β-Blockers, Pneumonia, and Outcome After Ischemic Stroke

Sýkora, Marek; Šiarnik, Pavel; Diedler, Jennifer; Lees, Kennedy R.; Alexandrov, Andrei V.; Bath, Philip M.; E, Bluhmki; Bornstein, Natan M.; Claesson, Lennart; Davis, Stephen; Donnan, Geoff; Diener, H. C.; Fisher, Miles; Ginsberg, Myron D.; Gregson, Barbara; Grotta, J.; Hacke, Werner; Mg, Hennerici; Hommel, Marc; Kaste, Markku; Lyden, Patrick; Marler, John R.; Muir, Keith W.; Sacco, R.; Shuaib, Ashfaq; Teal, Philip; Wahlgren, Nils-Gunnar; Warach, Steven; Weimar, C.

doi:10.1161/strokeaha.114.008260

Cited by 66 publications

(61 citation statements)

References 26 publications

(28 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In contrast to our findings, Tziomalos and colleagues did not find a beneficial effect of ACEI or ARB therapy [36]. Similarly, Sykora and colleagues found improved in-hospital and 3-month AIS outcomes with the use of BB pre-stroke [37]. One important distinction from the current analysis is the duration of follow up; in our study, the duration of follow-up was significantly longer.…”

Section: Discussioncontrasting

confidence: 99%

Interaction between Antihypertensive Therapy Class and Pulse Pressure on Outcomes Following Acute Ischemic Stroke

Lavelle¹,

Mathew²,

Arora³

et al. 2017

IJCM

View full text Add to dashboard Cite

Goal: The effect of pulse pressure and interactions with type of antihypertensive therapy on mortality after acute ischemic stroke has not been previously evaluated. Materials and Methods: A retrospective cohort study was conducted to evaluate the independent and interactive effects of pulse pressure and antihypertensive class (specifically angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker, or beta blocker) on mortality following acute ischemic stroke. Findings/Conclusions: 343 patients were identified with 49 months of follow-up. Baseline pulse pressure was 64 mmHg and age was 66.5 years. Patients were divided at a pulse pressure of 70. Patients with pulse pressure ≥ 70 were older (p < 0.001) and had higher comorbid vascular burden (p = 0.031) than those with pulse pressure < 70. Pulse pressure did not remain a significant predictor of follow-up mortality after adjustment for baseline comorbidities. Angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker based therapy was associated with lower follow-up mortality when beta blocker was not used in pulse pressure < 70 group (odds ratio 0.07, 95% confidence interval 0.01 -0.48). Prospective analysis will be needed to confirm the protective effect of angiotensin converting enzyme inhibitor/angiotensin type 1 receptor blocker based on pulse pressure in acute ischemic stroke.

show abstract

Section: Discussioncontrasting

confidence: 99%

Interaction between Antihypertensive Therapy Class and Pulse Pressure on Outcomes Following Acute Ischemic Stroke

Lavelle¹,

Mathew²,

Arora³

et al. 2017

IJCM

View full text Add to dashboard Cite

show abstract

“…In addition, up to now, the longitudinal occurrence of troponin elevations in ICH patients was only insufficiently established and pathophysiological considerations further include an increase of intracranial pressure additionally triggering sympathetic storms [10,21,[24][25][26]. To protect patients with cerebrovascular diseases from this excessive stress, the use of beta-blockers is currently discussed [27,28]; however, this treatment is currently not considered in current guidelines for ICH-patients [29].…”

Section: Discussionmentioning

confidence: 99%

Peak Troponin I Levels Are Associated with Functional Outcome in Intracerebral Hemorrhage

et al. 2018

View full text Add to dashboard Cite

Background: Troponin I is a widely used and reliable marker of myocardial damage and its levels are routinely measured in acute stroke care. So far, the influence of troponin I elevations during hospital stay on functional outcome in patients with atraumatic intracerebral hemorrhage (ICH) is unknown. Methods: Observational single-center study including conservatively treated ICH patients over a 9-year period. Patients were categorized according to peak troponin I level during hospital stay (≤0.040, 0.041–0.500, > 0.500 ng/mL) and compared regarding baseline and hematoma characteristics. Multivariable analyses were performed to investigate independent associations of troponin levels during hospital stay with functional outcome – assessed using the modified Rankin Scale (mRS; favorable 0–3/unfavorable 4–6) – and mortality after 3 and 12 months. To account for possible confounding propensity score (PS)-matching (1: 1; caliper 0.1) was performed accounting for imbalances in baseline characteristics to investigate the impact of troponin I values on outcome. Results: Troponin elevations (> 0.040 ng/mL) during hospital stay were observed in 308 out of 745 (41.3%) patients and associated with poorer status on admission (Glasgow Coma Scale/National Institute of Health Stroke Scale). Multivariable analysis revealed troponin I levels during hospital stay to be independently associated with unfavorable outcome after 12 months (risk ratio [95% CI]: 1.030 [1.009–1.051] per increment of 1.0 ng/mL; p = 0.005), but not with mortality. After PS-matching, patients with troponin I elevation (≥0.040 ng/mL) versus those without had a significant higher rate of unfavorable outcome after 3 and 12 months (mRS 4–6 at 3 months: < 0.04 ng/mL: 159/265 [60.0%] versus ≥0.04 ng/mL: 199/266 [74.8%]; p < 0.001; at 12 months: < 0.04 ng/mL: 141/248 [56.9%] versus ≥0.04 ng/mL: 179/251 [71.3%]; p = 0.001). Conclusions: Troponin I elevations during hospital stay occur frequently in ICH patients and are independently associated with functional outcome after 3 and 12 months but not with mortality.

show abstract

“…In contrast to previous studies, we found that baseline use of BBs was associated with a higher risk for infection. The previous 4 studies on BB treatment and infection risk reported that BBs were either associated with decreased infection risk or there was no association [4,5,8,9]. All studies had a retrospective study design and were heterogeneous with respect to stroke type (ischemic or hemorrhagic) and definitions of BB use (prior to stroke or after stroke admission) and infections.…”

Section: Discussionmentioning

confidence: 99%

“…Yet, effects of BBs have been shown to be dose dependent, and dosage dependent effects could have been missed since the dosage of BB therapy was not controlled in this study [15]. Also, effects might differ between BBs already used prior to stroke, as compared to BBs started directly after stroke [5]. Only a randomized clinical trial could investigate the true potential of BB treatment for reducing stroke-associated infections, but the results of this study are not encouraging.…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that in stroke patients, administration of BBs in the acute phase after stroke could influence the immune suppression associated with acute stroke and decrease the risk of infections after stroke. Two recent cohort studies reported conflicting results on the association between BBs use and occurrence of infections in patients with acute stroke [4,5]. …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pre-Stroke Use of Beta-Blockers Does Not Lower Post-Stroke Infection Rate: An Exploratory Analysis of the Preventive Antibiotics in Stroke Study

Westendorp

Vermeij²,

Brouwer³

et al. 2016

Cerebrovasc Dis

View full text Add to dashboard Cite

Background: Stroke-associated infections occur frequently and are associated with unfavorable outcome. Previous cohort studies suggest a protective effect of beta-blockers (BBs) against infections. A sympathetic drive may increase immune suppression and infections. Aim: This study is aimed at investigating the association between BB treatment at baseline and post-stroke infection in the Preventive Antibiotics in Stroke Study (PASS), a prospective clinical trial. Methods: We performed an exploratory analysis in PASS, 2,538 patients with acute phase of stroke (24 h after onset) were randomized to ceftriaxone (intravenous, 2 g per day for 4 days) in addition to stroke unit care, or standard stroke unit care without preventive antibiotic treatment. All clinical data, including use of BBs, was prospectively collected. Infection was diagnosed by the treating physician, and independently by an expert panel blinded for all other data. Multivariable analysis was performed to investigate the relation between BB treatment and infection rate. Results: Infection, as defined by the physician, occurred in 348 of 2,538 patients (14%). Multivariable analysis showed that the use of BBs at baseline was associated with the development of infection during clinical course (adjusted OR (aOR) 1.61, 95% CI 1.19-2.18; p < 0.01). BB use at baseline was also associated with the development of pneumonia (aOR 1.56, 95% CI 1.05-2.30; p = 0.03). Baseline BB use was not associated with mortality (aOR 1.14, 95% CI 0.84-1.53; p = 0.41) or unfavorable outcome at 3 months (aOR 1.10, 95% CI 0.89-1.35; p = 0.39). Conclusions: Patients treated with BBs prior to stroke have a higher rate of infection and pneumonia.

show abstract

β-Blockers, Pneumonia, and Outcome After Ischemic Stroke

Cited by 66 publications

References 26 publications

Interaction between Antihypertensive Therapy Class and Pulse Pressure on Outcomes Following Acute Ischemic Stroke

Interaction between Antihypertensive Therapy Class and Pulse Pressure on Outcomes Following Acute Ischemic Stroke

Peak Troponin I Levels Are Associated with Functional Outcome in Intracerebral Hemorrhage

Pre-Stroke Use of Beta-Blockers Does Not Lower Post-Stroke Infection Rate: An Exploratory Analysis of the Preventive Antibiotics in Stroke Study

Contact Info

Product

Resources

About