Abstract WP35: Penumbra Saved in Acute Stroke Patients Treated with IV Thrombolysis Predicts Minimal Infarct Growth Independent of Onset to Treatment

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Marie Luby ◽  
Zurab Nadareishvili ◽  
Kaylie Cullison ◽  
Richard T Benson ◽  
Amie W Hsia ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Independent Predictor ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Volume Increase ◽  
Multimodal Mri ◽  
Favorable Clinical Outcome ◽  
Iv Tpa

Purpose and Hypothesis: The ability to measure the immediate tissue effects in patients treated with thrombolysis ultra-early relative to their known onset has increased. We hypothesized that shorter onset to treatment times (OTT) would lead to more penumbra saved, calculated using multimodal MRI. Methods: Patients were included in this study if they met the following criteria: (1) were admitted between January 2010 and June 1, 2014 at one of two regional stroke centers, (2) had known last seen normal, acute MRI and IV tPA start times, (3) received an admit diagnosis of ischemic stroke, and (4) were treated with standard IV tPA. Penumbral volumes were calculated using the baseline MRI-defined mismatch regions minus the infarcted regions defined by the co-registered DWI at 24 hours. Patients were categorized to the “early” IV tPA cohort if their OTT was ≤ 120 minutes. Infarct growth was quantitatively defined as lesion volume increase > 5 mL from baseline DWI to 5-day FLAIR. Favorable clinical outcome was defined as discharge or later mRS < 2. Results: Sixty-three patients, 23 early- and 40 late-treated, were included in the study with mean age 75 (±15) years, 48% female, median [IQR]: admit NIHSS 10 [5-19], OTT 139 [109-185] minutes, baseline DWI volume 11.2mL [3.5-39.6], baseline MTT volume 120.9mL [37.8-220.7], and baseline mismatch volume 119.3mL [34.6-200.7]. Aside from time-based variables, only the amount of penumbra infarcted at 24 hours (p=0.015) was significantly different between the early- (9mL [1.7-19.7] and late-treated (2.4mL [0.7-7]) cohorts. The patients with favorable outcome were younger (p=0.012) with less severe admit NIHSS (p=0.026), smaller baseline DWI volume (p=0.017), smaller 24 hour DWI volume (p=0.041), and greater percentage of penumbra saved at 24 hours (p=0.010) but no difference in OTT (p=0.267). Using binomial logistic regression, percentage of penumbra saved at 24 hours (95%CI:0.000-0.011, p=0.010) was the only independent predictor of no infarct growth. Conclusions: This study establishes that significantly larger penumbral tissue saved at 24 hours, not early OTT, is predictive of both favorable clinical outcome and no infarct growth.

Abstract 2632: The Relationship Between MRI/PWI-Time Intensity Curve And 3-month Clinical Outcome Of The Acute Ischemic Patients Who Underwent Endovascular Reperfusion Therapy For IC Or MCA Occlusion.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
MASAHITO NAKAZAKI ◽  
Takahisa Mori ◽  
Hiroyuki Tajiri ◽  
Tomonori Iwata ◽  
Yuichi Miayazaki
Keyword(s):  
Regression Analysis ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Reperfusion Therapy ◽  
Intensity Curve ◽  
Stroke Patients ◽  
Time Intensity Curve ◽  
Favorable Clinical Outcome ◽  
The Relationship

The purpose of our study was to investigate the relationship between MRI/PWI-Time Intensity curve (TIC) and 3-month clinical outcome following endovascular reperfusion therapy in acute ischemic stroke patients with occlusion of the internal carotid artery (ICA) or the middle cerebral artery (MCA). We retrospectively analyzed the acute stroke patients 1) who were admitted to our institution from 2004 to 2010, 2) with serious neurological symptoms, 3) who had total occlusion of the ICA or MCA displayed by MRA with DWI -PWI mismatch and 5) who underwent emergency endovascular reperfusion therapy within 8 hours from stroke onset. We investigated patient's baseline characteristics, emergency MRI findings , successful recanalization defined as TICI 2B or 3,and 3-month modified Rankin scale(3M-mRS). We evaluated PWI findings using TIC types. Region of interests were set at symmetrical positions of the bilateral MCA territories and time-intensity-curves (TICs) were calculated. The types of TICs were classified into four patterns according to the timeto peak (TP) and the reduction value of the peak signal (PV). Comparing the affected side with the contralateral side, we defined type 1 as TPa>TPc and PVaTPc and PVc/2≤PVa<PVc, type 3 as TPa >TPc and PVa≥PVc, and type 4 as TPa=TPc. We analyzed the relationship between the PWI/TIC and mRS at 3 months (3M-mRS) statistically. We defined favorable clinical outcome as 3M-mRS of 0-2, and assessed pre-treatment predictors for favorable clinical outcome and death within 3months by using logistic regression analysis. Seventy one patients were analyzed. Their median age was 75 years, median admission NIHSS was 17, median DWI-ASPECT score was 7, sixty three patients had cadiogenic stroke, successful recanalization was achieved in 38 patients (54.0%), and median 3M-mRS was 3. Twenty three patients (32%) had 3M-mRS of 0-2 and 11 patients (37%) died within 3 months. PWI-TICs of type 1,2,3 and 4 were in 13, 37, 21 and 0 patients, respectively. Type of PWI-TIC was significantly correlated to 3M-mRS (r=-0.24,P=0.047). The higher PWI/TIC type were, the lower 3M-mRS were. Logistic regression analysis demonstrated that independent predictors of favorable clinical outcome (3M-mRS of 0-2) were DWI ASPECTS and age, whereas, independent predictors of death within 3months from onset were type 1 of PWI-TIC (OR,5.71;95%CI,1.28-25.4, P=0.022) and admission NIHSS. Conclusion; In ischemic stroke patients who underwent endovascular reperfusion therapy for the ICA or MCA occlusion within 8hours from onset, type of PWI-TIC was the significant predictor for death within 3months from onset.

Predictors of poor clinical outcome despite complete reperfusion in acute ischemic stroke patients

2020 ◽  
Vol 13 (1) ◽  
pp. 14-18 ◽  
Author(s):  
Noel van Horn ◽  
Helge Kniep ◽  
Hannes Leischner ◽  
Rosalie McDonough ◽  
Milani Deb-Chatterji ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Logistic Regression Analysis ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Poor Clinical Outcome ◽  
Poor Outcome

BackgroundIn patients suffering from acute ischemic stroke from large vessel occlusion (LVO), mechanical thrombectomy (MT) often leads to successful reperfusion. Only approximately half of these patients have a favorable clinical outcome. Our aim was to determine the prognostic factors associated with poor clinical outcome following complete reperfusion.MethodsPatients treated with MT for LVO from a prospective single-center stroke registry between July 2015 and April 2019 were screened. Complete reperfusion was defined as Thrombolysis in Cerebral Infarction (TICI) grade 3. A modified Rankin scale at 90 days (mRS90) of 3–6 was defined as ‘poor outcome’. A logistic regression analysis was performed with poor outcome as a dependent variable, and baseline clinical data, comorbidities, stroke severity, collateral status, and treatment information as independent variables.Results123 patients with complete reperfusion (TICI 3) were included in this study. Poor clinical outcome was observed in 67 (54.5%) of these patients. Multivariable logistic regression analysis identified greater age (adjusted OR 1.10, 95% CI 1.04 to 1.17; p=0.001), higher admission National Institutes of Health Stroke Scale (NIHSS) (OR 1.14, 95% CI 1.02 to 1.28; p=0.024), and lower Alberta Stroke Program Early CT Score (ASPECTS) (OR 0.6, 95% CI 0.4 to 0.84; p=0.007) as independent predictors of poor outcome. Poor outcome was independent of collateral score.ConclusionPoor clinical outcome is observed in a large proportion of acute ischemic stroke patients treated with MT, despite complete reperfusion. In this study, futile recanalization was shown to occur independently of collateral status, but was associated with increasing age and stroke severity.

Predictors of favorable outcome after endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion in young patients

2021 ◽  
pp. 028418512110564
Author(s):  
Maciej Szmygin ◽  
Michał Sojka ◽  
Piotr Tarkowski ◽  
Krzysztof Pyra ◽  
Piotr Luchowski ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mortality Rate ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Young Patients ◽  
High Rate ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Favorable Clinical Outcome

Background Mechanical thrombectomy (MT) became a standard of care for patients with acute ischemic stroke (AIS) with its efficacy demonstrated by meta-analysis and randomized studies. Although ischemic stroke is associated more with older patients, it may also have devastating neurological effects on young patients. Purpose To present our experience with stroke patients aged <50 years treated with endovascular means and to evaluate clinical and procedural factors associated with outcome and mortality. Material and Methods This study was conducted on 34 young stroke patients treated with MT. Clinical features including baseline results, radiological imaging, procedural details, and outcome results were documented and evaluated. Recanalization was assessed according to the TICI score. The clinical condition was evaluated after three months using mRS. Mortality rate was calculated. Results The rate of successful recanalization (TICI ≥2c) was 79% (27/34). Symptomatic intracranial hemorrhage (sICH) was observed in 5 (15%) patients. After 90 days, the mortality rate was 12%. Favorable clinical outcome (mRs 0–2) was regained in 65% of the patients whereas satisfactory clinical outcome was seen in 85%. Poor clinical outcome (mRs >2) was observed in 9 (23.7%) patients. Conclusion In conclusion, the results of this study demonstrate that MT for AIS in young patients is feasible and provides an excellent rate of arterial recanalization and high rate of favorable outcomes. Statistical analysis showed that shorter time from onset to arrival and reperfusion, successful recanalization and absence of hemorrhagic transformation are the predictors of favorable clinical outcome and overall survival rate.

Abstract TP318: High White Blood Cell (WBC) Counts Are Predictive of tPA-related Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Wenjun Deng ◽  
Bo Song ◽  
Lindsay Fisher ◽  
I-Ying Richard Chou ◽  
Maxwell Oyer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Immune System ◽  
Clinical Outcome ◽  
Blood Cell ◽  
White Blood Cell ◽  
Clinical Evidence ◽  
Stroke Onset ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Iv Tpa

Background: Infection is a major complication of ischemic stroke and contributes to the morbidity and mortality of stroke patients. Although growing evidence highlights the close relationship between inflammation and coagulation/fibrinolysis cascades, little has been reported regarding the influence of tPA on human immune system. Here, we explore changes in white blood cell (WBC) counts pre/post IV tPA and their association with tPA-related hemorrhagic transformation (HT). Method: 308 tPA-treated ischemic stroke patients were recruited with IRB approval, of which 16 developed HT within 24 hr post tPA. Routine WBC was analyzed at 1 month pre stroke, during stroke onset and during the first 48 hr post tPA. Result: We found that WBC was significantly increased within 12 hr post IV tPA and gradually reduced after 24 hr (Figure 1A). However, compared with patients without HT, HT patients had much higher levels of WBC throughout tPA treatment, and their WBC remained above normal even after 48 hr (Figure 1B). More importantly, we also found that HT patients had already developed elevated WBC as early as 1 month before their stroke onset (Figure 1B), which was predictive of tPA-related HT (Figure 1C, ROC AUC = 0.889, p = 0.001). Furthermore, the early elevation in WBC post-tPA was not associated with clinical evidence of infection. Conclusion: Our results provide early clinical evidence that in addition to activating fibrinolytic pathway, tPA may also modulate immune system during stroke treatment. In addition, elevated WBC pre-stroke maybe a predictive marker of tPA-related hemorrhage. While elevated WBC early in ischemic stroke was reported to correlate with poorer clinical outcome, the transient peak in WBC post tPA in this patient cohort ultimately had better clinical outcome, and is of interest. Further studies are needed and ongoing to evaluate differential WBC, stroke severity and long term clinical outcome, and to understand the molecular basis of tPA in immune cell modulation.

Risk Factors of Recurrent Ischemic Events after Acute Noncardiogenic Ischemic Stroke

2020 ◽  
Vol 25 (45) ◽  
pp. 4827-4834 ◽  
Author(s):  
Limin Zhang ◽  
Xingang Li ◽  
Dongzhi Wang ◽  
Hong Lv ◽  
Xuezhong Si ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Operating Characteristic ◽  
Control Group ◽  
Case Group ◽  
Stroke Patients ◽  
Clopidogrel Therapy ◽  
Ischemic Events

Background: A considerable proportion of acute noncardiogenic ischemic stroke patients continue to experience recurrent ischemic events after standard therapy. Aim: We aimed to identify risk factors for recurrent ischemic event prediction at an early stage. Methods : 286 non-cardioembolic ischemic stroke patients with the onset of symptoms within 24 hours were enrolled. Vascular risk factors, routine laboratory data on admission, thromboelastography test seven days after clopidogrel therapy and any recurrent events within one year were assessed. Patients were divided into case group (patients with clinical adverse events, including ischemic stokes, transient ischemic attack, myocardial infarction and vascular related mortality) and control group (events-free patients). The risk of the recurrent ischemic events was determined by the receiver operating characteristic curve and multivariable logistic regression analysis. Results: Clinical adverse events were observed in 43 patients (case group). The mean levels of Mean Platelet Volume (MPV), Platelet/Lymphocyte Ratio (PLR), Lymphocyte Count (LY) and Fibrinogen (Fib) on admission were significantly higher in the case group as compared to the control group (P<0.001). Seven days after clopidogrel therapy, the ADP-induced platelet inhibition rate (ADP%) level was lower in the case group, while the Maximum Amplitude (MA) level was higher in the case group as compared to the control group (P<0.01). The Area Under the Curve (AUC) of receiver operating characteristic(ROC) curve of LY, PLR, , Fib, MA, ADP% and MPV were 0.602, 0.614, 0.629, 0.770, 0.800 and 0.808, respectively. The logistic regression analysis showed that MPV, ADP% and MA were indeed predictive factors. Conclusion: MPV, ADP% and MA were risk factors of recurrent ischemic events after acute noncardiogenic ischemic stroke. Urgent assessment and individual drug therapy should be offered to these patients as soon as possible.

Association between Blood Urea Nitrogen-to-creatinine Ratio and Three-Month Outcome in Patients with Acute Ischemic Stroke

2019 ◽  
Vol 16 (2) ◽  
pp. 166-172 ◽  
Author(s):  
Linghui Deng ◽  
Changyi Wang ◽  
Shi Qiu ◽  
Haiyang Bian ◽  
Lu Wang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Blood Urea Nitrogen ◽  
Univariate Analysis ◽  
Density Lipoprotein ◽  
Hydration Status ◽  
Creatinine Ratio ◽  
Urea Nitrogen

Background: Hydration status significantly affects the clinical outcome of acute ischemic stroke (AIS) patients. Blood urea nitrogen-to-creatinine ratio (BUN/Cr) is a biomarker of hydration status. However, it is not known whether there is a relationship between BUN/Cr and three-month outcome as assessed by the modified Rankin Scale (mRS) score in AIS patients. Methods: AIS patients admitted to West China Hospital from 2012 to 2016 were prospectively and consecutively enrolled and baseline data were collected. Poor clinical outcome was defined as three-month mRS > 2. Univariate and multivariate logistic regression analyses were performed to determine the relationship between BUN/Cr and three-month outcome. Confounding factors were identified by univariate analysis. Stratified logistic regression analysis was performed to identify effect modifiers. Results: A total of 1738 patients were included in the study. BUN/Cr showed a positive correlation with the three-month outcome (OR 1.02, 95% CI 1.00-1.03, p=0.04). However, after adjusting for potential confounders, the correlation was no longer significant (p=0.95). An interaction between BUN/Cr and high-density lipoprotein (HDL) was discovered (p=0.03), with a significant correlation between BUN/Cr and three-month outcome in patients with higher HDL (OR 1.03, 95% CI 1.00-1.07, p=0.04). Conclusion: Elevated BUN/Cr is associated with poor three-month outcome in AIS patients with high HDL levels.

ICU Interventions in Ischemic Stroke Patients Treated Using Liberalized IV-tPA Criteria

2019 ◽  
Vol 28 (9) ◽  
pp. 2488-2495
Author(s):  
Nick M. Murray ◽  
Michael Ke ◽  
Alan Yee ◽  
Charlene Chen ◽  
Christine Wong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Stroke Patients ◽  
Iv Tpa

scholarly journals Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes

2016 ◽  
Vol 42 (1-2) ◽  
pp. 81-89 ◽  
Author(s):  
Mohamed Al-Khaled ◽  
Christine Matthis ◽  
Andreas Binder ◽  
Jonas Mudter ◽  
Joern Schattschneider ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Case Fatality ◽  
National Institutes Of Health ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Stroke Outcomes ◽  
Increased Risk ◽  
Reduced Risk

Background: Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Methods: Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale ≥2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Results: Of 12,276 patients (mean age 73 ± 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to <24, 24 to ≤72, and >72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p < 0.001). During hospitalization (mean 9 days), 1,271 patients (10.2%; 95% CI 9.7-10.8) suffered from stroke-related pneumonia. Patients with dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p < 0.001). Logistic regression revealed that dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p < 0.001), case fatality during hospitalization (OR 2.8; 95% CI 2.1-3.7; p < 0.001) and disability at discharge (OR 2.0; 95% CI 1.6-2.3; p < 0.001). EDS within 24 h of admission appeared to be associated with decreased risk of stroke-related pneumonia (OR 0.68; 95% CI 0.52-0.89; p = 0.006) and disability at discharge (OR 0.60; 95% CI 0.46-0.77; p < 0.001). Furthermore, dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p < 0.001) and disability (OR 2.3; 95% CI 1.8-3.0; p < 0.001) at 3 months after stroke. The rate of 3-month disability was lower in patients who had received EDS (52 vs. 40.7%; p = 0.003), albeit an association in the logistic regression was not found (OR 0.78; 95% CI 0.51-1.2; p = 0.2). Conclusions: Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability.

Abstract WP47: Reperfusion Following Ischemic Stroke is Associated with Reduced Brain Edema

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Hannah J Irvine ◽  
Thomas W Battey ◽  
Ann-Christin Ostwaldt ◽  
Bruce C Campbell ◽  
Stephen M Davis ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Brain Edema ◽  
Infarct Volume ◽  
Brain Magnetic Resonance Imaging ◽  
Lesion Volume ◽  
Stroke Patients ◽  
Early Reperfusion ◽  
Echoplanar Imaging ◽  
Swelling Volume

Introduction: Revascularization is a robust therapy for acute ischemic stroke, but animal studies suggest that reperfusion edema may attenuate its beneficial effects. In stroke patients, early reperfusion consistently reduces infarct volume and improves long-term functional outcome, but there is little clinical data available regarding reperfusion edema. We sought to elucidate the relationship between reperfusion and brain edema in a patient cohort of moderate to severe stroke. Methods: Seventy-one patients enrolled in the Echoplanar Imaging Thrombolysis Evaluation Trial (EPITHET) with serial brain magnetic resonance imaging and perfusion-weighted imaging (PWI) were analyzed. Reperfusion percentage was calculated based on the difference in PWI lesion volume at baseline and follow-up (day 3-5). Midline shift (MLS) was measured on the day 3-5 fluid attenuated inversion recovery (FLAIR) sequence. Swelling volume and infarct growth volume were assessed using region-of-interest analysis on the baseline and follow-up DWI scans based on our prior methods. Results: Greater percentage of reperfusion was associated with less MLS (Spearman ρ = -0.46; P <0.0001) and reduced swelling volume (Spearman ρ = -0.56; P <0.0001). In multivariate analysis, reperfusion was an independent predictor of less MLS ( P <0.006) and decreased swelling volume ( P <0.0054), after adjusting for age, baseline NIHSS, admission blood glucose, baseline DWI volume, and IV tPA treatment. Conclusions: Reperfusion is associated with reduced brain edema as measured by MLS and swelling volume. While our data do not exclude the possibility of reperfusion edema in certain circumstances, in stroke patients, reperfusion following acute stroke is predominantly linked to less brain swelling.

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.

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