Abstract MP41: Acute Ischemic Stroke and Coronavirus Disease 2019: An Analysis of 27,676 Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
William Baskett ◽  
Wei Huang ◽  
Daniel Shyu ◽  
Danny Myers ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Relative Risk ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Healthcare Facilities

Background and Purpose: Acute ischemic stroke may occur in patients with Coronavirus disease 2019 but risk factors, in hospital events, and outcomes are not well studied in large cohorts. We identified risk factors, co-morbidities, and outcomes in patients with Coronavirus disease 2019 with or without acute ischemic stroke and compared with patients without Coronavirus disease 2019 and acute ischemic stroke. Methods: We analyzed the data from 54 healthcare facilities using the Cerner de-identified Coronavirus disease 2019 dataset. The dataset included patients with an emergency department or inpatient encounter with a discharge diagnoses codes that could be associated to suspicion of or exposure to Coronavirus disease 2019, or confirmed Coronavirus disease 2019. Results: A total of 103 (1.3%) patients developed acute ischemic stroke among 8,163 patients with Coronavirus disease 2019. Among all Coronavirus disease 2019 patients, the proportion of patients with hypertension, diabetes mellitus, hyperlipidemia, atrial fibrillation and congestive heart failure was significantly higher among those with acute ischemic stroke. Acute ischemic stroke was associated with discharge to destination other than home or death (relative risk 2.1, 95% confidence interval 1.7-2.4, p<.0001) after adjusting for potential confounders. A total of 199 (1.0%) patients developed acute ischemic stroke among 19,513 patents without Coronavirus disease 2019. Among all ischemic stroke patients, Coronavirus disease 2019 was associated with discharge to destination other than home or death (relative risk 1.2, 95% confidence interval 1.0-1.3, p=.03) after adjusting for potential confounders. Conclusions: Acute ischemic stroke was infrequent in patients with Coronavirus disease 2019 and usually occurs in presence of other cardiovascular risk factors. The risk of discharge to destination other than home or death increased two folds with occurrence of acute ischemic stroke in patients with Coronavirus disease 2019.

scholarly journals Acute Ischemic Stroke and COVID-19

Stroke ◽  
2021 ◽  
Author(s):  
Adnan I. Qureshi ◽  
William I. Baskett ◽  
Wei Huang ◽  
Daniel Shyu ◽  
Danny Myers ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Emergency Department ◽  
Ischemic Stroke ◽  
Relative Risk ◽  
Acute Ischemic Stroke ◽  
Health Care Facilities ◽  
Stroke Patients ◽  
Care Facilities

Background and Purpose: Acute ischemic stroke may occur in patients with coronavirus disease 2019 (COVID-19), but risk factors, in-hospital events, and outcomes are not well studied in large cohorts. We identified risk factors, comorbidities, and outcomes in patients with COVID-19 with or without acute ischemic stroke and compared with patients without COVID-19 and acute ischemic stroke. Methods: We analyzed the data from 54 health care facilities using the Cerner deidentified COVID-19 dataset. The dataset included patients with an emergency department or inpatient encounter with discharge diagnoses codes that could be associated to suspicion of or exposure to COVID-19 or confirmed COVID-19. Results: A total of 103 (1.3%) patients developed acute ischemic stroke among 8163 patients with COVID-19. Among all patients with COVID-19, the proportion of patients with hypertension, diabetes, hyperlipidemia, atrial fibrillation, and congestive heart failure was significantly higher among those with acute ischemic stroke. Acute ischemic stroke was associated with discharge to destination other than home or death (relative risk, 2.1 [95% CI, 1.6–2.4]; P <0.0001) after adjusting for potential confounders. A total of 199 (1.0%) patients developed acute ischemic stroke among 19 513 patients without COVID-19. Among all ischemic stroke patients, COVID-19 was associated with discharge to destination other than home or death (relative risk, 1.2 [95% CI, 1.0–1.3]; P =0.03) after adjusting for potential confounders. Conclusions: Acute ischemic stroke was infrequent in patients with COVID-19 and usually occurs in the presence of other cardiovascular risk factors. The risk of discharge to destination other than home or death increased 2-fold with occurrence of acute ischemic stroke in patients with COVID-19.

scholarly journals Atrial fibrillation risk factors in patients with ischemic stroke

2021 ◽  
Vol 17 (1) ◽  
pp. 19-24
Author(s):  
Paweł Wańkowicz ◽  
Przemysław Nowacki ◽  
Monika Gołąb-Janowska
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Nonvalvular Atrial Fibrillation ◽  
Multivariable Logistic Regression Model ◽  
Lipid Metabolism Disorders

IntroductionAtrial fibrillation (AF) is the most common heart arrhythmia. The condition is known to increase the risk of ischemic stroke (IS). Classical risk factors for the development of AF include advanced age, hypertension, diabetes mellitus, coronary heart disease and lipid metabolism disorders. Importantly, these are also recognized risk factors for ischemic stroke. Therefore, the purpose of this study was to investigate AF risk factors in patients with IS.Material and methodsThis is single-centre retrospective study which included 696 patients with acute ischemic stroke and nonvalvular atrial fibrillation and 1678 patients with acute ischemic stroke without atrial fibrillation.ResultsIn this study we found – based on a univariable and multivariable logistic regression model – that compared to the patients with IS without AF, the group of patients which suffered from IS with nonvalvular atrial fibrillation (NVAF) had a higher proportion of patients who smoked cigarettes (OR = 15.742, p < 0.01; OR = 41.1, p < 0.01), had hypertension (OR = 5.161, p < 0.01; OR = 5.666, p < 0.01), history of previous stroke (OR = 3.951, p < 0.01; OR = 4.792, p < 0.01), dyslipidemia (OR = 2.312, p < 0.01; OR = 1.592, p < 0.01), coronary heart disease (OR = 2.306, p < 0.01; OR = 1.988, p < 0.01), a greater proportion of female patients (OR = 1.717, p < 0.01; OR = 2.095, p < 0.01), higher incidence of diabetes mellitus (OR = 1.341, p < 0.01; OR = 1.261, p = 0.106) and more patients in old age (OR = 1.084, p < 0.01; OR = 1.101, p < 0.01).ConclusionsOur study demonstrates a need for thorough and systematic monitoring of post-ischemic stroke patients in whom AF has not been detected and who display other important risk factors. Regardless of the stroke, these factors may be responsible for development of AF.

scholarly journals Cholesterol reducer and thrombolytic therapy in acute ischemic stroke patients

2020 ◽  
Author(s):  
Nicolas Poupore ◽  
Dan Strat ◽  
Tristan Mackey ◽  
Katherine Brown ◽  
Ashley Snell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Demographic Data ◽  
Clinical Risk Factors ◽  
Stroke Patients ◽  
Medication History ◽  
Factors Associated ◽  
Clinical Risk

Abstract Background Specific clinical risk factors may contribute to worsening or improving neurological functions in an acute ischemic stroke (AIS) patient pre-treated with a cholesterol reducer with a subsequent recombinant tissue plasminogen activator (rtPA) treatment. We investigated clinical risk factors associated with good or poor presenting neurological symptoms in ischemic stroke patients with prior cholesterol reducer use, specifically a statin and rtPA therapy. Methods We retrospectively analyzed baseline clinical and demographic data of 630 patients with AIS taking cholesterol reducers prior to rtPA treatment from January 2010 to June 2016 in a regional stroke center. Progressing (NIHSS ≤ 7) or worsening (NIHSS > 7) scores for neurologic improvement determined measures for treatment outcome. Multivariate logistic regression models identified demographic and clinical factors associated with worsening or progressing neurologic functions. Results Adjusted multivariate analysis showed that in an ischemic stroke population with a combined rtPA and cholesterol reducer medication history, increasing age (OR = 1.032, 95% CI, 1.015-1.048, P < 0.001) and atrial fibrillation (OR = 1.859, 95% CI, 1.098-3.149, P = 0.021) demonstrated a likely association with worsening neurologic functions, while direct admission (OR = 0.411, 95% CI, 0.246-0.686, P = 0.001) and being Caucasian (OR = 0.496, 95% CI, 0.297-0.827, P = 0.007) showed an association with improving or progressing neurologic functions. Conclusion A prior cholesterol reducer, namely a statin, plus rtPA combination may be associated with worsening neurological function for elderly AIS patients with atrial fibrillation, while Caucasians directly admitted to a neurology unit are more likely to show an association with progress or improvements in neurologic functions.

scholarly journals Who will benefit more from low-dose alteplase in acute ischemic stroke?

2019 ◽  
Vol 15 (1) ◽  
pp. 39-45 ◽  
Author(s):  
Xia Wang ◽  
Keon-Joo Lee ◽  
Tom J Moullaali ◽  
Beom Joon Kim ◽  
Qiang Li ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Low Dose ◽  
Standard Dose ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Lower Systolic Blood Pressure ◽  
Intravenous Alteplase

Objectives Controversy persists over the benefits of low-dose versus standard-dose intravenous alteplase for the treatment of acute ischemic stroke. We sought to determine individual patient factors that contribute to the risk–benefit balance of low-dose alteplase treatment. Methods Observational study using data from the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED), an international, randomized, open-label, blinded-endpoint trial that assessed low-dose (0.6 mg/kg) versus standard-dose (0.9 mg/kg) intravenous alteplase in acute ischemic stroke patients. Logistic regression models were used to estimate the benefit of good functional outcome (scores 0 or 1 on the modified Rankin scale at 90 days) and risk (symptomatic intracerebral hemorrhage), under both regimens for individual patients. The net advantage for low-dose, relative to standard-dose, alteplase was calculated by dividing excess benefit by excess risk according to a combination of patient characteristics. The algorithms were externally validated in a nationwide acute stroke registry database in South Korea. Results Patients with an estimated net advantage from low-dose alteplase, compared with without, were younger (mean age of 66 vs. 75 years), had lower systolic blood pressure (148 vs. 160 mm Hg), lower National Institute of Health Stroke Scale score (median of 8 vs. 16), and no atrial fibrillation (10.3% vs. 97.4%), diabetes mellitus (19.2% vs. 22.4%), or premorbid symptoms (defined by modified Rankin scale = 1) (16.3% vs. 37.8%). Conclusion Use of low-dose alteplase may be preferable in acute ischemic stroke patients with a combination of favorable characteristics, including younger age, lower systolic blood pressure, mild neurological impairment, and no atrial fibrillation, diabetes mellitus, or premorbid symptoms.

scholarly journals Sex Differences in Patients with Acute Ischemic Stroke in Tuzla Region, Bosnia and Herzegovina

2010 ◽  
Vol 10 (2) ◽  
pp. 116-120 ◽  
Author(s):  
Denisa Salihović ◽  
Dževdet Smajlović ◽  
Osman Sinanović ◽  
Biljana Kojić
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Bosnia And Herzegovina ◽  
Heart Diseases ◽  
Favourable Outcome ◽  
Stroke Severity

Although many aspects of stroke are similar at both sexes, however, there are some differences and characteristics as well. The aim of this study was to analyze sex differences in patients with acute ischemic stroke (IS) regarding to risk factors, subtypes, stroke severity and outcome.From January 1st 2001 to December 31st 2005 at the Department of Neurology Tuzla 2833 patients were admitted with acute ischemic stroke (IS). We were analyzed risk factors, subtypes, stroke severity (Scandinavian Stroke Scale), and thirty-day outcome.There were 1484 (52,3%) female, and they were older than male (67,8 ±10,6 vs. 65,7 ± 10,5, p<0,0001). Hypertension (78% vs. 67%, p<0,0001), heart diseases (50% vs. 45%, p=0,009), atrial fibrillation (22% vs. 14%, p<0,0001) and diabetes mellitus (33% vs. 21%, p<0,0001) were frequently in female, while smoking (45% vs. 14%) and alcohol overuse (18% vs. 0,6%) in male (p<0,0001). Atherothrombotic type of ischemic stroke was frequently in male (37,4% vs. 31,6%, p=0,0013) and cardioembolic in female (21,7% vs. 15,5%, p<0,0001). At admission female had lower SS (SS 31,0±15 vs. 34,0± 15, p<0,0001). Thirty-day mortality was significantly higher in female (23,3% vs. 18,4%, p=0,0015), and favourable outcome within one month (Rankin Scale < 2) had 58% male and 51% female (p=0,001).The frequency of ischemic stroke is higher in female who are older than male. There are some sex differences according to the distribution of risk factors and subtypes of ischemic stroke. Stroke severity at admission, thirty-day mortality, and disability are higher in female.

scholarly journals Prevalence and determinants of systolic and diastolic cardiac dysfunction and heart failure in acute ischemic stroke patients: The SICFAIL study

2020 ◽  
Author(s):  
Peter U. Heuschmann ◽  
Felipe A. Montellano ◽  
Kathrin Ungethüm ◽  
Viktoria Rücker ◽  
Silke Wiedmann ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cardiac Dysfunction ◽  
Stroke Patients

scholarly journals Resting Heart Rate and In-Hospital Mortality in Acute Ischemic Stroke Patients With and Without Atrial Fibrillation

2020 ◽  
Vol 84 (4) ◽  
pp. 656-661
Author(s):  
Qiao Han ◽  
Chunyuan Zhang ◽  
Shoujiang You ◽  
Danni Zheng ◽  
Chongke Zhong ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Resting Heart Rate ◽  
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.

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