Association of Stress Hyperglycemia Ratio With Acute Ischemic Stroke Outcomes Post-thrombolysis

Background and Purpose: The association between stress hyperglycemia and clinical outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis (IVT) is uncertain. We sought to analyze the association between the stress hyperglycemia ratio (SHR) using different definitions and clinical outcomes in acute patients with ischemic stroke undergoing IVT.Methods: A total of 341 patients with ischemic stroke receiving IVT were prospectively enrolled in this study. The SHR was evaluated using different equations: SHR1, fasting glucose (mmol/L)/glycated hemoglobin (HbA1c) (%); SHR2, fasting glucose (mmol/L)/[(1.59 × HbA1c)−2.59]; SHR3, admission blood glucose (mmol/L)/[(1.59 × HbA1c)−2.59]. A poor functional outcome was defined as a modified Rankin scale score of 3–6 at 3 months. Multivariate logistic regression analysis was used to identify the relationship between different SHRs and clinical outcomes after IVT.Results: A total of 127 (37.2%) patients presented with poor functional outcomes at 3 months. The predictive value of SHR1 for poor functional outcomes was better than that of SHR2 and SHR3 in receiver operating characteristic analyses. On multivariate analysis, SHR1 [odds ratio (OR) 14.639, 95% CI, 4.075–52.589; P = 0.000] and SHR2 (OR, 19.700; 95% CI; 4.475–86.722; P = 0.000) were independently associated with an increased risk of poor functional outcome but not SHR3.Conclusions: Our study confirmed that the SHR, as measured by SHR1 and SHR2, is independently associated with worse clinical outcomes in patients with ischemic stroke after intravenous thrombolysis. Furthermore, SHR1 has a better predictive performance for outcomes than other SHR definitions.

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Prognostic Value of Neutrophil To Lymphocyte Ratio In Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis: A Meta-Analysis

10.21203/rs.3.rs-189563/v1 ◽

2021 ◽

Author(s):

Chengbing Wang ◽

Qian Zhang ◽

Mingwei Ji ◽

Jing Mang ◽

Zhongxin Xu

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Poor Prognosis ◽

Meta Analysis ◽

Intravenous Thrombolysis ◽

Poor Functional Outcome ◽

Lymphocyte Ratio ◽

Increased Risk ◽

The Relationship

Abstract Background: The neutrophil to lymphocyte ratio (NLR) has been shown to be an important independent inflammatory indicator in stroke. The relationship between NLR and poor prognostics in acute ischemic stroke (AIS) patients who received intravenous thrombolysis (IVT) still unclear. The purpose of this meta-analysis was to evaluate the association between NLR and poor prognosis after IVT. Furthermore, we aim to concluded whether admission NLR or post-IVT NLR play a role in AIS.Methods: Pubmed, Embase, Wed of Science and China National Knowledge Infrastructure were searched for relevant articles until October 7, 2020. Cohort and case-control studies were included if related to NLR in AIS patients treated with IVT. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were pooled to estimate the relationship between NLR and poor prognosis after IVT. A random effects model was used to calculate the pooled data.Results: Twelve studies, including 3641 patients met the predefined inclusion criteria. Higher NLR levels were associated with an increased risk of hemorrhagic transformation (HT) (OR=1.33,95%CI=1.14-1.56, P<0.001) and 3-month poor functional outcome (OR=1.64,95%CI=1.38-1.94, P<0.001) in AIS patients receiving IVT. Subgroup analysis of HT suggested that admission NLR levels rather than post-IVT NLR levels was associated with higher risk of HT (OR=1.33,95%CI=1.01-1.75, P=0.039). But There had no statistically significant difference between higher NLR levels and 3-month mortality (OR=1.14, 95%CI=0.97-1.35, P=0.120).Conclusions: High NLR can predict HT and 3-month poor functional outcome in AIS patients received IVT. Admission NLR rather than post-IVT NLR was independent risk factor of increased risk of HT.

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Meta-analysis of the Smoker’s Paradox in Acute Ischemic Stroke Patients Receiving Intravenous Thrombolysis or Endovascular Treatment

Nicotine & Tobacco Research ◽

10.1093/ntr/ntz094 ◽

2019 ◽

Vol 21 (9) ◽

pp. 1181-1188 ◽

Cited By ~ 1

Author(s):

Peng Zhang ◽

Zhen-Ni Guo ◽

Xin Sun ◽

Yingkai Zhao ◽

Yi Yang

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Functional Outcomes ◽

Meta Analysis ◽

Intravenous Thrombolysis ◽

Cochrane Library ◽

Stroke Patients ◽

Good Functional Outcome

Abstract Introduction The existence of the smoker’s paradox is controversial and potential mechanisms have not been explained. We aimed to explore the association between cigarette smoking and functional outcome at 3 months in patients with acute ischemic stroke who were treated with intravenous thrombolysis (IVT) or endovascular treatment (EVT). Methods This meta-analysis was conducted in accordance with the PRISMA guidelines. Studies exploring the association between smoking and good functional outcome (modified Rankin Scale score ≤ 2) following IVT or EVT were searched via the databases of PubMed, Embase, and the Cochrane Library from inception to August 8, 2018. Information on the characteristics of included studies was independently extracted by two investigators. Data were pooled using a random-effects or fixed-effects meta-analysis according to the heterogeneity of included studies. Results Among 20 identified studies, 15 reported functional outcomes following IVT, and five reported functional outcomes following EVT. Unadjusted analyses showed that smoking increased the odds of good functional outcomes with a pooled odds ratio (OR) of 1.48 (95% confidence interval [CI]: 1.36–1.60) after IVT and 2.10 (95% CI: 1.47–3.20) after EVT. Of IVT studies, only eight reported outcomes adjusted for covariates and none of the EVT studies reported adjusted outcomes. After adjustment, the relation between smoking and good functional outcome following IVT lost statistical significance (OR 1.14 [95% CI: 0.81–1.59]). Conclusion Our meta-analysis suggested that smoking was not associated with good functional outcome (mRS ≤ 2) at 3 months in patients with acute ischemic stroke who were treated with intravenous thrombolysis. Implications The existence of the smoker’s paradox is controversial. A previous letter by Plas et al. published in 2013 reported a positive result for the association between smoking and good functional outcome at 3 months in acute ischemic stroke patients who received intravenous thrombolysis (IVT). However, a major limitation of their meta-analysis was that the process of data synthesis was based on unadjusted data. Therefore, we conducted this meta-analysis to investigate the association based on adjusted data and a larger sample size. Our meta-analysis suggested that smoking was not associated with good functional outcome after adjusting for covariates.

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Pre-Stroke Glycemic Variability Estimated by Glycated Albumin Is Associated with Early Neurological Deterioration and Poor Functional Outcome in Prediabetic Patients with Acute Ischemic Stroke

Cerebrovascular Diseases ◽

10.1159/000511938 ◽

2020 ◽

pp. 1-8

Author(s):

Sang-Hwa Lee ◽

Yerim Kim ◽

So Young Park ◽

Chulho Kim ◽

Yeo Jin Kim ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Status ◽

Functional Outcome ◽

Functional Outcomes ◽

Glycated Albumin ◽

Glycemic Variability ◽

Poor Functional Outcome ◽

Early Neurological Deterioration ◽

Poor Functional Status

Introduction: Whether glycemic variability prior to stroke increases the risk of stroke outcomes in prediabetic patients presenting with acute ischemic stroke is still unclear. We evaluated whether pre-stroke glycemic variability, estimated by glycated albumin (GA), increased early neurological deterioration (END) and functional outcomes in prediabetic patients with acute ischemic stroke. Methods: A total of 215 acute ischemic stroke patients with prediabetes were evaluated. The primary outcome was END, defined as an incremental increase in the National Institutes of Health Stroke Scale score by ≥1 point in motor power or ≥2 points in the total score within the 7 days after admission. The secondary outcome was poor functional status defined by a modified Rankin Scale at 3 months. Higher GA (≥16.0%) was determined to reflect glycemic fluctuation prior to ischemic stroke. Results: Of the 215 prediabetic patients, 77 (35.8%) were in the higher GA group. In prediabetic patients, END occurrence and poor functional status were higher in the higher GA group than in the lower GA group. The multivariate analysis showed that a higher GA was associated with an increased risk of END occurrence and poor functional outcomes at 3 months (adjusted odds ratio [95% confidence interval], 4.58 [1.64–12.81], p = 0.004 and 2.50 [1.19–5.25], p = 0.02, respectively). Conclusion: Pre-stroke glycemic variability estimated by GA was associated with END occurrence and poor functional outcome after ischemic stroke in patients with prediabetes.

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Differential effect of mechanical thrombectomy and intravenous thrombolysis in atrial fibrillation associated stroke

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016720 ◽

2020 ◽

pp. neurintsurg-2020-016720

Author(s):

Feras Akbik ◽

Ali Alawieh ◽

C Michael Cawley ◽

Brian M Howard ◽

Frank C Tong ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Clinical Outcomes ◽

Intracranial Hemorrhage ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Anterior Circulation ◽

Increased Risk ◽

First Pass

BackgroundAtrial fibrillation (AF) associated ischemic stroke has worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis (IVT). Limited data exist about the effect of AF on procedural and clinical outcomes after mechanical thrombectomy (MT).ObjectiveTo determine whether recanalization efficacy, procedural speed, and clinical outcomes differ in AF associated stroke treated with MT.MethodsWe performed a retrospective cohort study of the Stroke Thrombectomy and Aneurysm Registry (STAR) from January 2015 to December 2018 and identified 4169 patients who underwent MT for an anterior circulation stroke, 1517 (36.4 %) of whom had comorbid AF. Prospectively defined baseline characteristics, procedural outcomes, and clinical outcomes were reported and compared.ResultsAF predicted faster procedural times, fewer passes, and higher rates of first pass success on multivariate analysis (p<0.01). AF had no effect on intracranial hemorrhage (aOR 0.69, 95% CI 0.43 to 1.12) or 90-day functional outcomes (aOR 1.17, 95% CI 0.91 to 1.50) after MT, although patients with AF were less likely to receive IVT (46% vs 54%, p<0.0001).ConclusionsIn patients treated with MT, comorbid AF is associated with faster procedural time, fewer passes, and increased rates of first pass success without increased risk of intracranial hemorrhage or worse functional outcomes. These results are in contrast to the increased hemorrhage rates and worse functional outcomes observed in AF associated stroke treated with supportive care and or IVT. These data suggest that MT negates the AF penalty in ischemic stroke.

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Hemoglobin Concentration and Clinical Outcomes After Acute Ischemic Stroke or Transient Ischemic Attack

Journal of the American Heart Association ◽

10.1161/jaha.121.022547 ◽

2021 ◽

Author(s):

Runhua Zhang ◽

Qin Xu ◽

Anxin Wang ◽

Yong Jiang ◽

Xia Meng ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Clinical Outcomes ◽

Transient Ischemic Attack ◽

Stroke Recurrence ◽

Vascular Events ◽

Poor Functional Outcome ◽

Ischemic Attack ◽

The Relationship

Background Anemia or low hemoglobin can increase the risk of stroke. However, the association between hemoglobin and outcomes after stroke is uncertain. In this study, we aimed to investigate the association between hemoglobin and clinical outcomes, including mortality, poor functional outcome, stroke recurrence, and composite vascular events at 1 year. Methods and Results We included the patients diagnosed with acute ischemic stroke or transient ischemic attack from the Third China National Stroke Registry. We used the Cox model for mortality, stroke recurrence, and composite vascular events and the logistic model for the poor functional outcome to examine the relationship between hemoglobin and clinical outcomes. In addition, we used the restricted cubic spline to evaluate the nonlinear relationship. This study included 14 159 patients with acute ischemic stroke or transient ischemic attack. After adjusted for potential cofounders, both anemia and high hemoglobin were associated with the higher risk of mortality (hazard ratio [HR], 1.73; 95% CI, 1.39–2.15; HR, 2.71; 95% CI, 1.95–3.76) and poor functional outcome (odds ratio [OR], 1.36; 95% CI, 1.18–1.57; OR, 1.42; 95% CI, 1.07–1.87). High hemoglobin, but not anemia, increased the risk of stroke recurrence (HR, 1.37; 95% CI, 1.05–1.79) and composite vascular events (HR, 1.41; 95% CI, 1.08–1.83). There was a U‐shaped relationship between hemoglobin and mortality and poor functional outcome. Conclusions Abnormal hemoglobin was associated with a higher risk of all‐cause mortality, poor functional outcome, stroke recurrence, and composite vascular events. More well‐designed clinical studies are needed to confirm the relationship between hemoglobin and clinical outcomes after stroke.

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Association between low-density cholesterol change and outcomes in acute ischemic stroke patients who underwent reperfusion therapy

BMC Neurology ◽

10.1186/s12883-021-02387-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ting Cui ◽

Changyi Wang ◽

Qiange Zhu ◽

Anmo Wang ◽

Xuening Zhang ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Functional Outcomes ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Reperfusion Therapy ◽

Low Density ◽

Poor Functional Outcome ◽

Lower Tertile

Abstract Background Low-density lipoprotein cholesterol (LDL-C) can increase cardiovascular risk. However, the association between LDL-C change and functional outcomes in acute ischemic stroke (AIS) patients who underwent reperfusion therapy remains unclear. Methods Patients who received reperfusion therapy were consecutively enrolled. LDL-C measurement was conducted at the emergency department immediately after admission and during hospitalization. The change of LDL-C level (ΔLDL-C) was calculated by subtracting the lowest LDL-C among all measurements during hospitalization from the admission LDL-C. Poor functional outcome was defined as modified Rankin Scale (mRS) > 2 at 90 days. Results A total of 432 patients were enrolled (mean age 69.2 ± 13.5 years, 54.6 % males). The mean LDL-C level at admission was 2.55 ± 0.93 mmol/L. The median ΔLDL-C level was 0.43 mmol/L (IQR 0.08–0.94 mmol/L). A total of 263 (60.9 %) patients had poor functional outcomes at 90 days. There was no significant association between admission LDL-C level and functional outcome (OR 0.99, 95 % CI 0.77–1.27, p = 0.904). ΔLDL-C level was positively associated with poor functional outcome (OR 1.80, 95 % CI 1,12-2.91, p = 0.016). When patients were divided into tertiles according to ΔLDL-C, those in the upper tertile (T3, 0.80–3.98 mmol/L) were positively associated with poor functional outcomes compared to patients in the lower tertile (T1, -0.91-0.13 mmol/L) (OR 2.56, 95 % CI 1.22–5.36, p = 0.013). The risk of poor functional outcome increased significantly with ΔLDL-C tertile (P-trend = 0.010). Conclusions In AIS patients who underwent reperfusion therapy, the decrease in LDL-C level during hospitalization was significantly associated with poor functional outcomes at 90 days.

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Cerebral Microbleeds and Functional Outcomes after Ischemic Stroke

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2014.19 ◽

2014 ◽

Vol 41 (5) ◽

pp. 577-582 ◽

Cited By ~ 7

Author(s):

Tae-Won Kim ◽

Seung-Jae Lee ◽

Jaseong Koo ◽

Hyun-Seok Choi ◽

Jeong-Wook Park ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Functional Outcomes ◽

White Matter Hyperintensities ◽

Functional Group ◽

Chronic Phase ◽

Cerebral Microbleeds ◽

Poor Functional Outcome ◽

Outcome Group

AbstractBackgroundWhether an association exists between cerebral microbleeds (CMBs) and functional recovery after ischemic stroke is unclear. We aimed to evaluate the association between CMBs and functional outcome after acute ischemic stroke.MethodsConsecutive patients with acute stroke were enrolled, and all patients were stratified into good and poor functional outcome groups at discharge and 6 months after ischemic stroke by using a modified Rankin Scale score. Cardiovascular risk factors, CMBs, and white matter hyperintensities were compared between these two outcome groups. Logistic regression analysis was used to estimate the risk of poor functional outcomes.ResultsA total of 225 patients were enrolled, 121 of whom were classified as having a good functional outcome at discharge and 142 as having a good 6-month functional outcome. The presence of CMBs was associated with a poor functional outcome at discharge [CMBs (+) patients in poor vs. good functional group; 48.1% vs. 30.6%; p=0.007] and 6 months [53.0% vs. 30.3%; p=0.001]. After adjustment for confounding factors, only the presence of infratentorial CMBs was associated with a poor functional outcome at discharge and 6 months. The poor functional outcome group had more CMBs than the good outcome group at 6 months.ConclusionsInfratentorial cerebral microbleeds were significantly associated with worse functional outcomes not only in the early phase of ischemic stroke but also in the chronic phase. These findings suggest that the presence of infratentorial CMBs can predict poor functional outcome after acute ischemic stroke.

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Cerebral Microbleeds and Treatment Effect of Intravenous Thrombolysis in Acute Stroke: An Analysis of the WAKE-UP Randomized Clinical Trial

Neurology ◽

10.1212/wnl.0000000000013055 ◽

2021 ◽

pp. 10.1212/WNL.0000000000013055

Author(s):

Ludwig Schlemm ◽

Tim Bastian Braemswig ◽

Florent Boutitie ◽

Jan Vynckier ◽

Märit Jensen ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Treatment Effect ◽

Intravenous Thrombolysis ◽

Stroke Patients ◽

Randomized Controlled ◽

Link Type ◽

Increased Risk ◽

Search Trial

Background and ObjectivesCerebral microbleeds (CMBs) are common in acute ischemic stroke patients and are associated with increased risk of intracerebral hemorrhage (ICH) after intravenous thrombolysis. Whether CMBs modify the treatment effect of thrombolysis is unknown.MethodsWe performed a pre-specified analysis of the prospective randomized controlled multicenter WAKE-UP trial including patients with acute ischemic stroke with unknown time of symptom onset and DWI-FLAIR mismatch on MRI receiving alteplase or placebo. Patients were screened and enrolled between September 2012 and June 2017 (with final follow-up in September 2017). Patients were randomized to treatment with intravenous thrombolysis with alteplase at 0.9 mg / kg body weight or placebo. CMB status (presence, number, and distribution) was assessed after study completion by three raters blinded to clinical information following a standardized protocol. Outcome measures were excellent functional outcome at 90 days, defined by modified Rankin Scale score (mRS)≤1, and symptomatic intracerebral hemorrhage (ICH) according to NINDS trial criteria 22 to 36 hours after treatment.ResultsOf 503 patients enrolled in the WAKE-UP trial, 459 (91.3%; 288 [63%] men) were available for analysis; 98 (21.4%) had at least 1 CMB on baseline imaging; 45 (9.8%) had exactly 1 CMB, 37 (8.1%) had 2-4 CMBs, and 16 (3.5%) had ≥5 CMBs. Presence of CMBs was associated with a non-significant increased risk of symptomatic ICH (11.2% versus 4.2%; adjusted odds ratio 2.32 [95% CI 0.99-5.43]; P=.052), but had no effect on functional outcome at 90 days (mRS≤1: 45.8% versus 50.7%; adj. OR 0.99 [0.59-1.64]; P=.955). Patients receiving alteplase had better functional outcome (mRS≤1: 54.6% versus 44.6%, adj. OR 1.61 [1.07-2.43], P=.022) without evidence of heterogeneity in relation to CMB presence (P value of the interactive term .546). Results were similar for subpopulations with strictly lobar (presumed cerebral amyloid angiopathy-related) or non-strictly-lobar CMB distribution.DiscussionIn the randomized-controlled WAKE-UP trial, we saw no evidence of reduced treatment effect of alteplase in acute ischemic stroke patients with one or more CMBs. Additional studies are needed to determine the treatment effect of alteplase and its benefit-harm-ratio in patients with a larger number of CMBs.Trial registrationClinicalTrials.gov number, NCT01525290 (https://clinicaltrials.gov/ct2/show/NCT01525290); EudraCT number, 2011-005906-32 (https://www.clinicaltrialsregister.eu/ctr-search/trial/2011-005906-32/GB).Classification of EvidenceThis study provides Class II evidence that for patients with acute ischemic stroke with unknown time of onset and DWI-FLAIR mismatch who received IV alteplase, CMBs are not significantly associated with functional outcome at 90 days.

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Leukoaraiosis, intracerebral hemorrhage, and functional outcome after acute stroke thrombolysis

Neurology ◽

10.1212/wnl.0000000000003605 ◽

2017 ◽

Vol 88 (7) ◽

pp. 638-645 ◽

Cited By ~ 43

Author(s):

Kannikar Kongbunkiat ◽

Duncan Wilson ◽

Narongrit Kasemsap ◽

Somsak Tiamkao ◽

Fatima Jichi ◽

...

Keyword(s):

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Rating Scale ◽

Poor Functional Outcome ◽

Total N ◽

Increased Risk ◽

Statistical Heterogeneity ◽

Arterial Thrombolysis

Objective:To perform a systematic review and pooled meta-analysis of published studies to assess whether the presence of leukoaraiosis on neuroimaging before treatment with thrombolysis (IV or intra-arterial) is associated with an increased risk of symptomatic intracerebral hemorrhage (sICH) or poor functional outcome.Methods:We included studies of patients with acute ischemic stroke, treated with IV or intra-arterial thrombolysis, which assessed functional outcome (3-month modified Rankin Scale [mRS]) or sICH in relation to leukoaraiosis on pretreatment neuroimaging (CT or MRI). We used random-effects models to calculate pooled relative risks (RR) of sICH and poor functional outcome (mRS ≥ 2) for any vs no leukoaraiosis (using any rating scale) and for no to mild vs moderate to severe leukoaraiosis (using the Van Swieten or Fazekas Schmidt scale).Results:We identified 15 studies (total n = 6,967). For sICH outcome, the RR was 1.65 (n = 5,551; 95% confidence interval [CI] 1.26–2.16, p = 0.001) with an absolute risk (AR) increase of 2.5% for any leukoaraiosis vs none. The RR was 2.4 (n = 4,192; 95% CI 1.83–3.14, p = 0.001) with an AR increase of 6.2% for moderate to severe vs no to mild leukoaraiosis. For poor functional outcome; the RR was 1.30 (n = 3,401; 95% CI 1.19–1.42, p = 0.001) with an AR increase of 15.4% for any leukoaraiosis vs none. The RR was 1.31 (n = 3,659; 95% CI 1.22–1.42, p = 0.001) with an AR increase of 17.5% for moderate to severe vs no to mild leukoaraiosis. No statistical heterogeneity was noted for any of the analyses.Conclusions:Leukoaraiosis presence and severity are consistently associated with an increased risk of sICH and poor functional outcome after IV or intra-arterial thrombolysis for acute ischemic stroke.

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Abstract TP207: Pre-stroke Dementia is Associated With Poor Functional Outcome After Acute Ischemic Stroke: The Fukuoka Stroke Registry

Stroke ◽

10.1161/str.47.suppl_1.tp207 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Yoshinobu Wakisaka ◽

Ryu Matsuo ◽

Junya Hata ◽

Junya Kuroda ◽

Tetsuro Ago ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Stroke Severity ◽

Large Artery ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Vessel Occlusion ◽

Stroke Registry ◽

Increased Risk

Introduction: With an aging population, an increased number of acute stroke patients with pre-stroke dementia is expected. Although both stroke and dementia are major cause of disability, the effect of pre-stroke dementia on functional outcome after stroke has been still on debate. Hypothesis: Pre-stroke dementia is associated with poor functional outcome after acute ischemic stroke. Methods: Of 9198 stroke patients registered in the Fukuoka Stroke Registry in Japan from June 2007 to May 2014, 3843 patients with first-ever ischemic stroke within 24h of onset, who had been functionally independent before the onset, were enrolled in this study (cardioembolism [n=926], large artery atherosclerosis [n=583], small vessel occlusion [n=1045], others [n=1289]). Pre-stroke dementia was defined as any type of dementia that was present prior to the stroke. For propensity score (PS)-matched analysis, 320 pairs of patients with and without pre-stroke dementia were also selected. Study outcome was poor functional outcome (modified Rankin Scale 3-6) at discharge. Results: In the total cohort, 330 (8.6%) had pre-stroke dementia. The age (80±8 vs 69±13, year, mean±SD, p<0.01), frequencies of female (46 vs 36, %, p<0.01) and cardioembolism (41 vs 23, %, p<0.01), and NIHSS score on admission (6 [3 - 12] vs 3 [1 - 6], median [interquartile], p<0.01) were higher in patients with pre-stroke dementia than those without the dementia. Poor functional outcome (62 vs 25, %, p<0.01) were more prevalent in patients with pre-stroke dementia than those without the dementia. Multivariable-adjusted analysis showed that pre-stroke dementia was significantly associated with increased risk for poor functional outcome (OR 2.3, 95% CI 1.7-3.2). There were no interactions between pre-stroke dementia and 4 variables (age, sex, stroke subtype, and initial stroke severity [NIHSS≤7 or NIHSS≥8]). In the PS-matched analysis, pre-stroke dementia was still associated with poor functional outcome (OR 4.3, 95%CI 2.1-8.8). Conclusions: Pre-stroke dementia was significantly associated with poor functional outcome at discharge in patients with acute ischemic stroke.

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