Rate Of Ischemic Stroke Research Articles

Abstract 12823: As Anticoagulation Use Increases, Embolic Events Downtrend in Atrial Fibrillation Hospitalizations

Background: Direct oral anticoagulants and Left atrial appendage closure (LAAC) were approved for use in 2010 and 2015, respectively. Data on temporal changes in stroke prevention strategies and rates of embolic complications in atrial fibrillation (AF) in the 2010s decade are limited. Aims: Describe trends in long-term anticoagulation (AC), LAAC use, and in-hospital AF associated ischemic stroke (IS), transient ischemic attacks (TIA), and systemic embolic events (SEE) between 2010 and 2019. Methods: The national inpatient database was used to identify patients with AF from 2010 to 2019. Data were divided into 2 eras: 2010-2014 and 2015-2019. Results: A total of 40,787,136 inpatients with AF were identified: prevalence increased from 18,594,372 in 2010 to 2014 (46%; mean [SD] age 75.5 [12.0] years; 50.3% male) to 22,192,764 in 2015 to 2019 (54%; mean [SD] age 75.1 [11.8] years; 52.5% male). There was a marked increase in long-term AC use (27.2% to 40.2%; P=0.001) and rates of percutaneous LAAC procedures (0.01% to 0.6%; P <0.001) from 2015 to 2019. IS rates among patients with AF increased from 2010 to 2014 (3.5% to 3.8%; P=0.04), with no significant temporal change from 2015 to 2019 (P=0.84). TIA rates declined from 2010 to 2014 (1.2% to 1.0%; P=0.017) and continued a downtrend from 2015 to 2019 (0.9% to 0.7%; P=0.002). There was no temporal change in SEE or the composite outcome of all embolic events from 2010 to 2014, followed by a decline from 2015 to 2019 in SEE (0.5% to 0.4%; P 0.012) and all embolic events (5.1% to 4.8%; P 0.026) ( Figure 1 ). Mean rates of major bleeding events increased from 5.7% in 2010-2014 to 9.1% in 2015-2019 (P <0.001). Conclusion: In an inpatient AF population, the composite outcome of all embolic events and specifically SEE downtrend from 2015 to 2019, likely due to increased AC use. Further data assessing the risk-benefit ratio of available therapies for stroke prevention in inpatients with AF - AC and LAAC - are needed to optimize personalized strategies.

Abstract 13632: Predictors of Death and/or Readmission in Extremely Elderly Patients Hospitalized for Decompensated Heart Failure

Introduction: Heart Failure (HF) is the final stage of cardiac illness, and it has become highly prevalent with the aging population. The extremely elderly population is underrepresented in HF clinical studies. This study aims to identify predictors of readmission and mortality in extremely elderly patients hospitalized for decompensated heart failure. Research Question: What are the predictors of readmission and mortality in extremely elderly patients hospitalized for decompensated heart failure? Methods: Retrospective cohort study in the model of a single-center registry including data from 2019 to 2022. The study was conducted at a private tertiary institution located in Salvador-BA, Brazil and included patients ≥ 80 years old admitted with a diagnosis of HF. Data was collected from electronic medical records and through follow-up performed 30 days after discharge, analyzed using descriptive statistics and compared by parametric or non-parametric tests, as appropriate. Multivariate analysis with logistic regression was performed to evaluate independent predictors of readmission and death from HF. Results: A total of 221 extremely elderly patients hospitalized for decompensated HF were included. There was a higher prevalence of females (57.4%), mean age of 87.6 ± 4.9 years, and mean Left Ventricular Ejection Fraction (LVEF) of 49.5 ± 17.1%. After 30 days, it was found that 14.9% of this sample had a death outcome and 16.7% were readmitted, totaling 28.1% of combined outcome (death and/or rehospitalization). The outcome group had older age (88.7 ± 4.6 years vs. 87.2 ± 4.9; p = 0.039), lower diastolic blood pressure (DBP) (74.8 ± 18.4 mmHg vs. 81.5 ± 15.6 mmHg; p = 0.007), higher rate of past ischemic stroke (30.6% vs. 13.2%; p = 0.002), and higher palliative care rate (27.4% vs. 3.2%; p = 0.001). In logistic regression, history of ischemic stroke [OR: 3.43 (CI: 1.30 - 9.05); p = 0.013], DBP [OR: 0.96 (CI: 0.93 - 0.99); p = 0.010], and palliative care [OR: 66.71 (CI: 8.18 - 543.66); p < 0.001] were independent risk factors for the combined outcome at 30 days. Conclusion: In extremely elderly patients admitted for heart failure, death or hospitalization at 30 days demonstrated an independent association with a history of ischemic stroke, DBP and palliative care.

Abstract 13931: Direct Oral Anticoagulants in Atrial Fibrillation Patients With Rheumatic Heart Disease After Mitral Valve Replacement With Bioprosthesis

Background: We sought to investigate the outcomes of direct oral anticoagulants (DOACs) versus warfarin in patients with atrial fibrillation and bioprosthetic mitral valve replacement (bMVR) due to rheumatic heart disease. Methods: We performed a retrospective study using the TriNetX global database to identify patients with atrial fibrillation and bMVR due to rheumatic heart disease from 2010 to 2020. Patients who had mechanical mitral or aortic valve replacement were excluded. Patients were stratified into 2 groups: DOAC group and Warfarin group. 1:1 propensity-score matching to control for baseline differences between the two groups was performed. The primary endpoint was ischemic stroke and secondary endpoints were all-cause mortality, major bleeding, myocardial infarction, and all-cause hospitalization over a mean follow-up of 3 years. Results: A total of 2,011 patients were identified and 586 were included after propensity-score matching (293 patients in each group). Patients in the DOAC group, compared to the warfarin group aged 68.9 ± 11.2 vs 68.2 ± 11 years (P=0.41) and 63.4% vs 63.8% were females (P=0.93). There was no significant difference between the two groups in ischemic stroke, all-cause mortality, major bleeding, myocardial infarction, and all-cause hospitalization. (Table 1, figure 1). Conclusion: In patients with atrial fibrillation and bMVR due to rheumatic heart disease, DOACs use was associated with similar rates of ischemic stroke, mortality, major bleeding, myocardial infarction, or hospitalization compared to warfarin.

Abstract 16129: The Gender Difference in Risk Factors and Incidence Rate of Ischemic Stroke in Japanese Atrial Fibrillation Patients: The Fushimi AF Registry

Background: Gender-specific medicine is of concern in cardiovascular medicine. We previously reported that there was not gender difference in the incidence of ischemic stroke from the Fushimi AF Registry. However, the gender difference in risk factors of ischemic stroke in Japanese atrial fibrillation (AF) patients is little known. The aim of this study is to compare the risk factors and incidence rate of ischemic stroke in male and female using the latest data with longer follow-up. Method: In the Fushimi AF Registry, follow-up data were available for 4,496 patients. In the entire cohort, 2,677 were male and 1,819 were female. We compared clinical characteristics and risk factors and incidence rate of ischemic stroke between the two groups. Result: Male patients were younger (male vs. female; 71.5 years vs. 76.7 years, p<0.01), greater in body weight (65.0 kg vs. 51.2 kg, p<0.01), were more often sustained type (52.0% vs. 48.2%, p=0.04), more likely to have diabetes mellitus (26.2% vs. 19.9%, p<0.01), coronary artery disease (16.0% vs. 12.3%, p<0.01) and less likely to have prior heart failure (24.0% vs. 32.3%, p<0.01), chronic kidney disease (CKD) (33.7% vs. 39.3%, p<0.01) and had lower CHADS 2 score (1.96 vs. 2.15, p<0.01). In prescription data, male patients more often received oral anticoagulant (58.2% vs. 52.1%, p<0.01) and antiplatelet drug (APD) (29.0% vs. 23.8%, p<0.01). Hypertension, left atrium enlargement (LAE), previous stroke and major bleeding were comparable between the two groups. During the median follow-up of 1,824 days (longest 10 years), the incidence rate of ischemic stroke was not significantly different between two groups (0.86 vs. 0.89% per person-year, log rank p=0.32). On multivariate Cox regression analysis, age, previous stroke and LAE were significantly associated with an increased risk of ischemic stroke in both groups. CKD and prescription of APD were significantly associated with an increased risk of ischemic stroke in male, while body weight was in female. Conclusion: The incidence rate of ischemic stroke was not significantly different between male and female. The risk factors associated with ischemic stroke were different between male and female in Japanese AF patients.

Abstract 17536: Real World Analysis from the "Fast STEMI" Registry on Adherence and Discontinuation of Statin Therapy Within 6 Months After ST-Elevation Myocardial Infarction on First Year Follow-Up: Prognostic Impact and Predictors of Adherence

Background: The impact of statin therapy on cardiovascular outcomes after ST-elevation acute myocardial infarction (STEMI) in real-world patients is understudied. Objectives: to identify predictors of low adherence and discontinuation to statin therapy within 6 months after STEMI and to estimate their impact on cardiovascular outcomes at one year follow-up. Methods: We evaluated real-world adherence to statin therapy by comparing the number of bought tablets to the expected ones at 1 year follow-up through pharmacy registries. A total of 6043 STEMI patients admitted from 2012 to 2017 were enrolled in the FAST STEMI registry and followed up for 4,7±1,6 years; 299 patients with intraprocedural and intrahospital deaths were excluded. The main outcomes evaluated were all-cause death, cardiovascular death, myocardial infarction, major and minor bleeding events, and ischemic stroke. The compliance cut-off chosen was 80% as mainly reported in literature. Results: From a total of 5744 patients, 418 (7,2%) patients interrupted statin therapy within 6 months after STEMI. After univariate and multivariate analysis age over 75 years old, known ischemic cardiopathy and female gender resulted as predictors of therapy discontinuation. Statin discontinuation within 6 months showed an increase of both cardiovascular (5% vs 1.7%; HR 2.23; 95%CI 1.37-3.65; p=0,001) and all-cause mortality (14.8% vs 5.1%, HR 2.32; 95%CI 1.73-3.11; p<0,001) at 1 year follow-up. Regarding cardiovascular outcomes, statin optimal adherence (>80%) reduced ischemic stroke incidence (1% vs 2.5%, p=0.001) and both cardiovascular and all-cause death (0.1% vs 4.6%; 0.3% vs 13.4%; p<0.001) at 1 year follow-up. Age over 75 years old, chronic renal failure, previous atrial fibrillation, vasculopathy, known ischemic cardiopathy were found to be predictors of low statin adherence. Conclusions: In our real-world registry low statin adherence and discontinuation therapy within 6 months after STEMI were independently associated to an increase of cardiovascular and all-cause mortality at 1 year follow-up. Low statin adherence led to higher rates of ischemic stroke. This analysis confirmed the predictive factors of adherence and discontinuation therapy already described in literature.

Abstract 17695: Atrial Myopathy as a Predictor of Ischemic Stroke Independent of Atrial Fibrillation in Native Americans: Analysis of Strong Heart Study

Introduction: American Indian individuals have high rates of ischemic stroke. This increased incidence of stroke within the American Indian patient population compared to other ethnic groups may be due to the increased prevalence of atrial fibrillation or it may be due to atrial myopathy. Recent reports suggest that atrial myopathy, may be an independent risk factor for ischemic stroke prior to the development of atrial fibrillation. Hypothesis: Determine if atrial myopathy defined by C-reactive protein (CRP) or increased left atrial diameter (LAD) index independently predicts stroke irrespective of atrial fibrillation diagnosis in American Indians. Methods: We analyzed participants from phase 2 of the Strong Heart Study, 1993-1995 (n=2000) and identified cardioembolic stroke events through 2020 (n=45). Patients were excluded if they had a baseline diagnosis of atrial fibrillation, according to chart review (n=6). To analyze if CRP or LAD index were associated with cardioembolic stroke, we divided these variables into quartiles and then used Cox regression modeling to identify independent predictors of cardioembolic stroke. Results: CRP divided into quartiles was significantly associated with cardioembolic stroke (p= 0.03; Figure 1A). Likewise, higher LAD index predicted cardioembolic stroke (p=0.002; Figure 1B). The association between cardioembolic stroke and CRP and LAD index remained significant even after controlling for age, sex, hypertension and body mass index. Conclusions: Elevated LAD index and CRP markers of atrial myopathy are associated with subsequent development of cardioembolic stroke in the absence of diagnosed atrial fibrillation in American Indians. Further research is warranted to establish whether these biomarkers could be used for screening for risk of cardioembolic stroke in American Indians.

Abstract 18446: Rates and Risk Factors of Pregnancy-Related Ischemic Stroke During Labor Admissions

Background: Pregnancy-related stroke is a relatively uncommon yet devastating complication. However, the rates and associated risk factors of stroke in this context remain poorly described. Hypothesis: We aim to evaluate rates and associated risk factors for stroke. Methods: We conducted a population-based retrospective study using national inpatient data from 2016 to 2020 to assess ischemic stroke rates and identify associated risk factors during labor admissions. Regression analysis was performed, adjusting for multiple patient characteristics, to determine significant factors related to stroke occurrence. Results: We examined a total of 19,089,780 labor admissions. The incidence of ischemic stroke during labor admissions was recorded at a rate of 445 per 100,000 cases. Several factors showed significant associations with ischemic stroke in this context. Atrial fibrillation exhibited a strong correlation (odds ratio [OR] 5.98, 95% confidence interval [CI] [1.16-30.92], p=0.033), as did dyslipidemia (OR 9.54, 95% CI [4.38-20.80], p<0.001), heart failure (OR 3.95, 95% CI [1.09-14.34], p=0.037), chronic kidney disease (OR 6.27, 95% CI [1.92-20.47], p=0.002), cesarean section (OR 2.23, 95% CI [1.60-3.13], p<0.001), chronic hypertension (OR 1.67, 95% CI [1.12-2.47], p=0.011), and hypertensive disorders of pregnancy (OR 7.00, 95% CI [4.94-9.44], p<0.001). However, factors such as advanced maternal age, race/ethnicity, income quartile, gestational and non-gestational diabetes mellitus, coronary artery disease, tobacco use, polycystic ovarian syndrome, and peripartum cardiomyopathy did not exhibit significant associations with stroke. Conclusion: Our study highlights an incidence rate of 445 per 100,000 cases for pregnancy-related ischemic stroke during labor admissions and identified certain associated risk factors. These findings provide valuable guidance to healthcare professionals in identifying high-risk individuals.

Abstract 174: Treatment of Unruptured Saccular Aneurysms with PED: A Systematic Review and Meta‐Analysis of Long‐Term Outcomes

Introduction The Pipeline Embolization Device (PED) is commonly used for intracranial aneurysm treatment. While its effectiveness for certain types of aneurysms is well‐established, its efficacy for saccular aneurysms remains debatable. This review and meta‐analysis aimed to assess the long‐term outcomes of PED treatment for unruptured intracranial aneurysms (UIA). Methods A systematic review and meta‐analysis were conducted following PRISMA guidelines. Studies with at least one year of follow‐up after PED treatment for saccular aneurysms were included. The primary endpoint was angiographic complete aneurysm occlusion at long‐term (≥ 12 mo.) follow‐up. Secondary outcomes included long‐term complications. We conducted a meta‐regression analysis to explore the potential sources of heterogeneity across studies. Results Eleven studies on 594 patients with 726 aneurysms were included, of which 5% were previously treated. The mean age was 55.7 years, and 78.3% were women. The mean aneurysm size was 7.72 mm, 8.95% were treated with more than one device, and 2.9% had adjunct coiling. The long‐term complete occlusion rate was 81% (CI 95%: 72% to 88%, p<0.01). Regarding long‐term complications, the rate of symptomatic ischemic stroke was 1% (CI 95%: 0% to 4%, p=0.07), the rate of delayed rupture was 1% (95%, CI 0% to 3%, p=0.02), and the rate of intracranial hemorrhage was 3% (CI 95%: 1% to 6%, p=0.81). The meta‐regression analysis revealed a decreasing trend per year for aneurysmal occlusion, ischemic stroke rate, and aneurysmal rupture rate over time and an increasing trend for ICH over time. Conclusion PED demonstrates high long‐term occlusion and low complication rates, suggesting it is a safe and effective treatment option for unruptured intracranial saccular aneurysms. However, studies with greater than 5‐10 years of follow‐up are needed to evaluate the clinical and radiographical outcomes of incompletely occluded aneurysms Additionally, as newer devices exhibit reduced thrombogenic profiles and ICH rates increase over time, reevaluation of antiplatelet therapy's role, including dosage and DAPT, is warranted.

The impact of antiplatelet drugs on recurrent stroke in patients with intracerebral hemorrhage

BackgroundThe influence of antiplatelet drugs on the risk of hemorrhagic stroke and the reduction of ischemic stroke in patients with intracerebral hemorrhage (ICH) remains unclear. This study aimed to elucidate the impact of antiplatelet therapy on the risk of recurrent stroke in ICH patients. MethodsThe study encompassed ICH survivors discharged from a central Taiwanese teaching hospital between January 1, 2013, and December 31, 2019. Patient hospitalization and treatment data were retrieved from electronic medical records. The primary endpoint was re-hospitalization due to ischemic or hemorrhagic stroke. Patients who continued antiplatelet drug use for over a month prior to stroke recurrence constituted the antiplatelet drug use group. Risk factors for recurrent hemorrhagic and ischemic strokes were evaluated using binary logistic regression. ResultsThe study incorporated 407 ICH patients, each monitored for 4 years post-stroke. Recurrent stroke incidence showed no significant disparity between hemorrhagic and ischemic strokes. Hemorrhagic stroke recurrence stood at 5.16 % (21/407), and ischemic stroke recurrence was 4.42 % (18/407). In the non-antiplatelet group, hemorrhagic and ischemic stroke rates were 5.48 % (20/365) and 3.56 % (13/365) respectively. In the antiplatelet group, the rates were 2.38 % (1/42) for hemorrhagic and 11.9 % (5/42) for ischemic stroke, with a significantly higher ischemic stroke rate (p = 0.03). Hypertension emerged as a risk factor for recurrent hemorrhagic stroke, while diabetes mellitus was identified as a risk factor for ischemic stroke. Antiplatelet drug use did not escalate the risk of recurrent ICH. ConclusionDiabetes mellitus and hypertension are risk factors for recurrent ischemic and hemorrhagic strokes respectively in ICH patients. Antiplatelet therapy does not appear to elevate the risk of recurrent hemorrhagic stroke in these patients.

Abstract 175: Impact of COVID‐19 on Intracranial Aneurysm Treatment and Outcomes: A Nationwide Propensity Score Matched Study.

Introduction The coronavirus disease 2019 (COVID‐19) pandemic has had a global impact on healthcare systems. There is limited data on the influence of COVID‐19 on treatment and outcomes in patients with intracranial aneurysms. We aimed to investigate the impact of COVID‐19 on the overall complications, including ischemic stroke and subarachnoid hemorrhage (SAH) rates in patients treated for intracranial aneurysms (IAs). Methods This national, multicenter, retrospective cohort study included patients diagnosed and treated for IAs from January 2016 to December 2020 in the National Inpatient Sample (NIS). A total of 57,715 admissions were identified. Of these, 45,979 occurred pre‐COVID and 11,736 during the COVID pandemic period. The outcome data points included the occurrence of postprocedural ischemic strokes or SAHs, death, non‐routine discharge, total charges (US dollars), and length of stay (days). A 1:1 propensity score matching protocol was applied using a K‐nearest neighbor approach to evaluate differences in the outcome data points between the pre‐COVID and during COVID periods. The trends during the study period were assessed using piecewise joinpoint regression with the Mann‐Kendall test. Results Overall, the mean age was 65 years, with most of the patients (69.9%) being females. Endovascular interventions were performed in 82.9% of pre‐COVID IAs admissions compared to 82.4% during the COVID period, while open surgical treatment was performed in 17.1% of pre‐COVID and 17.6% of the patients during COVID (p=0.625). After matching, there were no differences in length of stay (p=0.266), non‐home discharge (p=0.475), and in‐hospital mortality rates (p=0.305) between the two periods; however, the overall complication rate was significantly higher during the pandemic (31.1% vs. 28.3%; p<0.001). From 2016 to 2020, an upward trend in hospitalizations for ischemic stroke was seen among patients treated for IAs (6.1% to 7.9%; p=0.04). No trends were observed with respect to the occurrence of SAH or death (p=0.31). Patients hospitalized after treatment of IAs during the COVID pandemic had significantly higher odds of ischemic strokes (OR 1.13; 95% CI 1.05 to 1.22; p=0.03) but not SAH (OR 0.97; 95% CI 0.88 to 1.06; p=0.89). Conclusion The COVID‐19 pandemic has significantly impacted the healthcare system. In patients receiving treatment for IAs, this analysis noted a correlation between the COVID‐19 pandemic and postoperative complications, notably ischemic strokes. Unraveling the pandemic’s “black box” leads to awareness of plausible breaches within the system, which acts as a crucial component in improving situational readiness and preparedness in the event of similar large‐scale crises.

The Role of Astrocytic Mitochondria in the Pathogenesis of Brain Ischemia.

The morbidity rate of ischemic stroke is increasing annually with the growing aging population in China. Astrocytes are ubiquitous glial cells in the brain and play a crucial role in supporting neuronal function and metabolism. Increasing evidence shows that the impairment or loss of astrocytes contributes to neuronal dysfunction during cerebral ischemic injury. The mitochondrion is increasingly recognized as a key player in regulating astrocyte function. Changes in astrocytic mitochondrial function appear to be closely linked to the homeostasis imbalance defects in glutamate metabolism, Ca2+ regulation, fatty acid metabolism, reactive oxygen species, inflammation, and copper regulation. Here, we discuss the role of astrocytic mitochondria in the pathogenesis of brain ischemic injury and their potential as a therapeutic target.

Burden ofischemic stroke inmainland China andTaiwan province from 1990 to 2019: with forecast forthe next 11 years.

Ischemic stroke is featured with high incidence, mortality, and disability. The aim of this study is to use Global Burden of Disease database to describe and compare the burden of ischemic stroke in mainland China and Taiwan province and to further predict the expected changes in the next 11 years using statistical modeling methods. Information on ischemic stroke incidence and mortality in China (mainland and Taiwan province) during 1990-2019 was obtained from the Global Burden of Disease database to analyze the effects of region, gender, and age on the incidence and mortality of ischemic stroke in China. The autoregressive integrated moving average model was used to predict the age-standardized incidence rate and age-standardized mortality rate of ischemic stroke in males and females in mainland China and Taiwan province in the next 11 years. The period from 1990 to 2019 witnessed an overall upward trend in the number of incidence and deaths in mainland China and Taiwan province. In 2019, there were nearly 2.87 million ischemic incidence cases with stroke in mainland China, with more female patients than male in the age group of over 60 years. Among the nearly 1.03 million deaths, the death toll of men under the age of 85 years was higher than that of women, while in Taiwan province, the number of incidence was 28 771, with more female patients of all ages than male. Among the 6788 deaths, the death toll of men under the age of 80 years was higher than that of women. In 2019, the age group with the highest number of patients in the two regions was 65-69 years, while the highest number of deaths was found in people aged 85 years and above. As our autoregressive integrated moving average model predicted, the age-standardized incidence rate value of ischemic stroke is expected to be 163.23/100 000 persons in mainland China by 2030, which would continue to increase, while the age-standardized mortality rate value of ischemic stroke is expected to be 16.41/100 000 persons in Taiwan province by 2030, which showed a decreasing trend. Disease burden of ischemic stroke is still increasing in mainland China and Taiwan province, and health resources should be deployed to implement effective prevention and control strategies, taking into account region, gender, and age.

The prevalence and prognosis of asymptomatic intracranial atherosclerosis in a community-based population: Results based on high-resolution magnetic resonance imaging.

Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke in China, but the prevalence and prognosis of asymptomatic ICAD detected using high-resolution magnetic resonance imaging (HR-MRI) is largely unknown. The aim of this study was to investigate the prevalence and prognosis in order to guide neurologists in interpreting ICAD detected on HR-MRI. We included stroke-free participants from a community-based prospective cohort (Shunyi study participants) who underwent HR-MRI between July 2014 and April 2016. The participants were divided into two groups: those with or without ICAD (ICAD+ and ICAD- , respectively). ICAD included intracranial artery stenosis and non-stenotic plaque. The primary outcome was ischemic stroke. Cox proportional hazard models were used to evaluate the association between ICAD and event outcomes. A total of 1060 stroke-free participants evaluated by HR-MRI were included from the Shunyi study. The median age at HR-MRI was 56 years and 64.7% were female. The ICAD prevalence was 36.3% (n = 385). The ICAD+ group was older and had more cerebrovascular risk factors. The rates of ischemic stroke in the ICAD- and ICAD+ groups were 1.3% (n = 9) and 5.2% (n = 20), respectively, with a median follow-up time of 54 months. ICAD was associated with an increased risk of ischemic stroke in the unadjusted and adjusted Cox models, with hazard ratios of 4.12 (95% confidence interval [CI] 1.87-9.05) and 2.50 (95% CI 1.05-5.94), respectively. The greatest risk of an event outcome was observed in participants with ≥70% stenosis or occlusion. The features of high-risk plaques were also identified. We found that ICAD detected using HR-MRI increases the long-term risk of a first-ever ischemic stroke in a stroke-free population, suggesting that the current primary prevention protocol of stroke awaits further optimization.

Temporal and age-specific trends in incidence and 1-year case-fatality of hospitalized ischaemic stroke in Victoria, Australia

ObjectivesInvestigate temporal and age-specific trends in the incidence of ischaemic stroke and case-fatality risk in Victoria, Australia. Materials and methodsPatients hospitalised with first ischaemic stroke between 2012 and 2018 were included. Trends in age-standardised incidence rates of ischaemic stroke were assessed using linear regression models. Cox proportional hazard regression models were used to examine the case-fatality risk. ResultsOverall age-standardised incidence of ischaemic stroke was stable from 2012/13 to 2017/18 (87.6 to 84.8 events per 100,000 population; Annual percentage change [APC] -0.32; 95% Confidence interval [CI] -1.13 to 0.50). The incidence declined in females (APC -1.00; 95% CI -1.49 to -0.50), people aged 75-84 years (APC -1.60; 95% CI -2.83 to -0.36) and in metropolitan areas (APC -0.74; 95% CI -1.02 to -0.45). The risk of 1-year case-fatality (HR 0.85; 95% CI 0.78 to 0.93) significantly declined in 2016/17 compared to 2012/13. ConclusionsOverall ischaemic stroke incidence remained stable while decreasing trends were observed in females, elderly and metropolitan areas. 1-year case-fatality declined from 2012 to 2017.

Risk factors for stroke recurrence in young patients with first-ever ischemic stroke: A meta-analysis.

At present, the incidence rate of ischemic stroke in young people is increasing yearly, and the age of onset is increasingly young. Therefore, primary and secondary prevention of ischemic stroke in young people, especially secondary prevention, is particularly crucial. We aimed to comprehensively evaluate risk factors for stroke recurrence in first-ever young ischemic stroke (YIS) patients. The meta-analysis was used to quantitatively analyze the research results on risk factors for stroke recurrence in first-ever YIS patients both domestically and internationally. Stata12.0 software was used for heterogeneity testing, publication bias analysis, sensitivity analysis, and the calculation of combined odds ratios and 95% confidence intervals. The odds ratio (OR) values of the relationship between hypertension and hyperlipidemia and recurrence of first-ever YIS were 1.54 (1.05-2.26) and 1.12 (1.00-1.25), respectively. The OR values of male sex, type 2 diabetes, smoking, drinking and YIS recurrence were 1.66 (0.98-2.79), 1.01 (0.64-1.59), 1.21 (0.83-1.76), and 1.28 (0.82-2.53), respectively. The relationship between male sex, type 2 diabetes, smoking, drinking and YIS recurrence was ambiguous. Hypertension and hyperlipidemia are important risk factors for stroke recurrence in first-ever YIS patients, and active intervention should be taken.

The effect of COVID-19 on treatment and outcomes following ischemic stroke: A national assessment

IntroductionCOVID-19 has had innumerable impacts on the healthcare system, both by worsening patient illness and impeding effective and efficient care. Further, COVID-19 has been tied to increased rates of ischemic stroke, particularly among young patients. We utilized a national database to assess associations of COVID-19 with thrombectomy rates, mortality, and discharge disposition among stroke patients. MethodsPatients were identified from the National Inpatient Sample (NIS, 2020). Inclusion criteria selected for adult ischemic stroke patients; those with venous thrombosis or unspecified cerebral infarction were excluded. Patients were stratified by presence or absence of COVID-19 diagnosis. Outcome variables included mechanical thrombectomy, in-hospital mortality, and discharge disposition. Additional patient demographics, hospital characteristics, and disease severity metrics were collected. Statistical analysis was performed via multivariable logistic regression and log-binary regression. Results54,368 patients were included in the study; 2116 (3.89%) were diagnosed with COVID-19. COVID-19 was associated with lower rates of mechanical thrombectomy (OR 0.94, p < 0.0001), higher rates of in-hospital mortality (OR 1.14, p < 0.0001), and unfavorable discharge disposition (OR 1.08, p < 0.0001), even when controlling for illness severity. Other relationships, such as a male predominance among stroke patients with COVID-19, were also identified. ConclusionThis study identified a relationship between COVID-19 diagnosis and worse outcomes for each metric assessed, including mechanical thrombectomy rates, in-hospital mortality, and discharge disposition. Several factors might underly this, ranging from systemic/multisystem inflammation and worsened disease severity to logistical barriers to treatment caused by COVID-19. Further research is needed to determine causality of these findings.

Cardiovascular diseases in Ukraine: results of a retrospective analysis of the morbidity and current problems of its monitoring

Annotation. Monitoring the population's morbidity is an essential component of effective public health management and the healthcare system. The study aimed to conduct a retrospective analysis of cardiovascular disease (CVD) morbidity in Ukraine and its regions for the years 2010-2017, as well as to compare it with European and European Union countries. The study utilized data from the Medical Statistics Center of the Ministry of Health of Ukraine, obtained from state statistical reporting forms (form No. 12) and analyzed using statistical methods. The regional differentiation of primary morbidity and prevalence indicators of CVD in Ukraine was assessed using the amplitude of regional distribution, upper and lower quartiles, and the coefficient of regional variation. A comparison of age-standardized CVD morbidity indicators in Ukraine with European and European Union countries for the years 2010-2019 was based on data from the Global Burden of Disease (GBD) international epidemiological study, updated for 2019. It was found that in 2017, over 22 million adult residents in Ukraine suffered from CVD, with more than 1.7 million new cases of CVD registered annually among the adult population. CVD ranked first in the prevalence of diseases among the adult population (with a relative share of 37.4%) and second in the structure of primary morbidity (10.3%). Age-standardized rates of primary CVD morbidity in Ukraine exceeded similar indicators in European countries by 1.6 times and in EU countries by 1.9 times, and this significant gap was primarily due to high national rates of ischemic heart disease and stroke. In Ukraine, there is significant territorial differentiation in the levels of CVD morbidity and prevalence (coefficients of regional variation exceeding 20%). The study identified regions with consistently high levels of CVD morbidity. The unfavorable epidemiological situation regarding CVD in Ukraine necessitates the development and implementation of comprehensive state and regional interdisciplinary prevention programs, taking into account positive European experience in CVD control. Solving the problem of preventing CVD morbidity is impossible without establishing a modern monitoring and evaluation system of the epidemiological situation regarding CVD at the regional and national levels, which should utilize not only information on hospitalization, disability, and mortality due to CVD but also revitalize data collection and synthesis on CVD incidence, prevalence, and risk factors at a new methodological level, using modern information technologies.

Global and national burden of atherosclerosis from 1990 to 2019: trend analysis based on the Global Burden of Disease Study 2019.

Atherosclerosis-related diseases represent significant health issues among adults globally. Despite their widespread impact, comprehensive data concerning the global and national burden and trends of these diseases remain sparse. Our objective is to examine the trends in the burden of atherosclerosis among adults from 1990 to 2019 at both global and national levels. We reported the average annual percentage changes (AAPCs) in prevalence, incidence, mortality, and disability-adjusted life years (DALYs) of atherosclerosis-related diseases (ischemic heart disease [IHD], ischemic stroke, and peripheral arterial disease [PAD]) at the global and national levels among individuals based on a trend analysis of the Global Burden of Diseases Study (GBD) 2019. We further analyzed these global trends as a function of age, gender, and the social development index. We also used joinpoint regression analysis to identify the year with the most substantial changes in global trends. Globally, the AAPC of IHD incidence rose from 1990 to 2019 (0.20; 95% confidence interval [CI], 0.12-0.28), with substantial surges in 1995, 2001, 2005, 2010, and 2017. Conversely, AAPC of IHD mortality rates exhibited a different trend until a rise in 2014. The AAPC of incidence rates of ischemic stroke and PAD also escalated during the same period, with respective 0.43 (95% CI, 0.39-0.48) and 0.13 (95% CI, 0.06-0.21). For ischemic stroke, both incidence and mortality soared in 2014, while PAD incidence declined in 1994 and 1998, then sharply climbed in 2016. Nationally, the Northern Mariana Islands experienced the steepest increase in IHD and PAD incidence and mortality between 1990 and 2019. China saw a significant rise in ischemic stroke incidence, whereas the highest mortality rate increase occurred in Timor-Leste. By sociodemographic index (SDI) quintile, low-middle-, middle-, and high-middle-SDI countries all showed upward trends in IHD, ischemic stroke, and PAD incidence. Simultaneously, IHD and ischemic stroke mortality rates, as well as DALYs, dropped in the low-, high-middle-, and high-SDI nations. However, PAD mortality rates and DALYs saw an uptick across all SDI quintiles. Regarding age demographics, a global decrease in the AAPC IHD incidence as noted in individuals above 55 years old, in contrast to an increase in the 20-55 age group during this period. AAPC of mortality rates for IHD, ischemic stroke, and PAD decreased across all ages. The AAPC showed an increase in IHD incidence in both genders. Conversely, IHD's DALYs saw a reduction in both males and females. Ischemic stroke patterns mirrored these trends, whereas all measures for PAD exhibited growth for both sexes. From 1990 to 2019, there was an overall increasing trend in the global incidence of all three clinical manifestations of atherosclerosis. Between 1990 and 2019, both the mortality rate and DALYs for IHD and ischemic stroke declined across all age groups. Overall, the burden of atherosclerosis-related diseases has not significantly decreased and even shows signs of trending upward. These findings strongly suggest that despite some progress made, efforts to control atherosclerosis diseases globally need to be intensified.

Cold Case of Thrombolysis: Cold Recombinant Tissue Plasminogen Activator Confers Enhanced Neuroprotection in Experimental Stroke.

Background Thrombolysis and endovascular thrombectomy are the primary treatment for ischemic stroke. However, due to the limited time window and the occurrence of adverse effects, only a small number of patients can genuinely benefit from recanalization. Intraarterial injection of rtPA (recombinant tissue plasminogen activator) based on arterial thrombectomy could improve the prognosis of patients with acute ischemic stroke, but it could not reduce the incidence of recanalization-related adverse effects. Recently, selective brain hypothermia has been shown to offer neuroprotection against stroke. To enhance the recanalization rate of ischemic stroke and reduce the adverse effects such as tiny thrombosis, brain edema, and hemorrhage, we described for the first time a combined approach of hypothermia and thrombolysis via intraarterial hypothermic rtPA. Methods and Results We initially established the optimal regimen of hypothermic rtPA in adult rats subjected to middle cerebral artery occlusion. Subsequently, we explored the mechanism of action mediating hypothermic rtPA by probing reduction of brain tissue temperature, attenuation of blood-brain barrier damage, and sequestration of inflammation coupled with untargeted metabolomics. Hypothermic rtPA improved neurological scores and reduced infarct volume, while limiting hemorrhagic transformation in middle cerebral artery occlusion rats. These therapeutic outcomes of hypothermic rtPA were accompanied by reduced brain temperature, glucose metabolism, and blood-brain barrier damage. A unique metabolomic profile emerged in hypothermic rtPA-treated middle cerebral artery occlusion rats characterized by downregulated markers for energy metabolism and inflammation. Conclusions The innovative use of hypothermic rtPA enhances their combined, as opposed to stand-alone, neuroprotective effects, while reducing hemorrhagic transformation in ischemic stroke.

Association Between Idiopathic Thrombocytopenic Purpura and Hemorrhagic and Nonhemorrhagic Stroke.

Idiopathic thrombocytopenic purpura (ITP) is characterized by a low platelet count. This may lead to an increased risk of hemorrhagic stroke but a lower rate of nonhemorrhagic stroke. The goal of this study was to evaluate the association between ITP and both hemorrhagic and nonhemorrhagic strokes using a large database. We used the Nationwide Inpatient Sample (NIS) database to analyze the occurrence of hemorrhagic and nonhemorrhagic stroke in patients with and without a diagnosis of ITP from 2005 to 2014. Univariate analysis revealed a higher incidence of hemorrhagic stroke in patients with ITP in the year studied. (for example, in 2005: OR, 1.75; 95% CI, 1.57-1.94; P < 0.001; 2014: OR, 2.19; 95% CI, 2.03-2.36; P < 0.001). After adjusting for age, gender, race, and hypertension, hemorrhagic stroke remained significantly associated with ITP (in 2005: OR, 1.85; 95% CI, 1.49-1.89; P < 0.001; 2014: OR, 2.01; 95% CI, 1.86-2.18; P < 0.001) for all the years studied. Nonhemorrhagic stroke occurred at a lower rate in patients with ITP in most years (2006: OR, 0.91; 95% CI, 0.85-0.97; P = 0.004; 2014: OR, 0.88; 95% CI, 0.83-0.93; P < 0.001). Multivariate analysis confirmed a higher rate of nonhemorrhagic stroke in ITP patients. Our analysis showed that there was a higher rate of hemorrhagic stroke but a lower rate of ischemic stroke in ITP patients, suggesting an important role of platelets in the occurrence of stroke.