Case Characteristics, Hyperacute Treatment, and Outcome Information from the Clinical Research Center for Stroke-Fifth Division Registry in South Korea

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Background and Purpose-We compared baseline characteristics and outcomes at 3 months between patients with minor anterior circulation infarction (ACI) versus minor posterior circulation infarction (PCI), including the influence of large vessel disease on outcomes. Methods-This study is an analysis of a prospective multicenter registry database in South Korea. Eligibility criteria were patients with ischemic stroke admitted within 7 days of stroke onset, lesions in either anterior or posterior circulation, and National Institutes of Health Stroke Scale score of ≤4 at baseline. Patients were divided into 4 groups for further analysis: minor ACI with and without internal carotid artery/middle cerebral artery large vessel disease and minor PCI with and without vertebrobasilar large vessel disease. Results-A total of 7178 patients (65.2±12.6 years) were analyzed in this study, and 2233 patients (31.1%) had disability (modified Rankin Scale score 2-6) at 3 months. Disability was 32.3% in minor PCI and 30.3% in minor ACI (P=0.07), and death was 1.3% and 1.5%, respectively (P=0.82). In a multivariable logistic regression analysis, minor PCI was significantly associated with disability at 3 months when compared with minor ACI (odds ratio, 1.23; 95% confidence interval, 1.09-1.37; P<0.001). In pairwise comparisons, minor PCI with vertebrobasilar large vessel disease was independently associated with disability at 3 months, compared with the other 3 groups. Conclusions-Our study showed that minor PCI exhibited more frequent disability at 3 months than minor ACI. Especially, the presence of vertebrobasilar large vessel disease in minor PCI had a substantially higher risk of disability. Our results suggest that minor PCI with vertebrobasilar large vessel disease could require more meticulous care and are important targets for further study.

Section: Subjectsmentioning

confidence: 99%

Clinical Outcomes of Posterior Versus Anterior Circulation Infarction With Low National Institutes of Health Stroke Scale Scores

Kim

Park

Choi

et al. 2017

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“…11 The registry includes consecutive acute stroke or transient ischemic attack cases from 12 academic and regional stroke centers across the nation (Figure 1). The collection of clinical information for the Clinical Research Center for Stroke 5th division registry was approved by the local institutional review boards in all participating centers with a waiver of patient consent because of the anonymity of the collected data and the minimal risk to participants.…”

Section: Patients and Work-upmentioning

confidence: 99%

Air Pollution Is Associated With Ischemic Stroke via Cardiogenic Embolism

Chung

Bang

Ahn

et al. 2017

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Background and Purpose-The aim of the study was to assessed the impact of short-term exposure to air pollution on ischemic stroke subtype, while focusing on stroke caused via cardioembolism. Methods-From a nationwide, multicenter, prospective, stroke registry database, 13 535 patients with acute ischemic stroke hospitalized to 12 participating centers were enrolled in this study. Data on the hourly concentrations of particulate matter <10 μm, nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ), ozone (O 3 ), and carbon monoxide (CO) were collected from 181 nationwide air pollution surveillance stations. The average values of these air pollutants over the 7 days before stroke onset from nearest air quality monitoring station in each patient were used to determine association with stroke subtype. The primary outcome was stroke subtype, including large artery atherosclerosis, small-vessel occlusion, cardioembolism, and stroke of other or undetermined cause. Results-Particulate matter <10 μm and SO 2 concentrations were independently associated with an increased risk of cardioembolic stroke, as compared with large artery atherosclerosis and noncardioembolic stroke. In stratified analyses, the proportion of cases of cardioembolic stroke was positively correlated with the particulate matter <10 μm, NO 2 , and SO 2 quintiles. Moreover, seasonal and geographic factors were related to an increased proportion of cardioembolic stroke, which may be attributed to the high levels of air pollution. Conclusions-Our findings suggest that the short-term exposure to air pollutants is associated with cardioembolic stroke, and greater care should be taken for those susceptible to cerebral embolism during peak pollution periods.

“…12,13 The collaborative registry study group consisted of 14 academic and regional tertiary stroke centers. Detailed information on the CRCS-5 registry is given in the online-only Data Supplement.…”

Section: Subjectsmentioning

confidence: 99%

Different Antiplatelet Strategies in Patients With New Ischemic Stroke While Taking Aspirin

Kim

Park

Choi

et al. 2016

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A spirin is a first line antiplatelet agent for the secondary prevention of ischemic stroke or transient ischemic attack.1 In addition, aspirin is recommended in national guidelines for primary prevention of vascular events in patients with multiple cardiovascular risk factors. 2,3With its low cost and easy accessibility, prophylacticBackground and Purpose-Selecting among different antiplatelet strategies when patients experience a new ischemic stroke while taking aspirin is a common clinical challenge, currently addressed by a paucity of data. Methods-This study is an analysis of a prospective multicenter stroke registry database from 14 hospitals in South Korea.Patients with acute noncardioembolic stroke, who were taking aspirin for prevention of ischemic events at the time of onset of stroke, were enrolled. Study subjects were divided into 3 groups according to the subsequent antiplatelet therapy strategy pursued; maintaining aspirin monotherapy (MA group), switching aspirin to nonaspirin antiplatelet agents (SA group), and adding another antiplatelet agent to aspirin (AA group). The primary study end point was the composite of stroke (ischemic and hemorrhagic), myocardial infarction, and vascular death up to 1 year after stroke onset. Results-A total of 1172 patients were analyzed for this study. Antiplatelet strategies pursued in study patients were MA group in 212 (18.1%), SA group in 246 (21.0%), and AA group in 714 (60.9%). The Cox proportional hazards regression analysis showed that, compared with the MA group, there was a reduction in the composite vascular event primary end point in the SA group (hazard ratio, 0.50; 95% confidence interval, 0.27-0.92; P=0.03) and in the AA group (hazard ratio, 0.40; 95% confidence interval, 0.24-0.66; P<0.001). Conclusions-This study showed that, compared with maintaining aspirin, switching to or adding alternative antiplatelet agents may be better in preventing subsequent vascular events in patients who experienced a new ischemic stroke while taking aspirin. Kim et al Antiplatelet Strategies in Prior Aspirin Users 129aspirin use is frequent in the middle-aged and elderly population. [4][5][6] Therefore, patients who suffer a new ischemic stroke while taking aspirin are frequently encountered in a daily practice. Antiplatelet management options in these patients are to maintain aspirin monotherapy, replace aspirin with other antiplatelet agents, such as clopidogrel, or add other antiplatelet agents to aspirin.1,7-10 However, both randomized trial and large-scale registry data to guide this decision are sparse. Accordingly, the most recent American Heart Association/American Stroke Association guideline states that there is no evidence that switching or combining antiplatelet agents reduces the risk of subsequent vascular events in patients who have had stroke while receiving aspirin (Class IIb, Level of Evidence C). 1A post hoc analysis of 838 patients, who have had a recent lacunar stroke while taking aspirin from the Secondary Prevention of Small Subcortical Strok...