Long-term mortality and recurrent vascular events in lacunar versus non-lacunar ischaemic stroke: A cohort study

Introduction Studies of differences in very long-term outcomes between people with lacunar/small vessel disease (SVD) versus other types of ischaemic stroke report mixed findings, with limited data on myocardial infarction (MI). We investigated whether long-term mortality, recurrent stroke and MI risks differ in people with versus without lacunar/SVD ischaemic stroke. Patients and methods We included first-ever strokes from a hospital-based stroke cohort study recruited in 2002–2005. We compared risks of death, recurrent stroke and MI during follow-up among lacunar/SVD versus other ischaemic stroke subtypes using Cox regression, adjusting for confounding factors. Results We included 812 participants, 283 with lacunar/SVD ischaemic stroke and 529 with other stroke. During a median of 9.2 years (interquartile range 3.1–11.8), there were 519 deaths, 181 recurrent strokes and 79 MIs. Lacunar/SVD stroke was associated with lower mortality (adjusted HR 0.79, 95% CI 0.65 to 0.95), largely due to markedly lower all-cause mortality in the first year. From one year onwards this difference attenuated, with all-cause mortality only slightly and not statistically significantly lower in the lacunar/SVD group (0.86, 95% CI 0.70 to 1.05). There was no clear difference in risk of recurrent stroke (HR 0.84, 95% CI 0.61–1.15) or MI (HR 0.83, 95% CI 0.52–1.34). Conclusion Long-term risks of all-cause mortality, recurrent stroke and MI are similar, or only slightly lower, in patients with lacunar/SVD as compared to other ischaemic stroke. Patients and physicians should be as vigilant in optimising short- and long-term secondary prevention of vascular events in lacunar/SVD as for other stroke types.

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Impaired oxygenation and hemodynamic instability are independent predictors of long-term mortality in a regional cohort needing urgent fixed-wing intensive care transport to tertiary care

10.21203/rs.3.rs-110401/v1 ◽

2020 ◽

Author(s):

Marcus Fredriksson Sundbom ◽

Amalia Sangfelt ◽

Emma Lindgren ◽

Helena Nyström ◽

Göran Johansson ◽

...

Keyword(s):

Intensive Care ◽

Tertiary Care ◽

Hemodynamic Instability ◽

Hazard Ratio ◽

Research Database ◽

Intensive Care Transport ◽

All Cause Mortality ◽

One Year ◽

Long Term Mortality

Abstract Background We aimed to test if impaired oxygenation or major hemodynamic instability at the time of emergency intensive care transport between hospitals are predictors of long-term mortality.Methods From a regional hospital intensive care transport research database, the study cohort was identified as those emergency intensive care cases transported in fixed-wing air ambulance from outlying hospitals to a regional tertiary care center during 2000–2016 for adults (16 years old or older). Impaired oxygenation was defined as oxyhemoglobin % - inspired oxygen fraction ratio (S/F ratio) < 100. Major hemodynamic instability was defined as need for treatment with noradrenaline infusion to sustain mean arterial pressure (MAP) at or above 60 mmHg or having a mean MAP < 60. All-cause mortality at 3 months after transport was the primary outcome, and secondary outcomes were all-cause mortality at 6 and 12 months. Multivariate cumulative survival and hazard analysis was performed for intervals 3, 6 and 12 months.Results There were 2142 patients included in the analysis. The S/F ratio < 100 was associated with increased mortality risk compared to S/F > 300 at all time-points, with hazard ratio (HR) 2.9 (1.9–4.4 95% CI, p < 0.001) at 12 months. Major hemodynamic instability during ICU transport was associated with increased HR of all-cause mortality up to one year with hazard ratio 1.9 (1.5–2.5, p < 0.001).Conclusion Major impairment of oxygenation and/or major hemodynamic instability at the time of ICU transport to get to urgent tertiary intervention is strongly associated with reduced survival at least up to one year after the transport, in this cohort. These findings support the conclusion that these conditions are markers for many fold increase in risk for death notable already at 3 months after transport for patients with these conditions. How much this risk is modifiable is not assessable in this analysis.

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Concurrent intracranial and extracranial artery stenosis and the prognosis of transient ischaemic symptoms or imaging-negative ischaemic stroke

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000377 ◽

2020 ◽

pp. svn-2020-000377

Author(s):

Yue Suo ◽

Jing Jing ◽

Yuesong Pan ◽

Weiqi Chen ◽

Hongyu Zhou ◽

...

Keyword(s):

Ischaemic Stroke ◽

Cox Regression ◽

Recurrent Stroke ◽

Time Interval ◽

Symptom Duration ◽

Large Artery ◽

Imaging Data ◽

Vascular Events ◽

Acute Infarction ◽

Atherosclerotic Stenosis

Background and purposeTransient ischaemic attack (TIA), transient symptoms with infarction (TSI) and diffusion-weighted imaging (DWI)-negative acute ischaemic stroke (AIS) share similar aetiologies but are considered to have a rather benign prognosis. We intended to investigate the association between intracranial atherosclerotic stenosis (ICAS), extracranial atherosclerotic stenosis (ECAS) and the prognosis of patients with TIA, TSI and DWI-negative AIS.MethodsClinical and imaging data of eligible participants were derived from the Chinese Intracranial Atherosclerosis study, according to symptom duration, acute infarction on DWI and discharge diagnosis. Based on the severity and location of arterial atherosclerosis, we categorised the study population into four groups: no or <50% ICAS and no ECAS; ≥50% ICAS but no ECAS; no or <50% ICAS with ECAS; and concurrent ≥50% ICAS and ECAS. Using multivariable Cox regression models, we analysed the relationship between the severity and distribution of large artery atherosclerosis and the prognosis of TIA, TSI and DWI-negative AIS.ResultsA total of 806 patients were included, 67.3% of whom were male. The median age of the study participants was 63 years. Patients in the concurrent ≥50% ICAS and ECAS subgroup had both a significantly higher 1-year recurrence rate (adjusted HR 3.4 (95% CI 1.15 to 10.04), p=0.027) and a higher risk of composite vascular events (adjusted HR 3.82 (95% CI 1.50 to 9.72), p=0.005).ConclusionsConcurrent ICAS and ECAS is associated with a higher possibility of 1-year recurrent stroke or composite vascular events. Large artery evaluation is necessary to assess patients with transient ischaemic symptoms or DWI-negative AIS. Progress in shortening the time interval between symptom onset and large vessel evaluation is needed.

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The Impact of Ischaemic Stroke Subtype on 30-day Hospital Readmissions

Stroke Research and Treatment ◽

10.1155/2018/7195369 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Anna Therese Bjerkreim ◽

Andrej Netland Khanevski ◽

Henriette Aurora Selvik ◽

Ulrike Waje-Andreassen ◽

Lars Thomassen ◽

...

Keyword(s):

Ischaemic Stroke ◽

Functional Outcome ◽

Cox Regression ◽

Recurrent Stroke ◽

Hospital Readmissions ◽

Large Artery ◽

Stroke Subtype ◽

Increased Risk ◽

One Year ◽

The Impact

Background. Stroke aetiology may affect the risk and causes of readmission after ischaemic stroke (IS) and transient ischaemic attack (TIA) due to differences in risk factors, functional outcome, and treatment. We aimed to examine frequencies, causes, and risk of 30-day readmission by stroke subtype, determine predictors of 30-day readmission, and study the impact of 30-day readmissions on one-year mortality. Methods. All surviving patients admitted with IS or TIA from July 2007 to December 2013 were followed by review of medical records for all unplanned readmissions within 30 days after discharge. Stroke subtype was classified as large-artery atherosclerosis (LAA), cardioembolism (CE), small vessel occlusion (SVO), stroke of other determined aetiology (SOE), or stroke of undetermined aetiology (SUE). Cox regression analyses were performed to assess the risk of 30-day readmission for the stroke subtypes and identify predictors of 30-day readmission, and its impact on one-year mortality. Results. Of 1874 patients, 200 (10.7%) were readmitted within 30 days [LAA 42/244 (17.2%), CE 75/605 (12.4%), SVO 12/205 (5.9%), SOE 6/32 (18.8%), SUE 65/788 (8.3%)]. The most frequent causes of readmissions were stroke-related event, infection, recurrent stroke/ TIA, and cardiac disease. After adjusting for age, sex, functional outcome, length of stay, and the risk factor burden, patients with LAA and SOE subtype had significantly higher risks of readmission for any cause, recurrent stroke or TIA, and stroke-related events. Predictors of 30-day readmission were higher age, peripheral arterial disease, enteral feeding, and LAA subtype. Thirty-day readmission was an independent predictor of one-year mortality. Conclusions. Patients with LAA or SOE have a high risk of 30-day readmission, possibly caused by an increased risk of recurrent stroke and stroke-related events. Awareness of the risk of readmission for different causes and appropriate handling according to stroke subtype may be useful for preventing some readmissions after stroke.

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HbA1c Levels and Long-Term Mortality in Patients Undergoing Coronary Angiography

Cardiology ◽

10.1159/000444008 ◽

2016 ◽

Vol 134 (2) ◽

pp. 101-106 ◽

Cited By ~ 3

Author(s):

Ofer Havakuk ◽

Shmuel Banai ◽

Amir Halkin ◽

Maayan Konigstein ◽

Eyal Ben Assa ◽

...

Keyword(s):

Coronary Angiography ◽

Cox Regression ◽

Mortality Rates ◽

Hazard Ratio ◽

All Cause Mortality ◽

Multiple Covariates ◽

Mixed Pattern ◽

Hba1c Levels ◽

Long Term Mortality

Objectives: Previous studies investigating the prognostic value of HbA1c in patients undergoing coronary angiography reported a mixed pattern of results. Therefore, we aimed to better define the prognostic power of HbA1c among coronary catheterized patients. Methods: Patients undergoing coronary angiography (n = 3,749) were divided into four groups according to HbA1c levels (<5, 5-6, 6-7 and >7%). Cox regression models assessed long-term mortality after adjusting for multiple covariates. Results: Baseline clinical profiles differed in HbA1c groups, with a higher prevalence of comorbidities in the groups with higher HbA1c levels. Median follow-up was 1,745 days (interquartile range 1,007-2,171). A J-shaped association curve was observed between HbA1c levels and all-cause mortality rates, with patients in the lowest and highest HbA1c groups suffering from significantly higher mortality rates compared to in-between groups (hazard ratio 1.9, 95% CI 1.32-2.74, p = 0.001, and hazard ratio 1.58, 95% CI 1.29-1.95, p < 0.001, for the lowest and highest HbA1c groups, respectively). This association persisted after adjustment for anemia, nutritional status, renal function, cardiovascular risk factors and inflammatory biomarkers. Conclusions: HbA1c levels <5 or >7% are predictors of all-cause mortality in patients undergoing coronary angiography.

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Long-term mortality predictors in pulmonary embolism

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.197 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

R Caldeira Da Rocha ◽

R Fernandes ◽

M Carrington ◽

F Claudio ◽

J Pais ◽

...

Keyword(s):

Pulmonary Embolism ◽

Troponin I ◽

Cox Regression ◽

Imaging Features ◽

All Cause Mortality ◽

History Of ◽

Acute Pe ◽

Long Term Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Acute Pulmonary embolism(PE)is a common and potentially fatal medical condition.In contemporary adult population,PE is associated with increased long-term mortality. Purpose Identify predictors of long-term all-cause mortality in patients(pts)admitted due to pulmonary embolism. Methods Retrospective single-center study of hospitalized pts with acute PE between 2015 and 2018.We evaluated comorbidities, admission(AD)presentation such as vitals(with hypotension defined as systolic blood pressure(SBP)<90mmHg,and tachycardia as >100ppm),lab analyses during in-hospital period,imaging features. Mortality(long-term >3months)was also assessed using national registry of citizens.We performed uni and multivariate analysis to compare clinical characteristics of pts who died and who survived,using Cox regression and Kaplan-Meier methods.For the predictor age we assessed discrimination power and defined the best cut-off using area under the ROC curve(AUC)method. Results From 2015 to 2018,182 pts were admitted with diagnosis of pulmonary embolism,60% female with a mean age of 74 ± 13years old.Seventy-one(39%)pts died after a median follow-up of 26[10-41]months.Pts who died were older(80 ± 8 vs71 ± 14,p < 0.001).The best cut-off value of age to predict mortality with 70%sensitivity and 61%specificity was 77years old(AUC 0.703;CI95% 0.63-0.78).Pts who died had more frequently history of neoplasia (21%vs 9%,p = 0.009).The remaining comorbidities were similar in both groups.Pts who did not survive were more frequently hypotensive(28% vs 13%, p = 0.008),had higher creatinine(1.1[0.8-1.4] vs 1.0[0.8-1.2], p = 0.002), lactate(2.3[1.8-2.8]vs 1.8[1.5-2.0],p = 0.007)and NT-proBNP(4694[1498-12300]vs2070[492-6660], p < 0.001)at AD.Maximum troponin I (0.176[0.037-0.727]vs0.126[0.050-0.365]ng/mL,p = 0.012) was also higher than in pts who survived. After adjusting for history of neoplasia,ADcreatinine and maximum troponin I,we found that age (HR1.057;95%CI 1.01-1.11,p = 0.021),AD SBP < 90(HR 2.215;95%CI 1.03-4.76,p = 0.041),lactate(HR 1.17;95%CI 1.01-1.36,p = 0.035)and NT-proBNP(HR 1.510;95%CI 1.250-1.780,p < 0.001)were independent predictors of all-cause mortality. Conclusion In our cohort,the long-term all-cause mortality was 39%over a median follow-up of 26[10-41]months.In patients with pulmonary embolism,aside from already identified age(especially when ≥70 years old)and NT-proBNP,lactate should also be considered when evaluating long-term prognosis. Furthermore,hypotension at admission increases by 2fold long-term mortality in patients who suffered acute PE.

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Utility of plasma galectin-3 in predicting long-term mortality in patients with acute heart failure

Biomedical Research and Therapy ◽

10.15419/bmrat.v8i4.669 ◽

2021 ◽

Vol 8 (4) ◽

pp. 4306-4314

Author(s):

Hoang Van Sy ◽

Dang Quang Toan ◽

Ta Thi-Thanh Huong ◽

Chau Ngoc Hoa ◽

Tran Kim Trang

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Troponin I ◽

All Cause Mortality ◽

Galectin 3 ◽

One Year ◽

Time Of Admission ◽

Long Term Mortality

Background: Several studies have investigated Galectin-3 as a promising biomarker for predicting the short-term and long-term mortality of patients with acute heart failure. This study aimed to examine the usefulness of plasma galectin-3 at the time of admission in predicting long-term mortality in Vietnamese patients with acute heart failure (AHF). Methods: We carried out a cohort study including 117 patients consecutively diagnosed with acute heart failure in a single cardiology department. Plasma galectin-3 and other biomarkers were measured at the time of admission. The patient’s clinical and analytical characteristics were recorded. The main endpoint was one-year all-cause mortality. Results: There were six patients (5%) lost to follow-up and 59 patients (53.2%) reaching primary outcome within one year after ‎hospital admission.‎ The median plasma galectin-3 level (ng/mL) in patients with acute heart failure was 34.6 (26.7 – 44.1). Plasma galectin-3 in the alive group was significantly higher than that in the deceased group at one-year follow-up. In predicting one-year all-cause mortality, galectin-3 had an area under the curve (AUC) of 0.71 (95% confidence interval (CI), 0.62 – 0.81) representing a good prognostic factor while brain natriuretic peptide (BNP) and troponin I were inferior to galectin-3 with an AUC of 0.69 (95% CI, 0.59 – 0.79) and 0.63 (95% CI, 0.53 – 0.74), respectively. The optimal cut-off value for galectin-3 was 40.75 ng/mL with a sensitivity of 50.1% and a specificity of 88.5%. In a multivariate model, patients with galectin-3 levels > 40.75 ng/mL had a hazard ratio (HR) of 2.8 (95% CI, 1.5 – 5; p = 0.001). The best prediction model was the combined model of galectin-3 and BNP, yielding an AUC of 0.78 (95% CI, 0.70 – 0.86; p < 0.001). Conclusions: Our study suggested that galectin-3 levels could predict long-term all-cause mortality in patients with acute heart failure with a good prognostic capacity. Combining galectin-3 and BNP could bring up a better risk-stratification.

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1349Effect of bariatric surgery on long-term cardiovascular outcomes in patients with obesity: a nation-wide nested cohort study

European Heart Journal ◽

10.1093/eurheartj/ehz748.0049 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Ardissino ◽

O M Moussa ◽

A R Tang ◽

T Heaton ◽

P Ziprin ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Bariatric Surgery ◽

Cohort Study ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

All Cause Mortality ◽

Secondary Endpoints ◽

Fatal Myocardial Infarction

Abstract Background Obesity is a cardinal risk factor for the development of atherosclerotic cardiovascular disease. Bariatric surgery is an effective method of achieving weight reduction and improving control of cardiovascular risk factors in patients with obesity. However, the effect of bariatric surgery on long-term cardiovascular outcomes has yet to be defined. Purpose The aim of this study is to evaluate the effect of bariatric surgery on long-term risk of major adverse cardiovascular events in a large population of patients with obesity. Methods A nested cohort study was carried out; including the 3,701 patients of the Clinical Practice Research Datalink database who had undergone bariatric surgery, and 3,701 age, gender and BMI matched controls. The primary endpoint was the composite of fatal or non-fatal myocardial infarction; and fatal or non-fatal acute ischaemic stroke. Secondary endpoints included all-cause mortality, new diagnosis of heart failure, fatal or non-fatal myocardial infarction, and fatal or non-fatal acute ischaemic stroke. Data was analysed using a Cox proportional hazards model to account for multiple covariates. Results Patients were followed up for a median of 11.2 years; 20.3% of the population were female, the median age was 36 years and median BMI was 40.4 kg/m2. Patients who had undergone bariatric surgery had a significantly lower occurrence of the primary composite outcome (HR 0.450; 95% CI 0.312–0.671, p<0.001, NNT=62); this was driven by a reduction in myocardial infarction (HR 0.444; 95% CI 0.302–0.654, p<0.001, NNT=64) and not in acute ischaemic stroke (HR 0.528; 95% CI 0.159–1.751, p=0.296). A significant reduction was observed in rates all-cause mortality (HR 0.254; 95% CI 0.183–0.353; p<0.001, NNT=27) and of new diagnosis of heart failure (HR 0.519; 95% CI 0.311–0.864, p=0.012, NNT=153). Table 1. Primary and secondary endpoints during follow-up Events No Bariatric Surgery Bariatric Surgery HR 95% CI p (n=3,701) (n=3,701) Primary endpoint 93 37 0.458 0.312–0.671 <0.001 Secondary endpoints All-cause mortality 182 45 0.254 0.183–0.353 <0.001 Heart failure 46 22 0.519 0.311–0.864 0.012 Fatal or non-fatal myocardial infarction 93 36 0.444 0.302–0.654 <0.001 Fatal or non-fatal ischaemic stroke 9 4 0.528 0.159–1.751 0.296 Adjusted primary endpoint rates Conclusion The results of this large, nation-wide nested cohort study support the role of bariatric surgery in reducing the risk of major cardiovascular events, all-cause mortality and new onset of heart failure in patients with obesity.

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P5534Causes and predictors of short, intermediate and long-term mortality in patients after PCI

European Heart Journal ◽

10.1093/eurheartj/ehz746.0480 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Zeitouni ◽

N Procopi ◽

M Kerneis ◽

N Hammoudi ◽

E Berman ◽

...

Keyword(s):

Cohort Study ◽

Median Time ◽

Causes Of Death ◽

Cardiovascular Death ◽

Multiple Time ◽

One Year ◽

Long Term Mortality ◽

Overall Mortality

Abstract Background Causes of death after percutaneous coronary intervention (PCI) along multiple time-periods are poorly described. Objective To describe causes and predictors of short-term, intermediate-term, and long-term mortality after PCI. Methods Consecutive men and women admitted for PCI from 2008 to 2011 were prospectively included and followed-up in this cohort study. A dedicated follow-up by independent reviewers was performed to collect the outcomes and adjudicate the causes of death. A log-rank analysis was used to compare the occurrence of cardiovascular and non-cardiovascular death at 30 days, one year and up to 8 years. Last detailed cardiovascular and vital status were collected in January 2019. Results A total of 3524 patients including 2720 men (77.2%) and 804 women (22.8%) were followed-up for a median time of 7.0 years (IQ1: 5.4; IQ 3: 7.2). The rate of complete follow-up was 97.6%. All-cause death occurred for 30.3% (n=1070) of patients in the cohort, in a median time of 2.5 years after PCI, with a rate of 5.3 deaths per 100 patient-years. Overall, mortality was mostly related to cardiovascular causes than non-cardiovascular causes (17.7% versus 12.6%, log-rank <0.001) (Figure). This trend was strong within 30 days (4.7% vs. 0.3%, p<0.0001) and the first year after PCI (3.1% vs. 2.2 p=0.01), but became non-significant beyond one year (9.9% vs. 10.2%, P=0.67). Of note, cancer was the major cause of non-cardiovascular death (5.6%; 1 per 100 patient-years). Diabetes (adHR = 1.48 95% [1.29–1.71], p<0.001), active smoking (adHR = 1.37, 95% [1.16–1.62]) and chronic kidney disease (adHR = 1.97, 95% [2.55–3.45], p<0.001) were the strongest risk factors for all-cause death. Survival after PCI Conclusions In this long-term cohort study, cardiovascular death was more frequent than non-cardiovascular death in patients treated with PCI in the short and intermediate-term but not beyond one year. Cancer accounted for one fifth of the overall mortality.

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Body mass index and clinical outcomes in patients after ischaemic stroke in South Korea: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2018-028880 ◽

2019 ◽

Vol 9 (8) ◽

pp. e028880

Author(s):

HeeKyoung Choi ◽

Hyo Suk Nam ◽

Euna Han

Keyword(s):

Body Mass Index ◽

Cohort Study ◽

Ischaemic Stroke ◽

Mortality Risk ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Normal Weight ◽

All Cause Mortality ◽

Related Mortality

ObjectivesAlthough obesity is a risk factor for stroke, its impact on mortality in patients with stroke remains unclear. In this study, we aimed to evaluate the relationship between body mass index (BMI) and mortality due to ischaemic stroke among adults aged 20 years and above in Korea.DesignRetrospective cohort study.SettingA tertiary-hospital-based stroke registry linked to the death records.Participants3599 patients admitted for ischaemic stroke from January 2007 to June 2013.Outcome measuresThe HRs for all-cause and stroke-related mortality were calculated using Cox proportional hazards models. Progression from stroke-related mortality was assessed using the Fine-Grey competing risk model, treating other-cause mortality as a competing risk. Adjustments were made for age, gender, smoking status, Charlson comorbidity index, cardiovascular or non-cardiovascular comorbidities, stroke severity, severity related to other medical conditions, complications and enrolment year. We repeated the analysis with stratification based on age groups (less than 65 vs 65 years and above).ResultsFor stroke-related mortality, there was no significant difference among the four BMI groups. The risk of all-cause mortality was 36% higher in the underweight group than in the normal weight group (long-term HR=1.36, 95% CI: 1.04 to 1.79), whereas the mortality risk of the obese group was significantly lower (HR=0.66, 95% CI: 0.54 to 0.81). Although this relationship was not estimated in the younger group, it was found that obesity had a protective effect on the all-cause mortality in the elderly (long-term HR=0.66, 95% CI: 0.52 to 0.83).ConclusionsObesity is more likely to reduce mortality risk than normal weight, especially in elderly patients.

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The Longer the Antithyroid Drug Is Used, the Lower the Relapse Rate in Graves' Disease: a Retrospective Multicenter Cohort Study in Korea

10.21203/rs.3.rs-316290/v1 ◽

2021 ◽

Author(s):

So Young Park ◽

Bo Hyun Kim ◽

Mijin Kim ◽

A Ram Hong ◽

Jun Park ◽

...

Keyword(s):

Cohort Study ◽

Relapse Rate ◽

Treatment Duration ◽

Cox Regression ◽

Antithyroid Drug ◽

Graves Disease ◽

Multicenter Cohort Study ◽

Cox Regression Analysis ◽

One Year

Abstract Purpose: Current literature suggests 12 to 18 months of antithyroid drug (ATD) treatment for patients with Graves’ disease, but the risk of relapse is high. Although some studies reported better outcomes of long-term ATD treatment, recent data that suggest the optimal treatment duration are limited.Methods: We performed a multicenter retrospective cohort study of 908 patients newly diagnosed with Graves’ disease between 2006 and 2013. The relapse rate according to ATD treatment duration was analyzed.Results: After initial ATD treatment, 338 patients (37.2%) had relapsed. The relapse rate according to ATD treatment duration was 42.4% at one year, 38.5% at two years, 33.8% at three years, 31.7% at four years, 30.2% at five years, 27.8% at six years, and 19.1% at more than six years, respectively, demonstrating a significant decreasing trend (P = 0.003). In a multivariable Cox regression analysis, ATD treatment duration was an independent risk factor for relapse (P = 0.043).Conclusions: The longer that ATD therapy is used, the lower the relapse rate is in patients with Graves' disease. Long-term ATD treatment may be considered in Graves’ patients who do not show complications or an economic burden from hyperthyroidism.

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