Risk Factors Associated With Outcomes of Non-cardioembolic Ischemic Stroke In Patients Stratified By Essen Stroke Risk Score

2020 ◽  
Author(s):  
Yanting Ping Ping ◽  
Qianqian Yang Yang ◽  
Yuwen Huang Huang ◽  
Huimin Xu Xu ◽  
Haibin Dai
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Risk Score ◽  
Protective Factor ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Vascular Events ◽  
Stroke Outcomes

Abstract Background: Identifying risk factors of cardiovascular events is crucial for stroke prevention and they can be used as predictive factors of stroke outcomes.In this study, it is to evaluate the risk factors that predict outcomes of acute non-cardioembolic ischemic stroke in patients stratified by Essen Stroke Risk Score (ESRS). Methods: A retrospective study was carried out in acute non-cardioembolic ischemic stroke patients in a Chinese tertiary-care teaching hospital. ESRS stratification and factors that might influence the outcomes of stroke, as indicated by fatal or non-fatal combined vascular events of recurrent stroke, myocardial infarction, or primary intracranial hemorrhage, were documented. Univariate analysis and multivariable regression analysis was used to identify independent predictors of stroke outcomes. Results: A total of 878 patients with acute non-cardioembolic ischemic stroke who completed a mean follow-up of 5.2 years were enrolled, and 163 patients experienced at least one component of the combined vascular event. In patients with an ESRS ≤ 3, age ≥ 65 years (OR , 2.935; 95% CI 1.625-5.301, P < 0.001) and clopidogrel treatment (OR , 1.685 ; 95% CI , 1.026-2.768; P = 0.041) were significantly associated with stroke outcomes. In patients with an ESRS > 3, age ≥ 65 years (OR , 2.107, 95% CI , 1.208-3.673 ; P = 0.008) and history of diabetes (OR , 1.465 ; 95% CI , 1.041–2.062 ; P = 0.027) were risk factors for stroke outcomes , whereas clopidogrel treatment (OR , 0.542; 95% CI , 0.356–0.824; P = 0.003) was a protective factor for stroke outcomes. Conclusions: According to this study, clopidogrel treatment, blood pressure control, and glycemic control are protective factors for stroke outcomes in high-risk patients (ESRS>3).

scholarly journals Risk of recurrent stroke and antiplatelet choice in breakthrough stroke while on aspirin

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Joon-Tae Kim ◽  
Beom Joon Kim ◽  
Jong-Moo Park ◽  
Soo Joo Lee ◽  
Jae-Kwan Cha ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Risk Score ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Vascular Events ◽  
Factors Associated ◽  
Increased Risk ◽  
Potential Factors ◽  
Predictive Risk ◽  
Multicenter Registry

Abstract Uncertainty regarding an optimal antiplatelet regimen still exists in patients with breakthrough acute ischemic stroke (AIS) while on aspirin. This study provides an analysis of a prospective multicenter registry between April 2008 and April 2014. Eligible patients were on aspirin at the time of AIS and treated with antiplatelet regimens (aspirin, clopidogrel, or clopidogrel-aspirin). Potential factors associated with the choice of each antiplatelet regimen were explored and included a predictive risk score for future vascular events, the Essen Stroke Risk Score (ESRS). A total of 2348 patients (age, 69 ± 11 years; male, 57.7%) were analyzed, and 55.3%, 25.3% and 19.4% were treated with clopidogrel-aspirin, aspirin and clopidogrel, respectively. While the likelihood of choosing clopidogrel-aspirin increased as the ESRS increased, the likelihood of choosing aspirin decreased as the ESRS increased (Ptrend < 0.001). The ESRS category (0–1/2–3/ ≥ 4) modified the effect of antiplatelet regimens for 1-year vascular events (Pinteraction < 0.01). Among patients with ESRS ≥ 4, clopidogrel-aspirin (HR 0.47 [0.30–0.74]) and clopidogrel (HR 0.30 [0.15–0.60]) significantly reduced the risk of outcome events. Our study showed that more than half of the patients with aspirin failure were treated with clopidogrel-aspirin. In particular, a higher ESRS, which indicates an increased risk of recurrent stroke, was associated with the choice of clopidogrel-aspirin rather than aspirin.

scholarly journals Validation of the Essen Stroke Risk Score and the Stroke Prognosis Instrument II in Chinese Patients

Stroke ◽  
2011 ◽  
Vol 42 (12) ◽  
pp. 3619-3620 ◽  
Author(s):  
Xia Meng ◽  
Yilong Wang ◽  
Xingquan Zhao ◽  
Chunxue Wang ◽  
Hao Li ◽  
...  
Keyword(s):  
Risk Score ◽  
Transient Ischemic Attack ◽  
Stroke Risk ◽  
Predictive Accuracy ◽  
Recurrent Stroke ◽  
Chinese Patients ◽  
Vascular Events ◽  
Ischemic Attack ◽  
Event Rates ◽  
Prognostic Instrument

Background and Purpose— Little was known about the predictive accuracy of the Essen Stroke Risk Score and the Stroke Prognostic Instrument II in Chinese patients with stroke. Methods— We evaluated the predictive accuracy of both Essen Stroke Risk Score and Stroke Prognostic Instrument II scores for both recurrent stroke and combined vascular events using data from a prospective cohort of 11 384 patients with acute ischemic stroke and transient ischemic attack admitted to 132 urban hospitals throughout China. Results— The cumulative 1-year event rates were 16% (95% CI, 15%–16%) for recurrent stroke and 18% (95% CI, 18%–19%) for combined vascular events. Both event rates were significantly higher in patients with transient ischemic attack and increased significantly from lower to higher Essen Stroke Risk Score and Stroke Prognostic Instrument II categories. Essen Stroke Risk Score and Stroke Prognostic Instrument II had similar predictive accuracies for each study outcome. Conclusions— In Chinese patients with ischemic stroke or transient ischemic attack, both Essen Stroke Risk Score and Stroke Prognostic Instrument II scores are equally able to stratify the risk of recurrent stroke and combined vascular events.

scholarly journals A Systematic Literature Review of Patients With Carotid Web and Acute Ischemic Stroke

Stroke ◽  
2018 ◽  
Vol 49 (12) ◽  
pp. 2872-2876 ◽  
Author(s):  
Andrew J. Zhang ◽  
Parth Dhruv ◽  
Philip Choi ◽  
Caitlin Bakker ◽  
Jonathan Koffel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Carotid Revascularization ◽  
Stroke Risk Factors ◽  
Patient Level

Background and Purpose— Carotid web (CW) is a rare form of focal fibromuscular dysplasia defined as an abnormal shelf-like projection of intimal fibrous tissue into the carotid bulb. It is theorized that CW leads to ischemic stroke secondary to blood flow stasis and subsequent embolization. The natural history and optimal management of CW are unclear. To address this knowledge gap, we performed a systematic literature review (SLR) of CW. Methods— Our librarians performed a SLR for CW and related terminology. Patient-level demographics, stroke risk factors, neuroimaging findings, stroke recurrence or stroke free-duration, and treatment modality were extracted. We used descriptive statistics to characterize our results. When specific patient-level metrics were not reported, the denominators for reporting percentage calculations were adjusted accordingly. Results— Our literature search produced 1150 articles. Thirty-seven articles including 158 patients (median age 46 years [range 16–85], 68% women, 76% symptomatic) met entry criteria and were included in our SLR. Of the symptomatic CW patients: 57% did not have stroke risk factors, 56% who received medical therapy had recurrent stroke (median 12 months, range 0–97), and 72% were ultimately treated with carotid revascularization (50% carotid stenting, 50% carotid endarterectomy). There were no periprocedural complications or recurrent strokes in carotid revascularization patients. Conclusions— CW leads to ischemic stroke in younger patients without conventional stroke risk factors. We found a high stroke recurrence rate in medically managed symptomatic CW patients, whereas carotid revascularization effectively prevented recurrent stroke. Our findings should be interpreted with caution because of risk of publication and reporting bias.

Intermediate risk of cardiac events and recurrent stroke after stroke admission in young adults

2017 ◽  
Vol 13 (6) ◽  
pp. 576-584 ◽  
Author(s):  
Peter Jin ◽  
Ivan Matos Diaz ◽  
Laura Stein ◽  
Alison Thaler ◽  
Stanley Tuhrim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Ischemic Stroke ◽  
Cardiovascular Events ◽  
Recurrent Stroke ◽  
Intermediate Risk ◽  
Cardiac Events ◽  
Vascular Events ◽  
Increased Risk ◽  
Index Stroke

Background In older adults with stroke, there is an increased risk of cardiovascular events in the intermediate period, up to one year after stroke. The risk of cardiovascular events in this period in young adults after stroke has not been studied. We hypothesized that in the intermediate risk period, young adults with ischemic stroke have an increased risk of recurrent stroke and a smaller increase of cardiac events. Methods Using the National Readmissions Database during the year 2013, we identified ischemic stroke admissions among those aged 18–45 years using International Classification of Disease, Ninth Revision, Clinical Modification codes to identify index vascular events and risk factors. Primary outcomes were readmission for cardiac events and stroke. Multivariable Cox proportional hazard models and Kaplan–Meier analysis were used to estimate risk of primary outcomes. Results We identified 12,392 young adults with index stroke. The readmission rate due to recurrent stroke was higher than for cardiac events (2913.3.1 vs. 1132.4 per 100,000 index hospitalizations at 90 days). There was a higher cumulative risk of both cardiac events and recurrent stroke in the presence of baseline diabetes and hypercholesterolemia. Conclusion In a large, nationally representative database, the intermediate risk of recurrent stroke after index stroke in young adults was higher than the risk of cardiac events. The presence of vascular risk factors augmented this risk but did not entirely account for it. The aggressive control of hypercholesterolemia and diabetes may play an important role in secondary prevention in young adults with stroke.

scholarly journals Sex differences in the risk of recurrent ischemic stroke after ischemic stroke and transient ischemic attack

2021 ◽  
pp. 239698732110585
Author(s):  
Elora Basu ◽  
Setareh Salehi Omran ◽  
Hooman Kamel ◽  
Neal S Parikh
Keyword(s):  
Risk Factors ◽  
Sex Differences ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Minor Stroke ◽  
Stroke Recurrence ◽  
Stroke Risk Factors ◽  
Minor Ischemic Stroke ◽  
Using Data

Background Sex differences in stroke outcomes have been noted, but whether this extends to stroke recurrence is unclear. We examined sex differences in recurrent stroke using data from the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial. Patients and methods We assessed the risk of recurrent stroke in women compared to men using data from the POINT trial. Adults >18 years old were randomized within 12 hours of onset of minor ischemic stroke or transient ischemic attack (TIA), and followed for up to 90 days for ischemic stroke, our primary outcome. We used Cox proportional hazards model adjusted for demographics and stroke risk factors to evaluate the association between sex and stroke recurrence. We used interaction term testing and prespecified subgroup analyses to determine if the association between sex and recurrent stroke differed by age (<60 versus >60 years old), locale (US versus non-US), and index event type (stroke versus TIA). Last, we evaluated whether sex modified the effect of common stroke risk factors on stroke recurrence. Results Of 4,881 POINT trial participants with minor stroke or high-risk TIA, 2,195 (45%) were women. During the 90-day follow-up period, 267 ischemic strokes occurred; 121 were in women and 146 in men. The cumulative risk of recurrent ischemic stroke was not significantly different among women (5.76%; 95% CI, 4.84%–6.85%) compared to men (5.67%; 95% CI, 4.83%–6.63%). Women were not at a different risk of recurrent ischemic stroke compared to men (hazard ratio [HR], 1.02; 95% CI, 0.80–1.30) in unadjusted models or after adjusting for covariates. However, there was a significant interaction of age with sex (P=0.04). Among patients <60 years old, there was a non-significantly lower risk of recurrent stroke in women compared to men (HR 0.66; 95% CI 0.42–1.05). Last, sex did not modify the association between common stroke risk factors and recurrent stroke risk. Discussion and Conclusion Among patients with minor stroke or TIA, the risk of recurrent ischemic stroke and the impact of common stroke risk factors did not differ between men and women.

scholarly journals Stroke Prevention: Managing Modifiable Risk Factors

2012 ◽  
Vol 2012 ◽  
pp. 1-15 ◽  
Author(s):  
Silvia Di Legge ◽  
Giacomo Koch ◽  
Marina Diomedi ◽  
Paolo Stanzione ◽  
Fabrizio Sallustio
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Stroke Prevention ◽  
Recurrent Stroke ◽  
Lifestyle Changes ◽  
Thrombin Inhibitors ◽  
Modifiable Risk Factors ◽  
Vascular Events

Prevention plays a crucial role in counteracting morbidity and mortality related to ischemic stroke. It has been estimated that 50% of stroke are preventable through control of modifiable risk factors and lifestyle changes. Antihypertensive treatment is recommended for both prevention of recurrent stroke and other vascular events. The use of antiplatelets and statins has been shown to reduce the risk of recurrent stroke and other vascular events. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are indicated in stroke prevention because they also promote vascular health. Effective secondary-prevention strategies for selected patients include carotid revascularization for high-grade carotid stenosis and vitamin K antagonist treatment for atrial fibrillation. The results of recent clinical trials investigating new anticoagulants (factor Xa inhibitors and direct thrombin inhibitors) clearly indicate alternative strategies in stroke prevention for patients with atrial fibrillation. This paper describes the current landscape and developments in stroke prevention with special reference to medical treatment in secondary prevention of ischemic stroke.

scholarly journals Validation of the ability of ESER score to predict recurrent stroke: a meta-analysis

2021 ◽  
Author(s):  
chengju liao ◽  
zhe luo ◽  
ying ru ◽  
jian yang ◽  
chenghong luo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Intervals ◽  
Risk Score ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Risk Groups ◽  
Low Risk ◽  
Risk Stratification Model ◽  
One Year

IntroductionA risk stratification model is pretty important to prevent the recurrent stroke for ischemic stroke patients. The present study aimed to meta-analysis the ability of Essen Stroke Risk Score (ESRS) to accurately predict recurrence of ischemic stroke.Material and methodsStudies on the diagnostic performance of Essen Stroke Risk Score in predicting recurrent stroke were searched by electronic and manual methods. Quality pooled C-statistics, and 95% confidence intervals (95% CI) were evaluated.ResultsFifteen studies with a total of 94,052 patients were included in the meta-analysis. The pooled C-statistics of ESER for patients without atrial fibrillation (AF) experiencing recurring strokes at 90-day or one-year were 0.65 (95% CI: 0.58-0.73) and 0.57 (95% CI: 0.53-0.60), and the heterogeneity was weak. The average ratio of one-year recurrent stroke in the low-risk and high-risk groups classified according to ESRS is 5.6%(range 1.4 to 12.1%) and 9.2%( range 3.2 to 20.1%), respectively. And the calibration analysis showed the pooled RR in the low-risk group is 0.88 (95%CI: 0.24-3.19) and 0.88 (0.24-3.31) with wide confidence intervals and high levels of heterogeneity, indicating the calibration ability was low.ConclusionsESRS had low to moderate ability to predict recurrence of stroke in patients with ischemic stroke and low calibration ability, which need to be further improved.

scholarly journals Coagulation factor XII, XI, and VIII activity levels and secondary events after first ischemic stroke

2019 ◽  
Author(s):  
Jessica L. Rohmann ◽  
Shufan Huo ◽  
Pia S. Sperber ◽  
Sophie K. Piper ◽  
Frits R. Rosendaal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Coagulation Factor ◽  
Cox Proportional Hazards ◽  
Factor Xii ◽  
Activity Levels ◽  
Continuous Variables ◽  
Vascular Events ◽  
Increased Risk

AbstractBackground and PurposeThough risk for recurrent vascular events is high following ischemic stroke, little is known about risk factors for secondary events post-stroke. The coagulation factors XII, XI, and VII (FXII, FXI, and FVIII) have already been implicated in first thrombotic events, and our aim was to estimate their effects on vascular outcomes within 3 years after first stroke.MethodsIn the PROSpective Cohort with Incident Stroke Berlin (PROSCIS-B) study, we followed participants aged 18 and older for three years after first mild to moderate ischemic stroke event or until occurrence of recurrent stroke, myocardial infarction or all-cause mortality (combined endpoint). High coagulation factor activity levels were compared to normal and low levels, and activities were also analyzed as continuous variables. We used Cox proportional hazards models adjusted for age, sex, and cardiovascular risk factors to estimate hazard ratios (HRs) for the combined endpoint.ResultsIn total, 92 events occurred in 570 included participants, resulting in an absolute rate of 6.6 events per 100 person-years. After confounding adjustment, high FVIII activity showed the strongest relationship with the combined endpoint (HR=2.05, 95%CI 1.28-3.29). High FXI activity was also associated with an increased risk (HR=1.80, 95%CI 1.09-2.98). Contrarily, high FXII activity was not associated with the combined endpoint (HR=0.86, 95%CI 0.49-1.51). Continuous analyses per standard deviation of each biomarker yielded similar results.ConclusionsIn our study of mild to moderate ischemic stroke patients, high activity levels of FXI and FVIII but not FXII were associated with worse vascular outcomes in the three-year period after first ischemic stroke. This is of special interest in light of the ongoing trials of antithrombotic treatments targeting FXI.

Abstract WMP117: Migraine With Aura as a Risk for Ischemic Stroke (MARS) Risk Score

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Tushar Trivedi ◽  
Alexandra Vezzetti ◽  
Petr Melikov ◽  
Alvaro Alonso ◽  
Lin Yee Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
High Risk ◽  
Migraine With Aura ◽  
Risk Score ◽  
Stroke Risk ◽  
Regression Coefficient ◽  
Low Risk ◽  
Independent Population ◽  
History Of

Introduction: Migraine with visual aura is associated with an increased risk of ischemic stroke. We developed a model to predict the risk of ischemic stroke in patients with migraine with aura. Methods: We prospectively evaluated 429 participants from Atherosclerosis Risk in Communities Cohort (ARIC) with a history of migraine with aura. The association of potential risk factors with ischemic stroke was tested by Cox proportional-hazards analysis and a risk score was created. Assignment of points to risk factors was based on a linear transformation of the corresponding β regression coefficient. The coefficient of each variable was divided by 0.18 (the lowest β value in the model, corresponding to Female Gender). Results: Among the 429 participants with a history of migraine with aura at baseline, 31 developed ischemic stroke during a mean follow-up of 20-years. Five independent prognostic factors were identified, and each was assigned a number of points proportional to its regression coefficient: Diabetes Mellitus (7 points), age > 65 years (5 points), heart rate variability (defined as the standard deviation of all normal-to-normal RR intervals) (3 points), hypertension (3 points), and gender (1 point). We calculated risk scores for each patient and defined three risk groups: low risk (0 to 4 points), moderate risk (5 to 10 points), and high risk (11 to 21 points). Hazards ratio for ischemic stroke in high risk (vs. low risk) group was 7.35 (p= 0. 003). Kaplan Meier curves showed significant discrimination of stroke risk among the risk stratification groups (p < 0.001, see Figure). Conclusions: Simple risk score was developed to predict stroke risk in those with migraine with aura. These findings can be useful to clinicians for predicting stroke risk in migraineurs and directing preventive therapy. Validation of MARS in an independent population cohort is warranted.

scholarly journals Antithrombotic selection and risk factor management in ischemic stroke and transient ischemic attack

2014 ◽  
Vol 36 (1) ◽  
pp. E10 ◽  
Author(s):  
Brian S. Katz ◽  
Kelly D. Flemming
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Management Options ◽  
Risk Factor Management ◽  
Stroke Risk Factors ◽  
Ischemic Stroke Risk ◽  
Ischemic Attack ◽  
Selection Of

In addition to appropriate antithrombotic therapy, the identification and treatment of modifiable ischemic stroke risk factors can reduce the likelihood of recurrent stroke. Neurosurgeons should be knowledgeable of the specific risk factors and general recommendations for ischemic stroke, as they may play a significant role in the management options for patients with intracranial and extracranial atherosclerotic disease. The authors of this article review the indications for and selection of antithrombotics in patients with cerebral ischemia. In addition, the identification and secondary prevention of select risk factors are discussed.

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