Early Arterial Study in the Prediction of Mortality After Acute Ischemic Stroke

Ois, Ángel; Cuadrado-Godia, Elisa; Jiménez‐Conde, Jordi; Gomis, Meritxell; Rodríguez-Campello, Ana; Martínez-Rodríguez, José Enrique; Munteis, Elvira; Roquer, Jaume

doi:10.1161/strokeaha.107.482950

Cited by 46 publications

(38 citation statements)

References 39 publications

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“…Correspondence with authors of relevant papers yielded additional data for 12 of the previously published studies, 4,17,20,21,35,[47][48][49][50][51][52][53] plus 3 additional unpublished data sets (1 of which has since been accepted for publication), 54 giving a total of 27 studies included in the primary analysis (Figure 1). …”

Section: Search Resultsmentioning

confidence: 99%

“…Some authors have reported improved survival and functional outcome associated with statin treatment, but these findings have not been consistently replicated. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][31][32][33][34][35][36] Interpretations can be difficult because of limited sample sizes in some reports and possible bias in statin allocation in other studies, particularly those in which statins were allocated in a nonrandomized fashion. Some authors have also reported worse outcomes in patients treated with the combination of acute statins and intravenous thrombolysis.…”

Section: Ní Chróinín Et Al Statin Therapy and Outcome After Ischemic mentioning

confidence: 99%

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Statin Therapy and Outcome After Ischemic Stroke

Chróinín

Asplund

Åsberg

et al. 2013

Stroke

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204

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Background and Purpose-Although experimental data suggest that statin therapy may improve neurological outcome after acute cerebral ischemia, the results from clinical studies are conflicting. We performed a systematic review and meta-analysis investigating the relationship between statin therapy and outcome after ischemic stroke. Methods-The primary analysis investigated statin therapy at stroke onset (prestroke statin use) and good functional outcome (modified Rankin score 0 to 2) and death. Secondary analyses included the following: (1) acute poststroke statin therapy (≤72 hours after stroke), and (2) thrombolysis-treated patients. Results-The primary analysis included 113 148 subjects (27 studies). Among observational studies, statin treatment at stroke onset was associated with good functional outcome at 90 days (pooled odds ratio [OR], 1.41; 95% confidence interval [CI], 1.29-1.56; P<0.001), but not 1 year (OR, 1.12; 95% CI, 0.9-1.4; P=0.31), and with reduced fatality at 90 days (pooled OR, 0.71; 95% CI, 0.62-0.82; P<0.001) and 1 year (OR, 0.80; 95% CI, P=0.01). In the single randomized controlled trial reporting 90-day functional outcome, statin treatment was associated with good outcome (OR, 1.5; 95% CI, 1.0-2.24; P=0.05). No reduction in fatality was observed on meta-analysis of data from 3 randomized controlled trials (P=0.9). In studies restricted to of thrombolysis-treated patients, an association between statins and increased fatality at 90 days was observed (pooled OR, 1.25; 95% CI, 1.02-1.52; P=0.03, 3 studies, 4339 patients). However, this association was no longer present after adjusting for age and stroke severity in the largest study (adjusted OR, 1.14; 95% CI, 0.90-1.44; 4012 patients). Conclusion-In the largest meta-analysis to date, statin therapy at stroke onset was associated with improved outcome, a finding not observed in studies restricted to thrombolysis-treated patients. 5-12 Experimental and clinical data also provide some evidence that statins may have neuroprotective effects after acute cerebral ischemia. [7][8][9][10][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] In animal models, treatment with statins either before, or early after, cerebral arterial occlusion has been associated with reduced infarct volume and improved neurological function. [5][6][7][8][9][10]13,14 Data are conflicting regarding the relationship between acute statin therapy and outcome after human ischemic stroke. Some authors have reported improved survival and functional outcome associated with statin treatment, but these findings have not been consistently replicated. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][31][32][33][34][35][36] Interpretations can be difficult because of limited sample sizes in some reports and possible bias in statin allocation in other studies, particularly those in which statins were allocated in a nonrandomized fashion. Some authors have also reported worse outcomes in patients treated with the combination of acute statins and intravenous thro...

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Section: Search Resultsmentioning

confidence: 99%

Section: Ní Chróinín Et Al Statin Therapy and Outcome After Ischemic mentioning

confidence: 99%

Statin Therapy and Outcome After Ischemic Stroke

Chróinín

Asplund

Åsberg

et al. 2013

Stroke

Self Cite

204

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“…All consecutive patients with acute stroke (nϭ1119) were considered for the study. Patients were included in the BasicMar database (grant supported by the Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III; FIS Number PI051737) 19 an ongoing prospective register of patients with AIS at our hospital. This is the only public hospital serving a population of 300 000 people in 3 districts of Barcelona city.…”

Section: Methodsmentioning

confidence: 99%

“…This methodology has demonstrated a good correlation between explorations and interobserver. 19 Treatment was decided in each case by a neurologist experienced in neurovascular diseases following international consensus. In all cases we started antiplatelet therapy in the acute phase with the exception of those patients with cardioembolic strokes, and in some selected patients with severe arterial disease (patients already pretreated with antiplatelet, crescendo TIA, or progressive stroke after antiplatelet treatment) in whom anticoagulation was initiated.…”

Section: Methodology Of Carementioning

confidence: 99%

Factors Associated With a High Risk of Recurrence in Patients With Transient Ischemic Attack or Minor Stroke

Ois

Gomis

Rodríguez-Campello

et al. 2008

Stroke

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147

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Background and Purpose-The aim of our study was to identify factors associated with stroke recurrence after an initial minor stroke or transient ischemic attack (TIA) in a prospective hospital-series. Methods-Included in the series were 689 patients with NIHSS lower than 4 at hospital admission. The end point was a new neurological event (worsening Ն4 points in the initial NIHSS was considered as recurrence) at 90 days (and additionally at 7 days). Factors based on two previous reported scores (ABCD and SPI-II) were analyzed in relation with stroke recurrence: age, duration of symptoms Ͼ1 hour, weakness, speech impairment, initial hypertension, hypertension, diabetes, coronary disease, minor stroke versus TIA, prior stroke, and heart failure. We also analyzed: gender, hyperlipidemia, severe alcohol intake (Ͼ60gr/d), current smoking habits, peripheral arterial disease, atrial fibrillation, acute lesion in initial head computed tomography, severe symptomatic extra or intracranial arterial disease (SSAD; arterial stenosis Ն70%), previous TIA, and vertebrobasilar event. Patients were also analyzed separately according to diagnosis of TIA or minor stroke. Results-90-day recurrence occurred in 111 patients (16.1%), whereas 62 patients had 7-day recurrence (9%). The independent variables associated with 90-day recurrence were: SSAD (ORϭ4.97), weakness (ORϭ3.25), speech impairment (ORϭ1.96), severe alcohol intake (ORϭ4.18), heart failure (ORϭ2.41), previous TIA (ORϭ4.62), and vertebrobasilar events (ORϭ2.87). SSAD was independently associated with 7-day recurrence (ORϭ7.73) and also for TIA (ORϭ3.45) and minor stroke (ORϭ5.15) patients. Conclusions-An arterial study to discard SSAD would be necessary, in combination with clinical factors, to improve the identification of patients with a higher risk of 90-day recurrence after an initial minor stroke or TIA.

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“…This last subgroup belongs to Parent Artery Disease (PAD), with the same prognosis of patients with large artery disease. The relation between the occlusive pattern and the outcome has been demonstrated by several studies, and then it is possible to say that "severe arterial stenosis/occlusion in the early arterial study was highly related with 90-day mortality in an unselected series of patients with stroke" (Ois et al 2007). This is right non only for severe stroke but also for mild stroke, and it is not related to the imaging technique used.…”

Section: Occlusive Pattern Diagnosismentioning

confidence: 97%