scholarly journals Quantifying the Contribution of Risk Factors for Ischemic Stroke in Patients with a History of TIA

ISRN Stroke ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-7
Author(s):  
Duncan C. Ramsey ◽  
Mark G. Burnett ◽  
Matthew C. Cowperthwaite
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Patient Population ◽  
Stroke Risk ◽  
Significant Risk ◽  
Individual Risk ◽  
Readmission Rates ◽  
Cardiovascular Comorbidities ◽  
History Of ◽  
Ischemic Attack

Background. Patients with a history of transient ischemic attack (TIA) are known to be at higher risk for a stroke. We sought to investigate predictors of individual risk for an ischemic stroke within 30 days of a TIA. Methods and Results. A retrospective analysis of 57,585 TIA admissions was collected from 155 United States hospitals. Data describing each admission included demographic and clinical data, and information about the admitting hospital. Cerebrovascular disease was the primary readmission reason (19% of readmissions) in the TIA patient population. The prevalence of 30-day ischemic stroke readmissions was 11 per 1,000 TIA admissions; however, 53% of stroke readmissions occurred within one week. Hierarchal regression models suggested that peripheral vascular disease and hypertensive chronic kidney disease were significant individual stroke risk factors, whereas history of myocardial infarction, essential hypertension, and diabetes mellitus was not associated with significant stroke risk. Certified stroke centers were not associated with significantly lower stroke readmission rates. Conclusions. The results suggest that cardiovascular comorbidities confer the most significant risk for an ischemic stroke within 30 days of a TIA. Interestingly, certified stroke centers do not appear to be associated with significantly lower stroke-readmission rates, highlighting the challenges managing this patient population.

EXPRESS: Risk factors for delayed-onset dementia after stroke or transient ischemic attack - A 5-year longitudinal cohort study

2021 ◽  
pp. 174749302110265
Author(s):  
Moamina Ismail ◽  
Vincent CT Mok ◽  
Adrian Wong ◽  
Lisa Au ◽  
Brian Yiu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Early Onset Dementia ◽  
Delayed Onset ◽  
Lower Baseline ◽  
History Of ◽  
Ischemic Attack ◽  
Moca Score

Background Stroke not only substantially increases the risk of incident dementia early after stroke, the risk remains elevated years after. Aim We aimed to determine the risk factors of dementia onset more than 3-6 months after stroke or transient ischemic attack (TIA). Methods This is a single center prospective cohort study. We recruited consecutive subjects with stroke/TIA without early-onset dementia. We conducted an annual neuropsychological assessment for 5 years. We investigated the association between baseline demographic, clinical, genetic (APOEε4 allele), and radiological factors, as well as incident recurrent stroke, with delayed-onset dementia using Cox proportional hazards models. Results 1,007 patients were recruited, of which 88 with early-onset dementia and 162 who lost to follow-ups were excluded. 49 (6.5%) out of 757 patients have incident delayed-onset dementia. The presence of ≥ 3 lacunes, history of ischemic heart disease (IHD), history of ischemic stroke and a lower baseline Hong Kong version of the Montreal Cognitive Assessment (MoCA) score, were significantly associated with delayed-onset dementia. APOEε4 allele, medial temporal lobe atrophy, and recurrent stroke were not predictive. Conclusion The presence of ≥ 3 lacunes, history of IHD, history of ischemic stroke and a lower baseline MoCA score, are associated with delayed-onset dementia after stroke/TIA.

scholarly journals Stroke Risk Factors, Subtypes and Outcome in Elderly Thai Patients

2021 ◽  
Author(s):  
Chatpol Samuthpongtorn ◽  
Tul Jereerat ◽  
Nijasri Suwanwela
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
The Elderly ◽  
P Value ◽  
Younger Patients ◽  
Factors Associated ◽  
Stroke Risk Factors ◽  
History Of ◽  
Ischemic Attack

Abstract Background: Nowadays, the number of elderly has steadily increased annually. Elderly patients with ischemic stroke often have worse outcomes than younger patients. However, there has not been a study of ischemic stroke in the elderly in Thailand. A better knowledge of the risk factors, subtypes, and outcomes of strokes in the elderly may have significant practical implications for the aged society in the future. The objective of the study was to assess the risk factor, stroke subtypes, and outcome of stroke in the elderly compared to the younger patients.Method: All patients presented with acute ischemic stroke and transient ischemic attack (TIA) aged over 45 years who were admitted in the Stroke unit between November 1st, 2016 and December 31st, 2017 were retrospectively studied.Result: 542 patients were included. The average age was 68.78±12.03, 44.8% of them were male. 186 (34.3%) patients were 75 or older. Cardioembolism was found to be the most common cause of ischemic stroke in 156 patients (28.8%). Patients who were 75 or older had significantly worse outcomes in all categories including NIHSS at discharge, modified Rankin scale, length of stay and the number of deaths) compared to the younger group. Atrial fibrillation was the risk factors associated with older age with OR 3.861 (p value<0.001). Aged 75 years or older, atrial fibrillation, more NIHSS score on admission and history of the previous stroke were the risk factors associated with a patient's death.Conclusion: The elderly who are 75 years or older accounts for more than one-third of ischemic stroke in our study. Stroke in the elderly correlates with higher mortality and poorer outcome. Cardioembolism related to atrial fibrillation is the major cause of stroke in this population.

scholarly journals Development and Validation of a Nomogram to Predict the Individual Future Stroke Risk for Adult Patients With Moyamoya Disease: A Multicenter Retrospective Cohort Study in China

2021 ◽  
Vol 12 ◽  
Author(s):  
Fei Ye ◽  
Tianzhu Wang ◽  
Haoyuan Yin ◽  
Jiaoxing Li ◽  
Haiyan Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Practice ◽  
Moyamoya Disease ◽  
Stroke Risk ◽  
External Validation ◽  
Roc Curves ◽  
Individual Risk ◽  
Kaplan Meier ◽  
History Of ◽  
The Individual

Background: Studies exploring the predictive performance of major risk factors associated with future stroke events are insufficient, and a useful tool to predict individual risk is not available. Therefore, personalized advice for preventing future stroke in patients with moyamoya disease (MMD) cannot provide evidence-based recommendations. The aim of this study was to develop a novel nomogram with reliable validity to predict the individual risk of future stroke for adult MMD patients.Methods: This study included 450 patients from seven medical centers between January 2013 and December 2018. Follow-ups were performed via clinical visits and/or telephone interviews from initial discharge to December 2019. The cohort was randomly assigned to a training set (2/3, n = 300) for nomogram development and a test set (1/3, n = 150) for external validation. The Kaplan-Meier analyses and receiver operating characteristic (ROC) curves were applied to assess the clinical benefits of this nomogram.Results: Diabetes mellitus, a family history of MMD, a past history of stroke or transient ischemic attack, clinical manifestation, and treatment were identified as major risk factors via the least absolute shrinkage and selection operator (LASSO) method. A nomogram including these predictors was established via a multivariate Cox regression model, which displayed excellent discrimination [Harrell's concordance index (C-index), 0.85; 95% confidence interval (CI): 0.75–0.96] and calibration. In the external validation, the nomogram was found to have good discrimination (C-index, 0.81; 95% CI: 0.68–0.94) and calibration. In the subgroup analysis, this predictive nomogram also showed great performance in both ischemic-type (C-index, 0.90; 95% CI: 0.77–1.00) and hemorrhagic-type MMD (C-index, 0.72; 95% CI: 0.61–0.83). Furthermore, the nomogram was shown to have potential in clinical practice through Kaplan-Meier analyses and ROC curves.Conclusions: We developed a novel nomogram incorporating several clinical characteristics with relatively good accuracy, which may have considerable potential for evaluating individual future stroke risk and providing useful management recommendations for adult patients with MMD in clinical practice.

scholarly journals Predictor Naïve Temporal Baseline Hazard of Recurrent Ischemic Stroke

2022 ◽  
Author(s):  
Marwa Elsaeed Elhefnawy ◽  
Siti Maisharah Sheikh Ghadzi ◽  
Orwa Albitar ◽  
Balamurugan Tangiisuran ◽  
Hadzliana Zainal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Significant Risk ◽  
Likelihood Estimation ◽  
Preventive Treatment ◽  
Hazard Models ◽  
Baseline Hazard ◽  
Time Points ◽  
History Of

Abstract There are established correlation between risk factors and the recurrence of ischemic stroke (IS), however does the hazard of recurrent IS change although without the influence of established risk factors? This study aimed to quantify the hazard of recurrent IS at different time points after the index IS. This was a population cohort study extracted data of 7697 patients with a history of first IS attack registered with National Neurology Registry of Malaysia. A repeated time to recurrent IS model was developed using NONMEM version 7.5. Three baseline hazard models were fitted into the data. The best model was selected using maximum likelihood estimation, clinical plausibility and visual predictive checks. Three hundred and thirty-three (4.32%) patients developed at least one recurrent IS within the maximum 7.37 years follow-up. In the absence of significant risk factors, the hazard of recurrent IS was predicted to be 0.71 within the first month after the index IS and reduced to 0.022 between the first to third months after the index attack. The hazard of IS recurrence accelerated with the presence of typical risk factors such as hyperlipidaemia (HR, 2.64 [2.10-3.33]), hypertension (HR, 1.97 [1.43-2.72], and ischemic heart disease (HR, 2.21 [1.69-2.87]). In conclusion, the absence of significant risk factors, predicted hazard of recurrent IS was prominent in the first month after the index IS and was non-zero even three months after the index IS or later. Optimal secondary preventive treatment should incorporate the ‘nature risk’ IS recurrence.

Abstract P267: Does Admission for Transient Ischemic Attack Lead to Differences in 1-Year Outcomes?

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Eric Cheng ◽  
Michael Cline ◽  
Joshua Robinson ◽  
Laura Myers ◽  
Flossy Lincoln ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Stroke Risk ◽  
Composite Outcome ◽  
Diagnosis Code ◽  
Stroke Risk Factors ◽  
History Of ◽  
One Year ◽  
Ischemic Attack ◽  
New Diagnosis

Background: A new transient ischemic attack (TIA) is a risk factor for a future vascular event. Reducing that risk requires a timely diagnostic workup and delivering secondary stroke preventive services. It is unknown whether such care should be performed in the inpatient or outpatient setting. Methods: Using administrative databases, we identified all veterans with a diagnosis code for TIA assigned in the emergency department or urgent care setting in the Veterans Health Administration during fiscal year 2008. We calculated the proportion who were admitted and predictors of admission. At one-year after presentation of TIA, we examined the proportion who were assigned a new diagnosis code for stroke, myocardial infarction, or death. We then determined whether admission was associated with outcomes using chi-square and multivariate logistic models. Results: The sample consisted of 2247 persons with a new diagnosis of TIA, and 35% were admitted within one day of presentation. The mean age was 68, and 25% had a prior history of stroke or TIA. At one-year, 12.1% developed the composite outcome of stroke, myocardial infarction, and death. Older age, history of hypertension, atrial fibrillation, and diabetes were associated with admission (p<0.05). In unadjusted analyses, the composite outcome was not significantly different among persons admitted vs. not admitted (13.1% vs. 11.6%, p=0.29). In multivariate analyses, admission was not significantly associated with the composite outcome (see Table ). Discussion: Persons admitted for TIA are more likely to possess stroke risk factors than those who were not admitted. The decision to admit was not associated with differences in one-year outcomes. Ongoing work will compare the completeness and timeliness of the diagnostic work-up of TIA as well as long-term control of stroke risk factors among persons admitted versus persons not admitted. Predictors of 1-year stroke, myocardial infarction, or death among persons with TIA Odds ratio [95% CI] p-value Hospital admission within one day 1.0 [0.8 - 1.4] 0.7 Age 1.0 [1.0 -1.0] <0.001 History of hypertension 1.2 [0.9 - 1.7] 0.2 History of atrial fibrillation 1.5 [1.1 - 2.0] <0.05 History of diabetes 1.2 [0.9 - 1.5] 0.3 History of stroke 1.8 [1.3 - 2.5] <0.001 History of TIA 0.7 [0.5 - 1.1] 0.1 History of myocardial infarction 2.9 [1.3 - 6.1] <0.01

scholarly journals Prediction of stroke risk in patients with transient ischemic attack: ABCD score and its derived scores

2017 ◽  
Vol 5 (12) ◽  
pp. 5093
Author(s):  
Wu Xin-Tong ◽  
Chen Jin-Bo ◽  
Xu Wen-Xiang ◽  
Lu Wen-Xian
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Ischemic Stroke ◽  
High Risk ◽  
Transient Ischemic Attack ◽  
Predictive Value ◽  
Stroke Risk ◽  
Ischemic Cerebrovascular Disease ◽  
Ischemic Attack ◽  
Abcd Score

Transient Ischemic Attack (TIA) is a high-risk signal of acute ischemic cerebrovascular disease, indicates a significant increase in the risk of ischemic stroke, especially within 7 days. Risk assessment and stratification are important in patient with TIA. A variety of simple prediction scales were developed based on the risk factors for stroke in patients with TIA, such as the California scale, ABCD scale, and ABCD2 scale. Among them, the ABCD scale score is used most commonly, but as its application becomes more and more common, the defects of this scale are also increasingly apparent. In recent years, some derived scales of ABCD score were introduced in order to improve the sensitivity and specificity of prediction. This article reviews the evolution, contents, characteristics, and predictive value of the ABCD score and its derived scales in the prediction of the stroke risk in patients with TIA.

scholarly journals Stroke risk factors, subtypes and outcome in elderly Thai patients

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chatpol Samuthpongtorn ◽  
Tul Jereerat ◽  
Nijasri C. Suwanwela
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
The Elderly ◽  
Younger Patients ◽  
Factors Associated ◽  
Stroke Risk Factors ◽  
History Of ◽  
Aged Society ◽  
Ischemic Attack

Abstract Background Nowadays, the number of elderly has steadily increased annually. Elderly patients with ischemic stroke often have worse outcomes than younger patients. However, there has not been a study of ischemic stroke in the elderly in Thailand. A better knowledge of the risk factors, subtypes, and outcomes of strokes in the elderly may have significant practical implications for the aged society in the future. The objective of the study was to assess the risk factor, stroke subtypes, and outcome of stroke in the elderly compared to the younger patients. Method All patients presented with acute ischemic stroke and transient ischemic attack (TIA) aged over 45 years who were admitted in the Stroke unit between November 1st, 2016 and December 31st, 2017 were retrospectively studied. Result Five hundred forty-two patients were included. The average age was 68.78 ± 12.03, 44.8% of them were male. 186 (34.3%) patients were 75 or older. Cardioembolism was found to be the most common cause of ischemic stroke in 156 patients (28.8%) and was associated with poor outcome. Patients who were 75 or older had significantly worse outcomes in all categories including NIHSS at discharge, modified Rankin scale, length of stay and the number of deaths compared to the younger group. Atrial fibrillation was the risk factors associated with older age with OR 3.861 (p value< 0.001). Aged 75 years or older, atrial fibrillation, more NIHSS score on admission and history of the previous stroke were the risk factors associated with a patient’s death. Conclusion The elderly who are 75 years or older accounts for more than one-third of ischemic stroke in our study. Stroke in the elderly correlates with higher mortality and poorer outcome. Cardioembolism related to atrial fibrillation is the major cause of stroke in this population.

scholarly journals Acute Cerebrovascular Events in Hospitalized COVID-19 Patients

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
Author(s):  
Aaron Rothstein ◽  
Olivia Oldridge ◽  
Hannah Schwennesen ◽  
David Do ◽  
Brett L. Cucchiara
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Significant Risk ◽  
The United States ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Stroke Incidence ◽  
Cerebrovascular Events ◽  
History Of

Background and Purpose: Initial reports suggest a significant risk of thrombotic events, including stroke, in patients hospitalized with coronavirus disease 2019 (COVID-19). However, there is little systematic data on stroke incidence and mechanisms, particularly in racially diverse populations in the United States. Methods: We performed a retrospective, observational study of stroke incidence and mechanisms in all patients with COVID-19 hospitalized from March 15 to May 3, 2020, at 3 Philadelphia hospitals. Results: We identified 844 hospitalized patients with COVID-19 (mean age 59 years, 52% female, 68% Black); 20 (2.4%) had confirmed ischemic stroke; and 8 (0.9%) had intracranial hemorrhage. Of the ischemic stroke patients, mean age was 64 years, with only one patient (5%) under age 50, and 80% were Black. Conventional vascular risk factors were common, with 95% of patients having a history of hypertension and 60% a history of diabetes mellitus. Median time from onset of COVID symptoms to stroke diagnosis was 21 days. Stroke mechanism was cardioembolism in 40%, small vessel disease in 5%, other determined mechanism in 20%, and cryptogenic in 35%. Of the 11 patients with complete vascular imaging, 3 (27%) had large vessel occlusion. Newly positive antiphospholipid antibodies were present in >75% of tested patients. Of the patients with intracranial hemorrhage, 5/8 (63%) were lobar intraparenchymal hemorrhages, and 3/8 (38%) were subarachnoid hemorrhage; 4/8 (50%) were on extracorporeal membrane oxygenation. Conclusions: We found a low risk of acute cerebrovascular events in patients hospitalized with COVID-19. Most patients with ischemic stroke had conventional vascular risk factors, and traditional stroke mechanisms were common.

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