early-onset delirium is a frequent complication after intracerebral hemorrhage; it is associated with markers of pre-existing brain vulnerability and with higher mortality risk, but not with higher dementia rates during long-term follow-up.

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Comparison of MRI and CT for Detection of Acute Cerebral Haemorrahge

10.53350/pjmhs211561892 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1892-1894

Author(s):

Memona Nazir ◽

Tahir Baig ◽

Atif Hussain ◽

Muhammad Tahir ◽

Haider Ali ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Diagnostic Accuracy ◽

Ct Scan ◽

Interrater Reliability ◽

P Value ◽

Time Duration ◽

Acute Intracerebral Hemorrhage ◽

The Mean ◽

Stroke Center

Objective: To compare the diagnostic accuracy of MRI and CT for detection of acute cerebral haemorrahge. Study Design: Comparative Study Place and Duration: Mohiuddin Islamic Teaching Hospital Mirpur AJK for period of six months from 1st August, 2020 to 31stJanuary, 2021. Methodology: A total of 20 patients of both genders with age of 25 years and onward with intracerebral hemorrhage who underwent MRI following CT in the first 6 hours of onset and last known well time and admission in stroke center were included in the study. The follow up time duration for both the scans was 24 hours to 48hours. The Mc-Nemar test was used to determine the comparison between MRI and CT on contingency table. Results: The mean age of the participants was 53.26±2.45. The frequency of the male participants was 13(65%) and that of female was 7(35%). All cases were of acute ICH 20(100%). The number of positive cases on MRI and CT scan was 17, while the frequency of positive cases on MRI and negative on CT scan was 3 with the p- value of less than 0.001 and a confidence interval of 95%. (See table 1 for details). The interrater reliability for acute ICH on MRI is from 0.72 to 0.80 on k statistics. The interrater reliability for acute ICH on CT is from 0.83 to 0.92. Conclusion: It is concluded that the findings of MRI scan were more accurate than CT in the detection of acute intracerebral hemorrhage. Keywords: Acute Cerebral Hemorrhage, MRI, CT, Diagnostic Accuracy

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Anticoagulation in addition to dual antiplatelet therapy has no impact on long-term follow-up after endovascular treatment of (sub)acute lower limb ischemia

VASA ◽

10.1024/0301-1526/a000786 ◽

2019 ◽

Vol 48 (4) ◽

pp. 321-329

Author(s):

Mariya Kronlage ◽

Erwin Blessing ◽

Oliver J. Müller ◽

Britta Heilmeier ◽

Hugo A. Katus ◽

...

Keyword(s):

Endovascular Treatment ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Limb Ischemia ◽

Bleeding Complications ◽

Severe Bleeding ◽

Short Term ◽

Long Term Follow Up

Summary. Background: To assess the impact of short- vs. long-term anticoagulation in addition to standard dual antiplatelet therapy (DAPT) upon endovascular treatment of (sub)acute thrombembolic occlusions of the lower extremity. Patient and methods: Retrospective analysis was conducted on 202 patients with a thrombembolic occlusion of lower extremities, followed by crirical limb ischemia that received endovascular treatment including thrombolysis, mechanical thrombectomy, or a combination of both between 2006 and 2015 at a single center. Following antithrombotic regimes were compared: 1) dual antiplatelet therapy, DAPT for 4 weeks (aspirin 100 mg/d and clopidogrel 75 mg/d) upon intervention, followed by a lifelong single antiplatelet therapy; 2) DAPT plus short term anticoagulation for 4 weeks, followed by a lifelong single antiplatelet therapy; 3) DAPT plus long term anticoagulation for > 4 weeks, followed by a lifelong anticoagulation. Results: Endovascular treatment was associated with high immediate revascularization (> 98 %), as well as overall and amputation-free survival rates (> 85 %), independent from the chosen anticoagulation regime in a two-year follow up, p > 0.05. Anticoagulation in addition to standard antiplatelet therapy had no significant effect on patency or freedom from target lesion revascularization (TLR) 24 months upon index procedure for both thrombotic and embolic occlusions. Severe bleeding complications occurred more often in the long-term anticoagulation group (9.3 % vs. 5.6 % (short-term group) and 6.5 % (DAPT group), p > 0.05). Conclusions: Our observational study demonstrates that the choice of an antithrombotic regime had no impact on the long-term follow-up after endovascular treatment of acute thrombembolic limb ischemia whereas prolonged anticoagulation was associated with a nominal increase in severe bleeding complications.

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