There is limited information on long-term risk of acute medical events after acute ischemic stroke (AIS) treatment with tissue plasminogen activator (tPA) or mechanical thrombectomy (MT). We sought to determine the incidence of seven acute medical events at 1 and 5 years after AIS treatment using an administrative database. The Optum Clinformatics Data Mart database was used to construct the cohort of patients aged 30+ years with AIS diagnosis (ICD-10 I63 or ICD-9 433.x1, 434.x1, 436 or DRG 061-063) during the period: 01/01/2015-06/30/2020 with at least 1-year observation prior to cohort entry. Using procedure coding (CPT or ICD-9/10), patients were grouped as tPA only, MT only, tPA+MT, or untreated. Excluded were patients with an acute event in year preceding first AIS treatment, or first AIS diagnosis for untreated patients. Acute medical events were assessed at 1 and 5 years. The denominator was calculated as the person-years (PY) (per 100) from AIS diagnosis date or treatment, until event occurrence date or database end. The Charlson-comorbidity score (CCS) was used to measure concomitant illness severity.The 313,756-patient AIS cohort was mostly male, had a mean age of 72 years, with 8% receiving intervention. In the first year, cardiovascular event rates were highest in the tPA+MT group for recurrent AIS (10.9/100 PY), myocardial infarction (4.8/100 PY), and venous thromboembolism (4.3/100 PY). All-cause mortality (35.2/100 PY) and urinary tract infections (31.4/100 PY) were highest in the tPA+MT group. The tPA group had the highest rate for pneumonia (18.6/100 PY). The untreated group had the lowest rate for all events. All event rates decreased at 5 years, with the largest decline (-34%) in recurrent AIS.Stroke patients remain at significant risk of morbidity in the first year after stroke, in spite of treatment, but rates of acute medical events decrease over time possibly related to prevention strategies.
Background and Objectives:
Time delay is a challenge in using biomarkers in guiding acute ischemic stroke (IS) therapy. Therapeutic decisions must be made quickly and standard blood draws with transport to a laboratory results in delay of results and possible degradation of biomarkers. We report the initial experience with rapid nanoparticle lateral flow (nLF) tests on fingerstick blood samples for the NR2 peptide (NP), a fragment of the NMDA receptor. This extends our prior research (PLoS ONE, 2012, 7, e42362).
Methods:
Capillary blood (20 microliter) withdrawn less than 15 hours after IS onset was developed within 5 min yielding test (T) and control ( C ) bands in a nLF assay (DRD/CIS Biotech, Inc, Atlanta, GA). An Epson V700 scanner and ImageJ software (Rasband, W.S., ImageJ, U. S. NIH, Bethesda, Maryland) were used to quantify the LF bands. Plasma measurements of NP using MP-ELISA were carried out as well.
Patient Selection:
Patients (n=13) with thrombotic and embolic stroke and controls (n=16) with non-vascular disease of the CNS and healthy volunteers were enrolled. Diagnosis of ischemic stroke was confirmed by clinical evaluation and neuroimaging (CT, MRI and transcranial doppler). Increased NR2 peptide was detected in plasma of 9/13 patients with IS, i.e., the rapid test showed 2 lines (control and test). In some patients both lines are visualized equally others the T-line is stained less intensively. In the control group there is only one band (16/16) Elevated NP correlated with new lesion areas on DWI/MRI with a slope of ~ 1ng per 5 ml stroke volume.
Conclusions:
NR2 peptide is elevated with IS and may be detected by rapid fingerstick tests. Plasma NR2 peptide levels correlate with stroke volume.
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