The Association Between Serum Endocan Level and Short-Term Prognosis of Patients With Acute Ischemic Stroke

Angiology ◽  
2021 ◽  
pp. 000331972110307
Author(s):  
Feng Han ◽  
Weifang Liao ◽  
Xunxin Duan ◽  
Yuying Shi ◽  
Zhijian Hu
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Characteristic Curve ◽  
Outcome Data ◽  
Stroke Onset ◽  
Risk Of Death ◽  
Increased Risk ◽  
Potential Prognostic Factor ◽  
Disability Outcome ◽  
Incident Rate

This cohort study was designed to assess the association between serum endocan levels and the prognosis of acute ischemic stroke. A total of 227 patients were recruited consecutively. Study outcome data on death and major disability (modified Rankin Scale score ≥3) were collected at 3 months after stroke onset. After 3 months of follow-up, death and disability occurred in 48 and 85 patients, respectively, while the primary (death) and secondary (death or disability) outcome incident rate was 21.15% and 37.44%, respectively. The multivariable adjusted odds ratio (OR) (95% confidence interval, 95% CIs) of the highest endocan quartile for death or major disability was 1.21 (1.10, 4.13) compared with the lowest quartile. After adjusting for confounding factors, the increase in the risk of death was not significant. Receiver operating characteristic curve analysis showed that endocan predicted primary and secondary outcomes with C-statistical values (95% CIs) of 0.61 (0.55–0.67, P = .001) and 0.68 (0.59–0.76, P < .001), respectively. Elevated endocan levels were independently related to increased risk of poor outcome at 3 months after ischemic stroke onset. Endocan is a potential prognostic factor for ischemic stroke.

scholarly journals Signs of Pulmonary Infection on Admission Chest Computed Tomography Are Associated With Pneumonia or Death in Patients With Acute Stroke

Stroke ◽  
2020 ◽  
Vol 51 (6) ◽  
pp. 1690-1695
Author(s):  
Jeroen C. de Jonge ◽  
Richard A.P. Takx ◽  
Frans Kauw ◽  
Pim A. de Jong ◽  
Jan W. Dankbaar ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Pulmonary Infection ◽  
Stroke Onset ◽  
Odds Ratios ◽  
Chest Computed Tomography ◽  
Risk Of Death ◽  
Increased Risk

Background and Purpose— In patients with acute stroke, the occurrence of pneumonia has been associated with poor functional outcomes and an increased risk of death. We assessed the presence and consequences of signs of pulmonary infection on chest computed tomography (CT) before the development of clinically overt pneumonia. Methods— In 200 consecutive patients with acute ischemic stroke who had CT angiography from skull to diaphragm (including CT of the chest) within 24 hours of symptom onset, we assessed the presence of consolidation, ground-glass-opacity and the tree-in-bud sign as CT signs of pulmonary infection and assessed the association with the development of clinically overt pneumonia and death in the first 7 days and functional outcome after 90 days with logistic regression. Results— The median time from stroke onset to CT was 151 minutes (interquartile range, 84–372). Thirty patients (15%) had radiological signs of infection on admission, and 22 (11.0%) had a clinical diagnosis of pneumonia in the first 7 days. Patients with radiological signs of infection had a higher risk of developing clinically overt pneumonia (30% versus 7.6%; adjusted odds ratios, 4.2 [95% CI, 1.5–11.7]; P =0.006) and had a higher risk of death at 7 days (adjusted odds ratios, 3.7 [95% CI, 1.2–11.6]; P =0.02), but not at 90 days. Conclusions— About 1 in 7 patients with acute ischemic stroke had radiological signs of pulmonary infection within hours of stroke onset. These patients had a higher risk of clinically overt pneumonia or death. Early administration of antibiotics in these patients may lead to better outcomes.

scholarly journals Serum matrix metalloproteinase-9 levels and prognosis of acute ischemic stroke

Neurology ◽  
2017 ◽  
Vol 89 (8) ◽  
pp. 805-812 ◽  
Author(s):  
Chongke Zhong ◽  
Jingyuan Yang ◽  
Tan Xu ◽  
Tian Xu ◽  
Yanbo Peng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Outcome Data ◽  
Antihypertensive Medications ◽  
Risk Of Death ◽  
Cell Counts ◽  
Increased Risk ◽  
White Blood Cell Counts ◽  
Matrix Metalloproteinases 9

Objective:To examine the association between serum matrix metalloproteinases-9 (MMP-9) levels and prognosis of acute ischemic stroke.Methods:We measured serum MMP-9 levels in 3,186 participants (2,008 men and 1,178 women) from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). Study outcome data on death, major disability (modified Rankin Scale score ≥3), and vascular disease were collected at 3 months after stroke onset.Results:During 3 months of follow-up, 767 participants (24.6%) experienced major disability or died. Serum MMP-9 was significantly associated with an increased risk of death and major disability after adjustment for age, sex, time from onset to randomization, current smoking, alcohol drinking, admission NIH Stroke Scale score, diastolic blood pressure, plasma glucose, white blood cell counts, use of antihypertensive medications, and history of hypertension, coronary heart disease, and diabetes mellitus. For example, 1-SD (0.32 ng/mL) higher log–MMP-9 was associated with an odds ratio (95% confidence interval) of 1.16 (1.06–1.28) for the combined outcome of death and major disability, 1.12 (1.01–1.23) for major disability, and 1.29 (1.01–1.66) for death. The addition of serum MMP-9 to conventional risk factors improved risk prediction of the combined outcome of death or major disability (net reclassification index 9.1%, p = 0.033; integrated discrimination improvement 0.4%, p = 0.004).Conclusions:Higher serum MMP-9 levels in the acute phase of ischemic stroke were associated with increased risk of mortality and major disability, suggesting that serum MMP-9 could be an important prognostic factor for ischemic stroke.

scholarly journals The Incremental Prognostic Value of Hepatocyte Growth Factor in First-Ever Acute Ischemic Stroke: An Early Link Between Growth Factor and Interleukins

2021 ◽  
Vol 12 ◽  
Author(s):  
Fangfang Li ◽  
Ping Liu ◽  
Yuyou Huang ◽  
Lingzhi Li ◽  
Sijia Zhang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Growth Factor ◽  
Hepatocyte Growth Factor ◽  
Acute Ischemic Stroke ◽  
Predictive Accuracy ◽  
Characteristic Curve ◽  
Stroke Outcome ◽  
Net Reclassification Improvement ◽  
Increased Risk ◽  
Hepatocyte Growth

Hepatocyte growth factor (HGF) is a potential prognostic factor for acute ischemic stroke (AIS). In this study, we sought to validate its earlier predictive accuracy within 24 h for first-ever AIS. Moreover, as HGF interacts with interleukins, their associations may lead to novel immunomodulatory therapeutic strategies. Patients with first-ever AIS (n = 202) within 24 h were recruited. Plasma HGF and related interleukin concentrations were measured by multiplex immunoassays. The primary and secondary outcomes were major disability (modified Rankin scale score ≥3) at 3 months after AIS and death, respectively. Elastic net regression was applied to screen variables associated with stroke outcome; binary multivariable logistic analysis was then used to explore the relationship between HGF level and stroke outcome. After multivariate adjustment, upregulated HGF levels were associated with an increased risk of the primary outcome (odds ratio, 7.606; 95% confidence interval, 3.090–18.726; p &lt; 0.001). Adding HGF to conventional risk factors significantly improved the predictive power for unfavorable outcomes (continuous net reclassification improvement 37.13%, p &lt; 0.001; integrated discrimination improvement 8.71%, p &lt; 0.001). The area under the receiver operating characteristic curve value of the traditional model was 0.8896 and reached 0.9210 when HGF was introduced into the model. An elevated HGF level may also be a risk factor for mortality within 3 months poststroke. The HGF level was also positively correlated with IL-10 and IL-16 levels, and HGF before interaction with all interleukins was markedly negatively correlated with the lymphocyte/neutrophil ratio. HGF within 24 h may have prognostic potential for AIS. Our findings reinforce the link between HGF and interleukins.

Gastrointestinal Hemorrhage is Associated with Mortality after Acute Ischemic Stroke

2019 ◽  
Vol 16 (2) ◽  
pp. 135-141
Author(s):  
Yongtao Zhou ◽  
Weihua Xu ◽  
Wei Wang ◽  
Shukun Yao ◽  
Bei Xiao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Acute Phase ◽  
Oral Anticoagulant ◽  
Oral Anticoagulants ◽  
Brain Herniation ◽  
Risk Of Death ◽  
Increased Risk ◽  
Age And Sex

Objective: Gastrointestinal (GI) hemorrhage is serious during the acute phase and is reported to be related to an increased risk of death during the acute phase of acute ischemic stroke in particular. Our study was designed to investigate the relationship between GI hemorrhage and the mortality of acute ischemic stroke, assessing the influence of cerebrovascular risk factors, brain herniation and oral anticoagulation on the onset of GI hemorrhage. The identified risk factors for the occurrence of GI hemorrhage help to elucidate their respective roles in the mortality of acute ischemic stroke. Methods: A total of 15993 consecutive patients with acute ischemic stroke, including 216 cases and 15777 controls, were enrolled in the study from October 2010 to December 2018. Basic clinical and examination data were collected at the time of study enrollment. GI hemorrhage was diagnosed according to the presence of clinical features and endoscopy. Chi-square test and multiple logistic regressions were conducted to explore the associations between the GI hemorrhage occurrence and known risk factors. Kaplan-Meier was used to assess the influence of GI hemorrhage on the age of mortality of acute ischemic stroke. Results: GI hemorrhage cases among patients with acute ischemic stroke accounted for 1.35%. Male patients with ischemic stroke were more likely to have GI hemorrhage than their female counterparts (odds ratio (OR): 1.79; P = 0.000). Patients with atrial fibrillation (AF) had a higher incidence of GI hemorrhage than their counterparts without AF (3.03% vs. 1.20%; P < 0.05). Use of oral anticoagulants was related to increased risk for GI hemorrhage (OR: 1.96; P = 0.00). After adjusting for age and sex, both AF and oral anticoagulant use maintained associations with increased risk for GI hemorrhage (2.59-times and 2.02-times risk respectively; P = 0.00). Patients with hyperlipidemia had a lower incidence of GI hemorrhage than their counterparts without hyperlipidemia (0.62% vs. 1.60%; P < 0.05). Hyperlipidemia was associated with a reduced risk of GI hemorrhage (OR: 0.38, 95% confidence interval (CI): 0.25-0.58; P = 0.00), even after adjusting for age and sex (OR: 0.41; P = 0.00). Patients with brain herniation had a 6.54-times increased risk for GI hemorrhage (P = 0.00). GI hemorrhage was associated with 10.98-fold risk for mortality of acute ischemic stroke (P = 0.00). There was an interaction between GI hemorrhage and brain herniation and increased 26.91-fold risk for the mortality after acute ischemic stroke (P = 0.00). Conclusion: AF, oral anticoagulant use, brain herniation and male sex increase GI hemorrhage risk, while hyperlipidemia reduces risk. GI hemorrhage itself increases the risk for mortality of acute ischemic stroke. The interaction between GI hemorrhage and brain herniation increased the risk for the mortality after acute ischemic stroke.

scholarly journals White Matter Hyperintensity, Immediate Antihypertensive Treatment, and Functional Outcome After Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (5) ◽  
pp. 1608-1612
Author(s):  
Shiguang Zhu ◽  
Sifan Qian ◽  
Tan Xu ◽  
Hao Peng ◽  
Ruiguo Dong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
White Matter ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Hospital Discharge ◽  
Scale Score ◽  
Antihypertensive Treatment ◽  
White Matter Hyperintensity ◽  
Risk Of Death ◽  
Increased Risk

Background and Purpose— It remains unknown that whether white matter hyperintensity (WMH) severity influences the effect of antihypertensive treatment in acute ischemic stroke. We aimed to investigate the effects of early antihypertensive treatment on death and disability among patients with acute ischemic stroke according to WMH severities. Methods— This study was a secondary analysis of the data from CATIS (China Antihypertensive Trial in Acute Ischemic Stroke). Severity of WMH was evaluated using Fazekas rating scale score among 303 participants with available magnetic resonance imaging data and was categorized into none-mild WMH (Fazekas score 0–2) and moderate-severe WMH (Fazekas score 3–6). Functional outcome was death or major disability (modified Rankin Scale score of ≥3) at 14 days or hospital discharge and within 3 months. Results— WMH severity was significantly associated with an increased risk of death or major disability. Each 1 score increase in Fazekas score was associated with an adjusted odds ratio (95% CI) of 1.25 (1.03–1.51) for 14 days or hospital discharge and 1.39 (1.12–1.72) for 3-month functional outcome. There were no significant interactions between antihypertensive treatment and WMH severity (both P >0.1) on functional outcome at 14 days or hospital discharge and within 3 months. The neutral effects of immediate antihypertensive treatment were observed both in patients with moderate-severe WMH and none-mild WMH. Conclusions— Participants with higher WMH burden had increased risk of death or major disability after acute ischemic stroke. Early antihypertensive treatment had a neutral effect on clinical outcomes among acute ischemic stroke patients with a variety of WMH severities. Registration— URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01840072.

Impact of old and very old age on outcomes in patients with acute ischemic stroke undergoing endovascular therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Proietti ◽  
A.P Mascolo ◽  
F Maramma ◽  
D Morosetti ◽  
V Da Ros ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Elderly Patients ◽  
Acute Ischemic Stroke ◽  
Age Groups ◽  
Sensitivity Analyses ◽  
Composite Outcome ◽  
Very Elderly ◽  
Risk Of Death ◽  
Increased Risk

Abstract Background and purpose Only a restricted number of elderly patients has been included in the majority of recent endovascular stroke trials. We provided an analysis about differences in outcomes after mechanical thrombectomy (MT) according to age. Methods A retrospective analysis of an observational registry of patients with anterior large vessel acute ischemic stroke was performed. Main analysis was performed comparing patients &lt;80 vs. ≥80 years old. A sensitivity analysis was performed comparing 3 age groups: i) &lt;80 years; ii) 80–84 years; iii) ≥85 years. Outcomes were: i) any hemorrhagic infarction; ii) alive with disability; iii) death; iv) a composite outcome of alive with disability/death. Results 615 patients were identified. 227 (36.9%) patients were ≥80 years old, with 115 (18.5%) ≥85 years old. Elderly (≥80 years) patients showed a higher modified Rankin Scale (mRS) at discharge and 3-months follow-up (F=9.819, p=0.001) [Figure 1]. Comparing the three groups (&lt;80 years, 80–84 years, ≥85 years) a progressively higher mRS was found at discharge and 3 months follow-up (F=4.899, p=0.008). A progressively higher rate of death and composite outcome between the age groups was found, both in the main and sensitivity analyses. In the logistic regression analysis age ≥80 years was found associated with an increased risk of death (odds ratio [OR]: 2.25, 95% confidence interval [CI]: 1.27–4.00) and showed a trend in higher risk for composite outcome (OR: 1.61, 95% CI: 0.92–2.281). No difference was found between 80–84 years and &lt;80 years patients, while very elderly (≥85 years) had an increased risk of death (OR: 2.85, 95% CI: 1.60–5.10) and composite outcome (OR: 2.37, 95% CI: 1.30–4.33). Conclusions In our analysis elderly patients have an increased risk of death and composite outcome of disability and death. In particular, this risk appears to be significantly higher in very elderly patients (≥85 years old). Figure 1. mRS according to main analysis Funding Acknowledgement Type of funding source: None

scholarly journals Serum uric acid as a prognostic indicator in acute ischemic stroke

2020 ◽  
Vol 8 (4) ◽  
pp. 1435
Author(s):  
Chandana Kaspa ◽  
Shankar Govindu
Keyword(s):  
Uric Acid ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Serum Uric Acid ◽  
Elevated Serum ◽  
Prognostic Indicator ◽  
Uric Acid Concentration ◽  
Risk Of Death ◽  
Increased Risk ◽  
Serum Uric Acid Concentration

Background: Association between serum uric acid (SUA) and the outcome of acute ischemic stroke is debated and needs to be evaluated. The present study was conducted to study the serum uric acid concentration as an indicator of   outcome among acute ischaemic stroke and to determine the role of serum uric acid as a risk factor for acute ischemic stroke.Methods: An observational study where 50 patients who presented within 48 hours of onset of stroke admitted to medical wards of government general Hospital Guntur were selected for the study.Results: Out of 50 patients included for the study, 6 belonged to the age group of 30-40 years. Majority were male (66%) and 44.5% of the males and 76.5% of females showed raised serum uric acid levels. 25 out of 50 patients were diabetic (i.e. 50%) Among them 16 had serum uric acid >6 mg% (ie.64%), 56% of the patients were hypertensive and among them 71% were found to have uric acid levels greater than 6mgs%, 38 out of 50 patients had bad outcome, with elevated uric acid levels found 30 among them. In the present study, BMI and outcome of Stroke were significantly associated with Serum Uric acid levels.Conclusions: Serum uric acid levels can be used as a prognostic indicator as a marker for increased risk of stroke. Elevated serum urate concentration may stratify risk of death after acute stroke.

Abstract P212: Blood pressure lowering and clinical outcomes in patients with acute ischemic stroke: China Antihypertensive Trial in Acute Ischemic Stroke (CATIS)

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Jiang He ◽  
Yonghong Zhang ◽  
Tan Xu ◽  
Qi Zhao ◽  
Chung-Shiuan Chen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Hospital Discharge ◽  
Antihypertensive Treatment ◽  
Stroke Onset ◽  
Odds Ratios ◽  
Risk Of Death

Introduction: Observational studies have reported that a decrease in blood pressure (BP) within the first several days after stroke onset was associated with poorer, better, or no difference in adverse clinical outcomes among patients with acute ischemic stroke. Hypothesis: We investigated the association of immediate BP lowering in acute ischemic stroke patients with major clinical outcomes at 14 days or hospital discharge and at a 3 month follow-up visit. Methods: CATIS is a randomized clinical trial conducted in 4,071 Chinese patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP). Patients were randomly assigned to receive antihypertensive treatment or control. The primary outcome was a combination of death and major disability (a modified Rankin score ≥3) at 14 days or hospital discharge or at the 3 month follow-up visit. Multiple logistic regression analysis was used to adjust for baseline age, gender, SBP, NIHSS score, time of stroke onset, history of antihypertensive treatment, and intervention assignment. Results: Compared to patients with a >0-10% reduction in systolic BP within the first 24 hours after admission, the multivariable-adjusted odds ratios (95% confidence interval [CI]) for patients with ≤0%, 11-20%, and ≥21% reduction in SBP were 1.40 (1.08, 1.82), 1.00 (0.81, 1.23), and 0.98 (0.73, 1.30) at 14 days or hospital discharge; and 1.31 (1.00, 1.71), 0.82 (0.66, 1.02), and 0.78 (0.58, 1.05) at 3 months follow-up. Compared to patients with a BP 130-139/85-89 mmHg at 7 days after admission, the multivariable-adjusted odds ratios (95% CI) for patents with BP <130/85, 140-159/90-99, and ≥160/100 mmHg were 1.07 (0.82, 1.38), 1.09 (0.89, 1.34), and 1.58 (1.18, 2.11) at 14 days or hospital discharge, and 0.89 (0.67, 1.17), 1.10 (0.89, 1.36), and 1.50 (1.11, 2.03) at 3 months follow-up, respectively. Conclusions: These data indicate that a lack of BP reduction in the first 24 hours of hospitalization and higher BP levels at 7 days after admission predict increased risk of death and major disability at 14 days or hospital discharge and at 3 months follow-up.

Abstract TMP17: Safety of Thrombolysis for Acute Ischemic Stroke in Patients with Recent Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Setareh Salehi Omran ◽  
Alexander E Merkler ◽  
Gino Gialdini ◽  
Michael Lerario ◽  
Shadi Yaghi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Vascular Risk Factors ◽  
Sensitivity Analyses ◽  
Secondary Outcome ◽  
Vascular Risk ◽  
Risk Of Death ◽  
Increased Risk ◽  
Iv Tpa

Background: The safety of intravenous tissue plasminogen activator (IV-tPA) is uncertain in acute ischemic stroke patients (AIS) with recent stroke because these patients were generally excluded from randomized stroke trials evaluating IV-tPA. We aimed to determine whether history of stroke within the previous 3 months is associated with an increased risk of intracerebral hemorrhage (ICH) or death after thrombolysis for AIS. Methods: Using previously validated ICD-9-CM codes, we retrospectively analyzed all adult patients with AIS who received IV-tPA in nonfederal EDs or acute care hospitals in CA, FL, and NY from 2005-2013. The primary outcome was the development of ICH (ICD-9-CM code 431) during index hospitalization for AIS. The secondary outcome was inpatient death. Logistic regression was used to compare the rate of ICH and death in patients with previous ischemic stroke within 3 months of IV-tPA therapy for AIS to all other patients treated with IV-tPA for AIS. Results: We identified 34,461 AIS patients treated with IV-tPA, including 454 with prior ischemic stroke in the past 3 months. Patients with recent stroke were on average younger and had more vascular risk factors and Elixhauser comorbidities than patients without recent stroke. The ICH rate after IV-tPA was similar in patients with AIS within the previous 3 months (6.6%, 95% CI 6.3-6.8) compared to patients without recent AIS (6.8%, 95% CI 4.5–9.1), but the rate of death was higher in those with AIS within the previous 3 months (16.5%, 95% CI 13.1-19.9 vs. 11.1%, 95% CI 10.7-11.4, p<0.001). After adjusting for demographics, vascular risk factors, and the Elixhauser comorbidity index, the risk of ICH following IV-rPA in patients with AIS in the previous 3 months was not different from those without recent AIS (OR=1.0, 95% CI 0.7-1.5, p=0.90), although the risk of death remained higher in patients with AIS in the previous 3 months (OR=1.6, 95% CI 1.2-2.1, p<0.001). Our results were unchanged in sensitivity analyses excluding patients with other approved indications for thrombolysis (e.g., MI, PE, and hemodialysis). Conclusions: In a large, multistate cohort, prior stroke within 3 months of receiving IV-tPA for AIS was not associated with an increased risk of ICH but was associated with a higher risk of death.

Day-by-Day Blood Pressure Variability in the Subacute Stage of Ischemic Stroke and Long-Term Recurrence

Stroke ◽  
2021 ◽  
Author(s):  
Kenji Fukuda ◽  
Ryu Matsuo ◽  
Masahiro Kamouchi ◽  
Fumi Kiyuna ◽  
Noriko Sato ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Recurrent Stroke ◽  
Competing Risk ◽  
Risk Of Death ◽  
Subacute Stage ◽  
Increased Risk ◽  
Day By Day

Background and Purpose: This study aimed to determine whether variability of day-by-day blood pressure (BP) during the subacute stage of acute ischemic stroke is predictive of long-term stroke recurrence. Methods: We analyzed 7665 patients (mean±SD age: 72.9±13.1 years; women: 42.4%) hospitalized for first-ever ischemic stroke in 7 stroke centers in Fukuoka, Japan, from June 2007 to November 2018. BP was measured daily during the subacute stage (4–10 days after onset). Its mean and coefficient of variation (CV) values were calculated and divided into 4 groups according to the quartiles of these BP parameters. Patients were prospectively followed up for recurrent stroke or all-cause death. The cumulative event rate was calculated with the Kaplan-Meier method. We estimated the hazard ratios and 95% confidence intervals of the events of interest after adjusting for potential confounders and mean BP values using Cox proportional hazards models. The Fine-Gray model was also used to account for the competing risk of death. Results: With a mean (±SD) follow-up duration of 3.9±3.2 years, the rates of recurrent stroke and all-cause death were 3.9 and 9.9 per 100 patient-years, respectively. The cumulative event rates of recurrent stroke and all-cause death increased with increasing CVs of systolic BP and diastolic BP. The systolic BP CV was significantly associated with an increased risk of recurrent stroke after adjusting for multiple confounders and mean BP (hazard ratio [95% CI] for fourth quartile versus first quartile, 1.26 [1.05–1.50]); the risk of recurrent stroke also increased with an increasing systolic BP CV for nonfatal strokes (1.26 [1.05–1.51]) and when death was regarded as a competing risk (1.21 [1.02–1.45]). Similar associations were observed for the diastolic BP CV. Conclusions: Day-by-day variability of BP during the subacute stage of acute ischemic stroke was associated with an increased long-term risk of recurrent stroke.

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