Abstract TMP91: Prediction of Recurrent Embolism and Major Hemorrhage in Patients With Acute Stroke and Atrial Fibrillation by Risk Stratification Schema: The Alessa Score Study

Background: We aim to derive and validate a score that predicts early ischemic events or major hemorrhage in acute stroke patients with atrial fibrillation (AF). Methods and results: The derivation cohort consisted of 854 patients with acute ischemic stroke and AF (mean age 76.3 y, 46.6% M) included between January 2012 and March 2014. Older age (HR 1.06 for each additional year, p=0.0025) and severe atrial enlargement (HR 2.05, p= 0.027) resulted being predictors for recurrent ischemic event (stroke, TIA, systemic embolism) within 90 days from acute stroke. Small infarct size (≤1.5 cm) was inversely correlated with both severe bleeding (HR 0.39, p=0.03) and recurrent ischemic events (HR 0.44, p=0.01). Considering the magnitude of the effect, we assigned 2 points to age ≥80 y; 1 point to 70-79 y; 1 point to presence of ischemic index lesion >1.5 cm; 1 point to severe atrial enlargement (ALESSA score). An increase in this score was associated with recurrent ischemic event but not major hemorrhage. A logistic regression with the ROC graph procedure (C-statistic) showed an area under the curve of 0.697 (0.632-0.763), p=0.0001 for ischemic outcome event and 0.585 (0.493-0.678), p=0.47 for major hemorrhage. On multivariate analysis, ALESSA >2 was associated with recurrent ischemic event (OR: 2.5, 95% CI 1.4-4.4, p=0.001) but not major hemorrhage (OR: 1.1, 95% CI 0.5-2.4, p=0.9). The validation cohort included 994 patients with acute stroke and AF (mean age 75.8 y, 46.0% M) included between April 2014 and June 2016. Also in this cohort, a higher ALESSA score was associated with recurrent ischemic event but not major hemorrhage. Logistic regression with the ROC graph procedure showed an area under the curve of 0.646 (0.529-0.763), p=0.009 for recurrent ischemic event and 0.407 (0.275-0.540), p=0.14 for major hemorrhage. On multivariate analysis, ALESSA >2 barely lacked being significantly correlated with recurrent ischemic event (OR: 2.07, 95% CI 0.93-4.67, p=0.07). Conclusions: A higher ALESSA score is associated with a higher risk of recurrent ischemic event but not with major hemorrhage. Therefore, patients with acute stroke and AF and an ALESSA score >2 may be candidates for early anticoagulation treatment. Further validations of this schema need to be performed.

Is Leukocytosis a Predictor for Recurrence of Ischemic Events after Coronary Artery Bypass Graft Surgery? A Cohort Study

Objective. Studies have shown that inflammation plays an important role in pathogenesis of coronary artery disease. The present study was designed to evaluate the role of high WBC count before CABG in predicting the risk of ischemic events after CABG. Methods and Results. This prospective study was carried out on 380 patients who underwent CABG surgery. Ninety seven patients (25.5%) had recurrent ischemic event. Mean WBC count before CABG surgery in patients with recurrent ischemic event was 7267 mic/lit ± 1863, which was significantly higher than the others, with a mean WBC count of 6721 mic/lit ± 1734 (P=0.011). Patients with a WBC count more than 6000 mic/lit were at the highest risk for recurrent ischemic event (OR = 2.11, 95% CI = 1.18–3.44, P=0.009). After adjustment for age, sex, family history, smoking, hyperlipidemia, Logestic Euro score, post opretive enzyme release (CK.mb), arterial graft and BMI, the relationship between the group with WBC count higher than 6000 mic/lit and recurrent of ischemic event remained significant (OR = 2.25, 95% CI = 1.2 to 4, P=0.005). Conclusions. High WBC count before CABG surgery is an independent risk factor for ischemic events one year after the surgery.