Predictive Clinical Factors of In-Hospital Mortality in 231 Consecutive Patients with Cardioembolic Cerebral Infarction

Abstract

Cardioembolic cerebral infarction is a subtype of stroke with a high mortality. The purpose of this study was to determine predictors of in-hospital mortality in 231 consecutive patients with cardioembolic stroke by means of a multivariate analysis. Three predictive models were constructed. A first model was based on demographic, anamnestic and clinical variables collected at the bedside examination (total 8 variables). A second model was based on clinical and neuroimaging variables (total 10 variables). A third model was based on the aforementioned clinical and neuroimaging variables and the presence of early recurrent embolism (total 11 variables). Deteriorated level of consciousness, limb weakness, presence of congestive heart failure, male gender, and age appeared to be independent prognostic factors of in-hospital mortality in the predictive model based on clinical variables and in the predictive model based on clinical and neuroimaging variables. In addition to these variables, early recurrent embolization was selected in the third predictive model. In the first two models, setting a cut-off point of 0.50 for predicting vital status at hospital discharge resulted in a sensitivity of 60%, a specificity of 89% and a total correct classification of 81%. The corresponding values of the third model were 62, 89 and 81%, respectively. These data may help clinicians to establish an early prognosis of this stroke subtype more accurately as well as to allocate patients with cardioembolic stroke in clinical trials correctly.

Recurrence after a First- ever Ischemic Stroke Development of a Clinical Prediction Rule

“…Although cardioembolic and atherothrombotic stroke have been linked to increased risk of recurrence in some studies [36,37] in our study, as in others [38],there was no difference in recurrence between different etiological subtypes of ischemic stroke.…”

Specific cardiac disorders in 402 consecutive patients with ischaemic cardioembolic stroke

“…In this respect, early anticoagulation would effectively reduced the incidence of recurrent embolization [45] and the risk for in-hospital mortality associated with recurrent attacks [46] if started as soon as possible after initial stroke, with careful monitoring of the level of anticoagulation to maintain the activated partial thromboplastin time below two times control values.…”

Hemostatic markers and platelet aggregation factors as predictive markers for type of stroke and neurological disability following cerebral infarction

“…31 In short, to classify a patient as having cardioembolic stroke disease required the presence of a medium-sized (maximal diameter of the lesion (1.5-3 cm) or large (>3 cm)) cerebral infarction, cerebral cortex involvement, stroke onset during ordinary daily activities, duration of focal neurological deficit: >24 h, absence of a lacunar clinical syndrome and identification of a commonly accepted cardiac source of embolus in the absence of confirmatory clinical (ipsilateral carotid bruit) or investigative results (Doppler ultrasonography, carotid angiography or angio-magnetic resonance imaging [MRI]) of lesions (stenosis P50%) in the ipsilateral supra aortic trunks. To classify a patient as having atherothrombotic stroke required the presence of a medium or large cerebral infarction, absence of a lacunar clinical syndrome documented by CT and/or MRI and evidence of two or more of the following manifestations: (a) presence of carotid, subclavian, vertebral bruit or absent carotid pulses or unequal radial pulses; (b) duplex sonography or angiography showing arterial stenosis P50%, or occlusion, of symptomatic artery; and (c) evidence of clinical complications of atherothrombotic disease elsewhere, i.e., angina pectoris, previous myocardial infarction, claudication, femoral bruits, and absence of foot pulses.…”