Death In Ischemic Stroke Patients Research Articles

Ischemic Stroke and COVID-19 Infection: an Analysis of Treatment Outcomes in Patients who Underwent Endovascular Thrombectomy

Aim. This study aimed to compare and evaluate treatment outcomes in groups of ischemic stroke patients with or without COVID-19 infection who underwent endovascular thrombectomy (EVT).
 Materials and methods. We conducted a retrospective analysis of 817 case records of IS patients aged 25 to 99 years with confirmed thrombotic occlusion of cerebral arteries and subsequent EVT who were treated in regional vascular centers in St. Petersburg from January 1, 2021
 to December 31, 2021.
 Results. Patients without COVID-19 had favorable outcome more often than patients with confirmed COVID-19 (35.0% vs. 7.3%, p 0.001); mortality rate was 30% vs. 52%, respectively (p 0.001).
 Conclusions. Intercurrent COVID-19 significantly worsened prognosis and increased risk of death in ischemic stroke patients who underwent EVT.

Effect of enteral nutrition on the intestinal microbiome and risk of death in ischemic stroke patients.

Studies have shown that the intestinal microbiome of stroke patients is significantly altered and that the degree of microbiota disturbance correlates with prognosis. Enteral nutrition (EN) can reshape the intestinal microbiome and is important for stroke patients with dysphagia. We aimed to describe the intestinal microbiome in patients with ischemic cerebral infarction receiving standard EN. First, 17 healthy controls (HCs), 54 stroke patients with oral feeding (ON), and 50 stroke patients with EN were matched to investigate the changes in the intestinal microbiota with EN in the first week after admission and dynamic changes in the EN group in the second week. Second, we investigated the relationship between the intestinal microbiome and clinical characteristics in a larger sample of participants receiving EN (n = 147). Survival analysis was performed using Cox proportional hazards regression. The composition and structure of the intestinal microbiota were analyzed by 16S rRNA sequencing. Compared with the HC and ON groups, patients with EN exhibited significantly different compositions of the intestinal microbiota in the first week, including enrichment of the opportunistic pathogen Enterococcus and depletion of bacteria such as Lachnospiraceae, and Ruminococcus, which were further depleted in the second week. An increase in Parvimonas and Comamonas abundances was associated with an increased risk of 180-day mortality. The intestinal microbiota in ischemic stroke patients receiving EN is significantly altered, and specific strains of bacteria may be associated with prognosis and clinical indicators.

Anemia Is a Risk Factor for the Development of Ischemic Stroke and Post-Stroke Mortality

Background: anemia is known to be a risk factor for developing ischemic stroke in long-term follow-up studies, and it is also known to increase the risk of death in ischemic stroke patients. We aimed to determine the association of anemia with the risk of ischemic stroke and the risk of death after ischemic stroke. Methods: The study included patients from National Health Insurance Service cohort, from January 2005 to December 2015. Anemia patients were defined as those with confirmed diagnostic codes and related medications in the sample cohort, and patients under the age of 18 were excluded. To perform a comparative analysis with the control group, twice as many patients were extracted by propensity score matching. The effects of anemia on the development of ischemic stroke were analyzed. Results: A total of 58,699 patients were newly diagnosed with anemia during the study period. In anemia group, the rate of ischemic stroke occurring within 1 year was 0.550%, and the rate was 0.272% in the control group. The odds ratio of anemia related to ischemic stroke was 1.602 (95% confidence intervals (CI) 1.363–1.883). During the follow-up period, 175 out of 309 (56.6%) died in anemia group, and 130 out of 314 (41.4%) died in control group. The anemia group showed a higher risk of death than the control group (Hazard ratio 1.509, 95% CI 1.197–1.902). Conclusion: Analysis of the nationwide health insurance data revealed that anemia is one of the risk factors for the development of ischemic stroke, and also an independent prognostic factor affecting post-stroke mortality.

Platelet counts affect the prognostic value of homocysteine in acute ischemic stroke patients

Background and aimsThe association between homocysteine and prognosis of ischemic stroke remains controversial, and the role of platelet count on the effects of homocysteine in the prognosis of ischemic stroke is still not elucidated. MethodsA total of 3229 acute ischemic stroke patients from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) with homocysteine and platelet measurements were included in this analysis. They were prospectively followed up for death, recurrent stroke and vascular events within 1 year after acute ischemic stroke. ResultsThere was a significant interaction effect between platelet count and homocysteine level on death (p for interaction < 0.05) within 1 year after ischemic stroke. After multivariate adjustment, high homocysteine level was associated with increased risk of 1-year mortality in patients with low platelet level (hazard ratio, 1.70; 95% confidence interval, 1.01–2.88) but not in those with high platelet level (hazard ratio, 1.08; 95% confidence interval, 0.65–1.75). The addition of homocysteine to a model containing conventional risk factors improved risk prediction of 1-year death (net reclassification index 0.53%, p < 0.001; integrated discrimination improvement 0.07%, p < 0.001). ConclusionsHigh homocysteine may be merely an independent risk factor of death in ischemic stroke patients with low platelet levels. Further prospective studies from other populations and randomized clinical trials are needed to verify our findings and clarify the potential mechanisms.

Hyperfibrinogenemia predicts long-term risk of death after ischemic stroke.

In stroke patients higher levels of plasma fibrinogen are associated with increased risk of unfavourable functional outcome and short-term mortality. The aim of our study was to determine the relationship between plasma fibrinogen level and long-term risk of death in ischemic stroke patients. Seven hundred thirty six patients (median age 71; 47.1 % men) admitted to the stroke unit within 24 h after stroke were included. Plasma fibrinogen level was measured on day 1 of hospitalisation. Hyperfibrinogenemia was defined as plasma fibrinogen concentration >3.5 g/L. The maximal follow-up period was 84 months. Hyperfibrinogenemia was found in 25.0 % of patients. On multivariate logistic regression analysis, after adjustment for age, stroke severity, atrial fibrillation, smoking, white blood cell count, fever, in-hospital pneumonia and hyperglycemia, hyperfibrinogenemia was associated with increased case fatality (HR 1.71, 95 % CI 1.29–2.26, P < 0.01). Hyperfibrinogenemia predicts the long-term risk of death in ischemic stroke patients.

Cardiac diastolic dysfunction predicts in-hospital mortality in acute ischemic stroke with atrial fibrillation

BackgroundThe aim of this study was to identify whether diastolic dysfunction predicts in-hospital death in ischemic stroke patients with atrial fibrillation. MethodWe retrospectively analyzed data from enrolled patients with ischemic stroke patients with atrial fibrillation who presented within 24h of onset. All patients underwent transthoracic echocardiography to evaluate diastolic filling pressure estimated as the ratio of early transmitral flow velocity (E) to mitral annular velocity (e′) within 24h of admission. We evaluated initial ischemic lesion volume and National Institute of Health Stroke Scale (NIHSS) score. ResultsTwo hundred and sixty-six patients were enrolled. During hospitalization, 30 patients (11%) died. The deceased group had a higher NIHSS score, a higher D-dimer level, a higher creatinine level, a larger initial ischemic lesion volume and a higher E/e′ ratio than those in the survival group. In a multivariate analysis, a higher E/e′ ratio was an independent predictor of in-hospital death. The cutoff value for the E/e′ ratio for prediction in-hospital death was 20 with the sensitivity of 75% and specificity of 86%. ConclusionDiastolic dysfunction may be associated with in-hospital death in ischemic stroke patients with atrial fibrillation.

The China Stroke Secondary Prevention Trial (CSSPT) Protocol: A Double-Blinded, Randomized, Controlled Trial of Combined Folic Acid and B Vitamins for Secondary Prevention of Stroke

Epidemiological studies suggest that elevated homocysteine is linked to stroke and heart disease. However, the results of lowering homocysteine levels in reducing the risk of stroke recurrence are controversial. The study aims to evaluate whether homocysteine-lowering therapy with folic acid and vitamins B6 and B12 reduces recurrent stroke events and other combined incidence of recurrent vascular events and vascular death in ischemic stroke patients of low folate regions. This is a multicenter, randomized, double-blinded, placebo-controlled trial. Patients (n = 8000, α = 0.05, β = 0.10) within one-month of ischemic stroke (large-artery atherosclerosis or small-vessel occlusion) or hypertensive intracerebral haemorrhage with plasma homocysteine level ≥ 15 μmol/l will be enrolled. Eligible patients will be randomized by a web-based, random allocation system to receive multivitamins (folic acid 0.8 mg, vitamin B6 10 mg, and vitamin B12 500 μg) or matching placebo daily with a median follow-up of three-years. Patients will be evaluated at six monthly intervals. The primary outcome event is the composite event 'stroke, myocardial infarction, or death from any vascular cause', whichever occurs first. Secondary outcome measures include nonvascular death, transient ischemic attack, depression, dementia, unstable angina, revascularization procedures of the coronary, and cerebral and peripheral circulations. This is the first multicenter randomized trial of secondary prevention for ischemic stroke in a Chinese population with a higher homocysteine level but without folate food fortification.

Genetic variation in MDR1, LPL and eNOS genes and the response to atorvastatin treatment in ischemic stroke

Statins reduce the risk of cardiovascular events by lowering the blood cholesterol. Many genes involved in the pharmacodynamic pathway of statins have been part of pharmacogenetic research in patients with hypercholesterolemia, with an emphasis on genes involved in the cholesterol pathway. The present study was carried out with an aim to evaluate the association between the genetic variants of lipoprotein lipase gene [HindIII (+/+)/HindIII (-/-)], multiple drug resistance gene (C3435T) and endothelial nitric oxide synthase gene (4a/4b) with clinical outcome including an increased risk of recurrent stroke or death in ischemic stroke patients on atorvastatin therapy. 525 stroke patients and 500 healthy controls were involved in the study. Follow-up telephone interviews were conducted with patients post-event to determine stroke outcome. Blood samples were collected and genotypes determined by polymerase chain reaction-restriction digestion technique. A significant association of MDR1 and LPL gene variants with bad outcome in stroke patients on atorvastatin therapy was found. However, there was no significant association of 27bp VNTR polymorphism of eNOS gene with outcome. MDR analysis was carried out to analyze gene-gene interaction involving these gene variants contributing to clinical outcome of patients on stratin therapy but no significant interaction between these variants was observed. In conclusion the individuals with HindIII (-/-) genotype of LPL and CC genotype of MDR1 gene would benefit more from atorvastatin therapy.

Beta-blockers reduce the risk of early death in ischemic stroke

Objectives Beta-blockers reduce mortality in patients after myocardial infarction. Experimental studies suggest that beta-blockers have also neuroprotective properties. The aim of this study was to assess if use of beta-blockers is associated with reduced risk of early death in ischemic stroke patients. Materials and methods Retrospective data analysis of 841 consecutive patients with acute ischemic stroke admitted to the stroke unit within 24 h after stroke onset. Results 10.6% of patients received beta-blockers during hospitalization. Thirty-day case fatality was significantly lower in patients treated with beta-blockers than in those not treated with beta-blockers (6.8% versus 19.0%, P<0.01). After adjustment for other prognostic factors, the use of beta-blockers was associated with reduced risk of early death (relative hazard 0.37, 95% confidence interval 0.16–0.84) independently of age, stroke severity, fasting glucose, total cholesterol level and pneumonia. When patients who died of cardiovascular causes were excluded from the analysis, the use of beta-blocker was no longer significantly associated with risk of death ( P = 0.12). Conclusion In a retrospective series the use of beta-blockers was associated with reduced risk of early death in patients with ischemic stroke.

Homocysteine

The authors of the much publicized though not yet published Norwegian Vitamin Study (NORVIT)1 of vitamin therapy in coronary artery disease, are widely quoted as saying that vitamin therapy for lowering plasma total homocysteine (tHcy) was harmful, and that “homocysteine is dead.” However, the slides of their presentation1 do not show the B12 status of the participants, nor do they indicate whether B12 injections were given to participants with low levels of B12. Commentators2 have called NORVIT “the largest trial to date to test the hypothesis that folate supplementation reduces risk of cardiovascular disease,” but because there were 4 treatment arms in NORVIT, each with 900 participants, the number of patients randomized to folate/B12 or folate/B12/B6 was essentially the same as that in the Vitamin Intervention for Stroke Prevention (VISP) trial3 (≈1800). They used a much higher dose of B6 than other studies and cannot exclude the possibility that their results were driven by that choice. As did VISP, they also used a dose of B12 that, as has recently become apparent, was too low for adequate absorption of B12 in elderly subjects (discussed below). In this issue of Stroke , a substudy of the Vitamins to Prevent Stroke (VITATOPS) trial4 reports that in Singapore, treatment with 2.5 mg folic acid, 0.5 mg vitamin B12, and 25 mg B6 reduced levels of tHcy by 3.8 μmol/L compared with placebo.5 The authors also studied 2 polymorphism …