HbA1c is associated with increased all-cause mortality in the first year after acute ischemic stroke

2014 ◽  
Vol 36 (5) ◽  
pp. 444-452 ◽  
Author(s):  
Shuolin Wu ◽  
Chunxue Wang ◽  
Qian Jia ◽  
Gaifen Liu ◽  
Kolin Hoff ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
First Year ◽  
All Cause Mortality

Abstract TP251: Onset-to-Door Times and Means of Transportation for Acute Ischemic Stroke Patients Attending a Public Hospital in Bogota DC, Colombia. Is an Ambulance the Fastest Way to Reach the Hospital?

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Javier Vicini-Parra ◽  
Jenny Ospina ◽  
Cristian Correa ◽  
Natalia Gomez ◽  
Stephania Bohorquez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Public Transportation ◽  
Public Hospital ◽  
Descriptive Analysis ◽  
First Year ◽  
Stroke Patients ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Ischemic Attack

Introduction: A prospective stroke database was implemented as part of a still-growing comprehensive stroke centre (CSC). This CSC is located within a referral public hospital (Hospital Occidente de Kennedy) in Bogota DC, Colombia , that serves 2.3 million people of mainly low economic income. In this abstract, we present the data pertaining patients who were thrombolysed in our institution during the first year of data collection, and specify onset-to-door (OTD) times as they relate to the means of transportation used. Hypothesis: Acute stroke patients who arrive in ambulance have the shortest onset-to-door times. Methods: Printed forms were filled for every patient who arrived with diagnosis of acute ischemic stroke (AIS) or transient ischemic attack (TIA). Data was transcribed to an electronic database (Numbers, Apple Inc.) and analyzed with SPSS Statistics version 23 (IBM Corporation). A retrospective descriptive analysis was performed for central tendency and dispersion measures. Results: Since August 1st 2014 until July 31st 2015, 39 patients (17.7% of AIS patients) were thrombolysed. Mean onset-to-door times are shown in table 1. Prenotification was received for only 1 patient. All patients came from their homes. Conclusions: Almost half of our thrombolysed patients arrived in taxi to our institution. Taxi was the fastest means of transportation, ambulance was the slowest and private cars were in the middle of those. This confirmed our suspicion that the state-owned emergency medical services (SEMD) are suboptimal and that stroke patients prefer to use public transportation rather than SEMD. This should warn public health authorities on he urgent need to improve our SEMD. In the meantime, this finding prompts us to include taxi drivers in our periodic stroke campaigns.

Abstract 115: Improving Door-to-Needle Times in Acute Ischemic Stroke: Interim Findings From Target: Stroke Phase II

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Gregg C Fonarow ◽  
Margueritte Cox ◽  
Eric E Smith ◽  
Jeffrey L Saver ◽  
Mathew J Reeves ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Phase I ◽  
Acute Ischemic Stroke ◽  
Phase Ii ◽  
Best Practice ◽  
Patient Characteristics ◽  
Clinical Decision ◽  
Absolute Difference ◽  
First Year ◽  
Rate Of Increase

Background: The benefits of intravenous tPA in acute ischemic stroke are time-dependent with guidelines recommending a door-to-needle (DTN) time of ≤60 minutes. The implementation of Target: Stroke Phase I in 2010 was associated with an increase in the proportion of patients with DTN times ≤60 minutes in the US from 28.9% in 2009 to 51.0% in 2013. This study aims to assess whether these improvements in DTN times could be maintained or further improved since the launch of Target: Stroke Phase II in Q2 2014. Methods: Target: Stroke Phase II identified and disseminated additional best practice strategies, provided updated clinical decision support tools, and set new hospital recognition goals. Rates of DTN times ≤60 minutes were compared during final 4 quarters of Phase I (Q4 2012-Q3 2013) vs. Phase II (Q2 2014-Q1 2015) and overall by linear weighted regression. Results: There were 99,176 intravenous tPA treated patients from 1228 GWTG-Stroke hospitals. Patient characteristics were similar during Phase I and II. Median DTN time significantly declined from the last 4 quarters of Phase I to the first 4 quarters of Phase II: 61 minutes (IQR 47-81) to 57 minutes (IQR 43-74) (P<0.0001). The % of patients with DTN times ≤60 minutes increased from last 4 quarters of Phase I to Phase II: 49.7% to 58.5%, absolute difference +8.8%, (P<0.0001). The % of patients with DTN times ≤45 minutes also increased from Phase I to Phase II: 22.0% to 29.2%, absolute difference +7.2%, (P<0.0001). The estimated annual rate of increase in patients with DTN times ≤60 minutes was 0.6% per year pre-Target Stroke, 5.6% per year during Phase I, and 8.6% in the first year of Phase II (P<0.0001) (Figure). Conclusions: The timeliness of tPA administration is continuing to improve in GWTG-Stroke hospitals participating in Target: Stroke Phase II. Nevertheless, ongoing quality improvement efforts will be required to meet the goals of ≥75% of patients with DTN times ≤60 minutes and ≥50% of patients with DTN times ≤ 45 minutes.

scholarly journals High Incidence of Arterial and Venous Thrombosis in Antineutrophil Cytoplasmic Antibody–associated Vasculitis

2018 ◽  
Vol 46 (3) ◽  
pp. 285-293 ◽  
Author(s):  
Amy Kang ◽  
Marilina Antonelou ◽  
Nikki L. Wong ◽  
Anisha Tanna ◽  
Nishkantha Arulkumaran ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Venous Thrombosis ◽  
Independent Predictor ◽  
Antineutrophil Cytoplasmic Antibody ◽  
First Year ◽  
High Incidence ◽  
All Cause Mortality ◽  
Coronary Events ◽  
The Uk ◽  
Event Rates

Objective.To determine the incidence of arterial thrombotic events (ATE) and venous thromboembolism (VTE) in antineutrophil cytoplasmic antibody–associated vasculitis (AAV).Methods.This is a retrospective cohort study presenting the incidence of ATE (coronary events or ischemic stroke) and VTE [pulmonary embolism (PE) or deep venous thrombosis (DVT)] in patients diagnosed with AAV between 2005 and 2014.Results.There were 204 patients with AAV who were identified. Median followup for surviving patients was 5.8 (range 1–10) years, accounting for 1088 person-years (PY). The incidence of ATE was 2.67/100 PY (1.56 for coronary events and 1.10 for ischemic stroke) and for VTE was 1.47/100 PY (0.83 for DVT only and 0.64 for PE with/without DVT). On multivariate analysis, prior ischemic heart disease (IHD) and advancing age were the only independent predictors of ATE. Among patients without prior IHD or stroke, the incidence of ATE remained elevated at 2.32/100 PY (1.26 for coronary events and 1.06 for ischemic stroke). ATE, but not VTE, was an independent predictor of all-cause mortality. Event rates for both ATE and VTE were highest in the first year after diagnosis of AAV but remained above the population incidence during the 10-year followup period. In comparison to reported rates for the UK population, the event rates in our AAV patients were 15-times higher for coronary events, 11-times higher for incident stroke, and 20-times higher for VTE.Conclusion.Patients with AAV have a high incidence of arterial and venous thrombosis, particularly in the first year after diagnosis.

scholarly journals Outcome of Patients with Acute Ischemic Stroke in the First Year after the Establishment of a Stroke Care Unit

2008 ◽  
Vol 4 (2) ◽  
pp. 96-105
Author(s):  
Yuichi Komaba ◽  
Nobuto Nakajima ◽  
Kouichi Nomura ◽  
Genki Mizukoshi ◽  
Eiko Sunami ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Care ◽  
First Year

Abstract 5: Do Stroke Centers Reduce Mortality for Patients with Acute Ischemic Stroke? An Instrumental Variable Analysis

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Ying Xian ◽  
Robert G Holloway ◽  
Katia Noyes ◽  
Manish N Shah ◽  
Bruce Friedman
Keyword(s):  
New York ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
New York State ◽  
Selection Effect ◽  
Stroke Care ◽  
Instrumental Variable Analysis ◽  
All Cause Mortality ◽  
Stroke Center

Background: Although the establishment of stroke centers based on the Brain Attack Coalition recommendations has great potential to improve quality of stroke care, little is known about whether stroke centers improve health outcomes such as mortality. Methods: Using 2005-2006 New York State Statewide Planning and Research Cooperative System data, we identified 32,783 hospitalized patients age 18+ with a principal diagnosis of acute ischemic stroke (ICD-9 433.x1, 434.x1 and 436). We compared in-hospital mortality and up to one year all-cause mortality between New York State Designated Stroke Centers and non-stroke center hospitals. Because patients were not randomly assigned to hospitals, stroke centers might treat different types of patients than other hospitals (a selection effect). We used a “natural randomization” approach, instrumental variable analysis (differential distance was the instrument), to control for this selection effect. To determine whether the mortality difference was specific to stroke care, we repeated the analysis using a different group of patients with gastrointestinal (GI) hemorrhage (N=53,077). Results: Of the 32,783 stroke patients, nearly 50% (16,258) were admitted to stroke centers. Stroke centers had lower unadjusted in-hospital mortality and 30-, 90-, 180-, and 365-day all-cause mortality than non-stroke centers (7.0% vs. 7.8%, 10.0% vs. 12.6%, 14.6% vs. 17.5%, 18.0% vs. 21.0%, 22.4% vs. 26.2%, respectively). After adjusting for patient and hospital characteristics, comorbidities, and the patient selection effect, stroke centers were associated with significantly lower all-cause mortality. The adjusted differences were -2.6%, -2.7%, -1.8%, and -2.3% for 30-, 90-, 180- and 365-day mortality (all p<0.05). The adjusted difference in in-hospital mortality was -0.8% but was not statistically significant. In a specificity analysis of patients with GI hemorrhage, stroke centers had slightly higher mortality. Conclusions: Hospitals that are Designated Stroke Centers had lower mortality for acute ischemic stroke than non-stroke center hospitals. The mortality benefit was specific to stroke and was not observed for GI hemorrhage. Providing stroke centers nationwide has the potential to reduce mortality.

Abstract 19892: Association Between Estimated-glomerular Filtration Rate and Clinical Outcomes at One Year After Acute Ischemic Stroke

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
xiaoqing bu ◽  
Yonghong Zhang ◽  
Tan Xu ◽  
Hao Peng ◽  
Jing Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Recurrent Stroke ◽  
Vascular Events ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
The Relationship

Introduction: The relationship between estimated-glomerular filtration rate (eGFR) and acute ischemic stroke outcomes remains controversial. Hypothesis: We aimed to evaluate the impact of eGFR on all-cause mortality, recurrent stroke, and vascular events in patients with acute ischemic stroke. Methods: 4036 patients with acute ischemic stroke recruited from 26 hospitals across China from August 2009 to May 2013 were included in our study. GFR was estimated by CKD-EPI equations based on serum creatinine and/or cystatin C (CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys). The Cox proportional hazards models were used to examine the relationship between declined eGFR and 1-year all-cause mortality, recurrent stroke, and vascular events. Declined eGFR was defined as <60 mL/min /1.73 m2. Results: Declined eGFR was present in 7.22% (n=281) of patients based on the CKD-EPIcr equation, 3.43% (n=119) based on the CKD-EPIcys equation, and 5.67% (n=170) based on the CKD-EPIcr-cys equation. Compared to patients with an eGFR ≥90 mL/min /1.73 m2, adjusted hazard ratios (95% confidence interval) for all-cause mortality associated with eGFR<60 mL/min /1.73 m2 were 1.68 (1.06 to 2.66, p=0.026), 2.29 (1.29 to 4.06, p=0.005), and 1.79 (1.08 to 2.98, p=0.024) using CKD-EPIcr, CKD-EPIcys, and CKD-EPIcr-cys equations, respectively. For recurrent stroke, adjusted hazard ratios (95% confidence interval) were 0.90 (0.49 to 1.66, p=0.743), 0.60 (0.19 to 1.93, p=0.393), and 0.89 (0.40 to 1.95, p=0.762), respectively. For vascular events, adjusted hazard ratios (95% confidence interval) were 1.33 (0.81 to 2.19, p=0.266), 1.07 (0.46 to 2.47, p=0.880), and 1.31 (0.70 to 2.43, p=0.403), respectively. Conclusion: Our study indicates that declined eGFR is a strong independent risk factor for total mortality among patients with acute ischemic stroke. However, there is no association between low eGFR and recurrent stroke or vascular events among patients with acute ischemic stroke. In addition, the association of eGFR with all-cause mortality among patients with acute ischemic stroke is stronger when eGFR was calculated based on the CKD-EPIcys equation compared to CKD-EPIcr and CKD-EPIcr-cys equations.

scholarly journals C-reactive protein for predicting all-cause mortality in patients with acute ischemic stroke: a meta-analysis

2019 ◽  
Vol 39 (2) ◽  
Author(s):  
Bo Yu ◽  
Ping Yang ◽  
Xuebi Xu ◽  
Lufei Shao
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Observational Studies ◽  
Meta Analysis ◽  
C Reactive Protein ◽  
Stroke Patients ◽  
Reactive Protein ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Unit Increase

Abstract Studies on the association of C-reactive protein (CRP) with all-cause mortality in acute ischemic stroke patients have yielded conflicting results. The objective of this meta-analysis was to evaluate the prognostic value of CRP elevation in predicting all-cause mortality amongst patients with acute ischemic stroke. We searched the original observational studies that evaluated the association of CRP elevation with all-cause mortality in patients with acute ischemic stroke using PubMed and Embase databases until 20 January 2018. Pooled multivariate-adjusted hazard ratio (HR) with 95% confidence intervals (CI) of all-cause mortality was obtained for the highest compared with the lowest CRP level or per unit increment CRP level. A total of 3604 patients with acute ischemic stroke from eight studies were identified. Acute ischemic stroke patients with the highest CRP level were independently associated with an increased risk of all-cause mortality (HR: 2.07; 95% CI: 1.60–2.68) compared with the lowest CRP category. The pooled HR of all-cause mortality was 2.40 (95% CI: 1.10–5.21) for per unit increase in log-transformed CRP. Elevated circulating CRP level is associated with the increased risk of all-cause mortality in acute ischemic stroke patients. This meta-analysis supports the routine use of CRP for the death risk stratification in such patients.

scholarly journals Cardiac troponin for predicting all-cause mortality in patients with acute ischemic stroke: a meta-analysis

2018 ◽  
Vol 38 (2) ◽  
Author(s):  
Yu Fan ◽  
Menglin Jiang ◽  
Dandan Gong ◽  
Changfeng Man ◽  
Yuehua Chen
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mortality Risk ◽  
Cardiac Troponin ◽  
Prognostic Value ◽  
Meta Analysis ◽  
Stroke Patients ◽  
Troponin Elevation ◽  
Increased Risk ◽  
All Cause Mortality

Cardiac troponins are specific biomarkers of cardiac injury. However, the prognostic usefulness of cardiac troponin in patients with acute ischemic stroke is still controversial. The objective of this meta-analysis was to investigate the association of cardiac troponin elevation with all-cause mortality in patients with acute ischemic stroke. PubMed and Embase databases were searched for relevant studies up to April 31, 2017. All observational studies reporting an association of baseline cardiac troponin-T (cTnT) or troponin-I (cTnI) elevation with all-cause mortality risk in patients with acute ischemic stroke were included. Pooled adjusted risk ratio (RR) and corresponding 95% confidence interval (CI) were obtained using a random effect model. Twelve studies involving 7905 acute ischemic stroke patients met our inclusion criteria. From the overall pooled analysis, patients with elevated cardiac troponin were significantly associated with increased risk of all-cause mortality (RR: 2.53; 95% CI: 1.83–3.50). The prognostic value of cardiac troponin elevation on all-cause mortality risk was stronger (RR: 3.54; 95% CI: 2.09–5.98) during in-hospital stay. Further stratified analysis showed elevated cTnT (RR: 2.36; 95% CI: 1.47–3.77) and cTnI (RR: 2.79; 95% CI: 1.68–4.64) level conferred the similar prognostic value of all-cause mortality. Acute ischemic stroke patients with elevated cTnT or cTnI at baseline independently predicted an increased risk of all-cause mortality. Determination of cardiac troponin on admission may aid in the early death risk stratification in these patients.

scholarly journals Five‐Year Risk of Acute Myocardial Infarction After Acute Ischemic Stroke in Korea

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Keon‐Joo Lee ◽  
Seong‐Eun Kim ◽  
Jun Yup Kim ◽  
Jihoon Kang ◽  
Beom Joon Kim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cumulative Incidence ◽  
Multivariable Analysis ◽  
First Year ◽  
Vessel Occlusion ◽  
History Of ◽  
Annual Risk

Background The long‐term incidence of acute myocardial infarction (AMI) in patients with acute ischemic stroke (AIS) has not been well defined in large cohort studies of various race‐ethnic groups. Methods and Results A prospective cohort of patients with AIS who were registered in a multicenter nationwide stroke registry (CRCS‐K [Clinical Research Collaboration for Stroke in Korea] registry) was followed up for the occurrence of AMI through a linkage with the National Health Insurance Service claims database. The 5‐year cumulative incidence and annual risk were estimated according to predefined demographic subgroups, stroke subtypes, a history of coronary heart disease (CHD), and known risk factors of CHD. A total of 11 720 patients with AIS were studied. The 5‐year cumulative incidence of AMI was 2.0%. The annual risk was highest in the first year after the index event (1.1%), followed by a much lower annual risk in the second to fifth years (between 0.16% and 0.27%). Among subgroups, annual risk in the first year was highest in those with a history of CHD (4.1%) compared with those without a history of CHD (0.8%). The small‐vessel occlusion subtype had a much lower incidence (0.8%) compared with large‐vessel occlusion (2.2%) or cardioembolism (2.4%) subtypes. In the multivariable analysis, history of CHD (hazard ratio, 2.84; 95% CI, 2.01–3.93) was the strongest independent predictor of AMI after AIS. Conclusions The incidence of AMI after AIS in South Korea was relatively low and unexpectedly highest during the first year after stroke. CHD was the most substantial risk factor for AMI after stroke and conferred an approximate 5‐fold greater risk.

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