Stroke recurrence

Jerrgensen, H. S.; Nakayama, Hirofumi; Reith, Jakob; Raaschou, Hans Otto; Olsen, Tom Skyhøj

doi:10.1212/wnl.48.4.891

Cited by 244 publications

(186 citation statements)

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“…We found that the rate of recurrent stroke was remarkably higher in the patients with poor functional outcome. Because prognosis of recurrent stroke was unfavorable, 29 it is possible that subsequent stroke instead of minor stroke or TIA per se led to functional disability in our study.…”

Section: Strokementioning

confidence: 87%

High-Sensitive C-Reactive Protein Predicts Recurrent Stroke and Poor Functional Outcome

Li¹,

Wang²,

Meng³

et al. 2016

Stroke

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A cute minor ischemic stroke and transient ischemic attack (TIA) are common, and patients with recent stroke or TIA are at high risk for subsequent stroke. It is estimated that 10% to 20% of these patients have a stroke within 3 months after the index event, most of which even occur within the first 2 days. [1][2][3][4] Though several clinical risk factors have been reported to be associated with recurrent stroke, these characteristics do not fully explain the risk of recurrence of stroke. 5 Inflammation is increasingly recognized as playing a central role in atherosclerosis and cardiovascular disease. 6 High-sensitive C-reactive protein (hsCRP), one of the most investigated inflammatory makers in cardiovascular research, has been independently associated with increased risk of recurrent cardiovascular events. 7 However, the association between hsCRP and recurrent stroke is less established. [8][9][10] On the contrary, disability from stroke has brought huge personal and societal burden. Though the predictive value of hsCRP in mortality has been proved, 11,12 its association with functional disability in the patients with stroke is still undefined. 13,14 The CHANCE (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) trial showed that the combination of clopidogrel and aspirin was superior to aspirin alone in reducing recurrent stroke in patients with acute minor stroke or high-risk TIA during 90-day and 1-year Background and Purpose-Minor stroke and transient ischemic attack are common disorders with high rate of subsequent disabling stroke. We aim to investigate the role of high-sensitive C-reactive protein (hsCRP) in predicting recurrent stroke and poor functional outcome. Methods-In the Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events (CHANCE) trial, 3044 (59%) consecutive patients from 73 (64%) prespecified centers had hsCRP levels measured. The primary outcome was any stroke within 90 days. The secondary outcome included combined vascular events and dependence or death defined as modified Rankin Scale score of 2 to 6 at 90 days and a new vascular event during 1-year follow-up. The associations of hsCRP with recurrent stroke and functional outcome were analyzed by using Cox proportional hazards and logistic regression models. Results-Elevated hsCRP (>3.0 mg/L) was observed in 32% of the study population. Patients with hsCRP >3 mg/L had an increased risk of recurrent stroke (adjusted hazard ratio, 1.46; 95% confidence interval, 1.08-1.98; P=0.039), ischemic stroke and combined vascular events, and poor functional outcome (adjusted odds ratio, 1.68; 95% confidence interval, 1.22-2.32; P=0.002) compared with those with hsCRP <1 mg/L within 90-day follow-up period. High hsCRP levels also independently predicted recurrent stroke during 1-year follow-up. There was no interaction of hsCRP levels with randomized antiplatelet therapy. Conclusions-High

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Section: Strokementioning

confidence: 87%

High-Sensitive C-Reactive Protein Predicts Recurrent Stroke and Poor Functional Outcome

Li¹,

Wang²,

Meng³

et al. 2016

Stroke

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“…Vol.7 No.2:87 2016 with higher mortality than first stroke and functional recovery is often poorer [9,23]. The available data on stroke patients suggest that medication persistence is often sub-optimal, and that many patients are consequently at a significantly increased risk of a further stroke [6,13,16].…”

Section: Journal Of Neurology and Neuroscience Issn 2171-6625mentioning

confidence: 99%

Stroke Secondary Medication Persistence and Risk for Hospital Readmission within 90 Days after Discharge

Han¹,

Bushnell

2016

J Neurol Neurosci

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Purpose: In stroke patients, a group at high risk for readmission, there is limited information on medication persistence and its impact on readmission. Utilizing data from a quality improvement program for post-acute processes of care, we investigated the relationship between secondary prevention medication persistence and risk for 90-day readmission in acute stroke patients. Methods:Patients were eligible for the study if they were age 18 years or older and hospitalized with a primary diagnosis of acute ischemic or hemorrhagic stroke, or transient ischemic attack (TIA). A total of 142 patients who had been enrolled in the Transition Coaching for Stroke (TRACS) program were included in the analysis. Results:The mean age was 63.6 ± 13.13 years and 52.8% were women. History of a prior stroke was significantly associated with medication non-persistence (p=0.013, odds ratio [OR], 4.85; 95% confidence interval [CI] 1.39-16.96). History of a prior stroke was also significantly associated with readmission for recurrent stroke or TIA within 30 days of discharge (p= 0.029, OR 7.00; 95% CI 1. 22-40.23). Logistic regression modeling with stroke/TIA readmission at 90 days showed that only prior stroke was significant (p= 0.012, OR 5.54; 95% CI 1.45-21.10). A trend toward lower medication persistence was observed in patients readmitted with a stroke/TIA within 90 days (60.0% vs. 81.8%, p=0.095). Conclusions:In patients discharged with stroke, history of a prior stroke was significantly associated with stroke/TIA readmission at 30 and 90 days after discharge. Poor secondary prevention medication persistence may be a potential risk factor for stroke/TIA readmission. Quality improvement programs focused on improving medication persistence may be essential, especially in patients with a history of recurrent strokes.

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“…The increased risk of recurrent stroke due to diabetes ranges from 2.1 to 5.6 times that of nondiabetic patients (154,156) and is independent of glucose control during the interstroke period (163). The significance of these findings is underscored by the increased morbidity and mortality associated with recurrent stroke (164).…”

Section: Hypercoaguability Conferred By Diabetes -mentioning

confidence: 99%