History Of Stroke Research Articles

Comparative analysis of risk factors and clinical outcomes in young patients with acute ischemic and hemorrhagic stroke

BackgroundStroke is a leading cause of death and disability worldwide and has significant socioeconomic impacts, particularly among young adults. This study focused on young adults (18–55 years) who experienced acute ischemic (AIS) or hemorrhagic stroke (HS) in Zanjan, Iran.MethodsA retrospective registry-based analysis was conducted using data from the Vali-e-Asr Hospital Stroke Center. A total of 5345 stroke patients were recorded between March 2016 and June 2023, and 616 young stroke survivors were included. Baseline demographic data, stroke risk factor data, functional status (modified Rankin scale (mRS) score, stroke severity (NIHSS score), treatment history, and mortality were analyzed. The statistical analyses included chi-square tests, independent t tests, and logistic regression.ResultsThe cohort comprised 525 AIS (85.23%) and 91 HS (14.77%) patients. Significant differences were observed between groups in terms of atrial fibrillation incidence, antiplatelet treatment history, hypertension, previous smoking, and recent stroke history. HS patients had a higher baseline NIHSS score (12.90 ± 6.04 vs. 7.69 ± 8.56, p < 0.05). In-hospital and three-month mortality rates were significantly greater in the HS group. Factors significantly associated with in-hospital mortality included hemorrhagic stroke, female sex, higher NIHSS score, and current smoking status. Lower odds of achieving excellent functional outcomes and functional independence at three months were noted for HS patients, influenced by NIHSS scores and prior health conditions.ConclusionYoung stroke patients, particularly those with hemorrhagic stroke, have higher mortality and poorer outcomes. The key risk factors included stroke type, NIHSS score, smoking status, and sex. Identifying and managing these factors could improve patient outcomes.

Polygenic Risk of Epilepsy and Poststroke Epilepsy.

Epilepsy is highly heritable, with numerous known genetic risk loci. However, the genetic predisposition's role in poststroke epilepsy (PSE) remains understudied. This study assesses whether a higher genetic predisposition to epilepsy raises poststroke survivor's risk of PSE. We conducted a case-control genetic association study nested within the UK Biobank, a large UK-based prospective cohort. Our exposures of interest were 2 distinct polygenic risk scores-generalized and focal epilepsy-modeled as deciles and constructed using genetic variants identified in the latest International League Against Epilepsy genome-wide association study meta-analysis. We aimed to evaluate the association between these polygenic risk scores and their corresponding subtype of PSE-generalized and focal. In sensitivity analyses, we evaluated participants of European ancestry separately and considered focal and generalized epilepsy outcomes in participants without a history of stroke. In secondary analyses, we evaluated the polygenic risk of PSE by stroke subtype (ischemic, hemorrhagic, or any stroke). Multivariable logistic regression models were fitted, adjusting for age, sex, genetic ancestry, and the first 5 principal genetic components. Among 17 549 UK Biobank stroke survivors with available genetic information (mean age, 61; 43% female), 185 (1%) developed generalized PSE, while 124 (0.7%) developed focal PSE. Multivariable logistic regression results showed that, when compared against the lowest decile, participants within the highest PRS decile for generalized PSE had 5-fold higher odds of developing generalized PSE (OR, 5.05 [95% CI, 2.37-12.5]; P trend<0.001). Similarly, when compared against the lowest decile, participants within the highest polygenic risk score decile for focal PSE had 3-fold higher odds of developing focal PSE (OR, 3.20; [5% CI, 1.25-9.82]; P trend=0.024). Sensitivity analyses among participants of European ancestry yielded similar results. Our findings suggest that, like other forms of epilepsy, genetic predisposition plays an essential role in PSE. These results underscore the need for future studies to elucidate the mechanisms underlying PSE development and to identify novel therapeutic avenues.

Một số yếu tố ảnh hưởng đến thời gian nhập viện ở bệnh nhân nhồi máu não cấp

Object: Some factors affect hospitalization time in patients with acute cerebral infarctionMethod: Cross-sectional, retrospective descriptive study including 150 patients with acute cerebral infarction treated at the Neurology Center and Stroke Center, Bach Mai Hospital from January 2023 to December 2023.Result: The average hospital admission time was 661.5 minutes (11 hours); Only 26 patients were hospitalized early before 4.5 hours, accounting for 17.3%; Factors affecting the early hospitalization time of patients are high educational level (OR: 2.362; 95% CI [1.002-5.565]), daytime onset time (OR: 3.787; 95% CI [ 0.081-0.996]), having a witness at the time of symptom onset (OR: 5.928; 95% CI [1.336-26.308]), using ambulance transportation (OR: 32.445; 95% CI [9,916-106,223]), history of stroke or TIA (OR: 5.9; 95% CI [1.73-20,121]), recognition of symptoms of stroke (OR: 256.82; 95% CI [31] ,69-2081.44]) and knowledge of fibrinolytic drugs (OR: 83.18; 95% CI [16.81-411.69]); Factors affecting the patient's late hospitalization time include: distance to the hospital &gt;15km (OR: 0.33; 95% CI [0.117-0.931]), admission to a front-line medical facility (OR: : 0.165; 95% CI [0.054-0.507]).Conclusion: Factors affecting the patient's early hospitalization time include: high educational level, time of illness onset during the day, presence of witnesses at the time of symptom onset, use of public transport ambulance, history of stroke or TIA, recognition of stroke symptoms and knowledge of thrombolytic drugs.

Factors Associated with Heart Disease in Japan: Multivariate Analysis Based on Specific Health Checkups

The global population affected by heart failure is projected to reach 30 million. The number of deaths due to heart disease has surged, rising from 2 million in 2000 to 8.9 million in 2019. In Japan, the prevalence of heart failure is rapidly increasing, with the number expected to reach 1.3 million by 2030. Primary prevention is crucial to prevent heart disease. We explored the associations of heart disease incidence with findings from checkups performed a decade ago. A multivariate logistic regression analysis revealed that individuals who reported a history of stroke, history of chronic renal failure, or weight gain ≥ 10 kg since age 20 in the questionnaire-based health checkup are at high risk for developing heart disease. Additionally, those with biochemical test results from 10 years ago indicating the use of antihypertensive drugs, use of insulin injections or hypoglycemic medications, systolic hypertension, and abnormal creatinine levels also exhibited a significantly higher risk of heart disease. Conversely, individuals who identified as female, walked faster than people of the same age, drank alcohol daily, and felt refreshed upon awakening in the questionnaire-based health checkup were protected from heart disease.

Study on the predictive model of delirium risk after surgery for elderly hip fractures based on meta-analysis.

To develop and validate a risk prediction model for postoperative delirium in elderly patients with hip fractures, aiming to identify high-risk patients and implement preventive measures. A systematic search of five authoritative medical databases was conducted, retrieving a total of 1368 relevant articles. After screening, 44 high-quality studies were included in the meta-analysis, analyzing 13 potential risk factors, such as age, gender, diabetes, and history of stroke. A risk prediction model was constructed and validated in a cohort of 189 elderly hip fracture patients. The model's predictive performance was evaluated using ROC curves, with calibration assessed through the Hosmer-Lemeshow test, and clinical utility examined via Decision Curve Analysis (DCA) and Clinical Impact Curves (CIC). The meta-analysis identified the following as independent risk factors for postoperative delirium: age (≥ 70years), male gender, diabetes, history of stroke, preoperative comorbidities (≥ 2), previous delirium, preoperative cognitive impairment, low preoperative albumin levels (≤ 40g/L), prolonged preoperative waiting time (≥ 48h), anemia (≤ 100g/L), ASA classification (≥ 3), use of general anesthesia, and prolonged surgery duration (≥ 2h). The prediction model demonstrated strong efficiency in the validation cohort, with an AUC of 0.956, sensitivity of 87.3%, specificity of 94.8%, and a Brier score of 0.144, indicating high predictive accuracy and calibration. DCA and CIC analyses showed the model to have strong clinical decision-making value and impact across most thresholds. The risk prediction model developed in this study shows high predictive accuracy and clinical utility, making it valuable for identifying high-risk patients and implementing preventive measures in clinical practice. However, the study has limitations, such as potential retrospective bias, and further validation in larger, multicenter prospective studies is needed to confirm the model's broader applicability and stability.

Longitudinal outcomes of chronically transfused adults with sickle cell disease and a history of childhood stroke.

Many children with sickle cell disease (SCD) who suffer a stroke receive chronic transfusion therapy (CTT) indefinitely; however, their adulthood neurologic outcomes have not been reported. Understanding these outcomes is critical to inform decisions regarding curative therapy in childhood. In this retrospective study, we described a cohort of adults with SCD and a history of childhood stroke who received care at a single center and compared their outcomes with matched subjects without childhood strokeusing chi2 and Mann-Whitney U tests. Of 42 subjects with childhood stroke, all received CTT for secondary stroke prophylaxis. Five (11%) developed recurrent stroke. The rate of stroke was similar in subjects with and without childhood stroke (0.7 vs. 1.1 per 100 person·years, p = .63). Both cohorts exhibited evidence of iron overload (median ferritin 2227 vs. 1409 ng/dL, p = .10) and alloimmunization (45% vs. 45%, p = 1.0), despite receiving care in a comprehensive SCD program. For adults with SCD who had a childhood stroke, our results suggest CTT returns the risk of stroke to that of age-matched stroke naïve patients with SCD.

Iterative random forest-based identification of a novel population with high risk of complications post non-cardiac surgery

Assessing the risk of postoperative cardiovascular events before performing non-cardiac surgery is clinically important. The current risk score systems for preoperative evaluation may not adequately represent a small subset of high-risk populations. Accordingly, this study aimed at applying iterative random forest to analyze combinations of factors that could potentially be clinically valuable in identifying these high-risk populations. To this end, we used the Japan Medical Data Center database, which includes claims data from Japan between January 2005 and April 2021, and employed iterative random forests to extract factor combinations that influence outcomes. The analysis demonstrated that a combination of a prior history of stroke and extremely low LDL-C levels was associated with a high non-cardiac postoperative risk. The incidence of major adverse cardiovascular events in the population characterized by the incidence of previous stroke and extremely low LDL-C levels was 15.43 events per 100 person-30 days [95% confidence interval, 6.66–30.41] in the test data. At this stage, the results only show correlation rather than causation; however, these findings may offer valuable insights for preoperative risk assessment in non-cardiac surgery.

Assessing the efficacy of an educational video on stroke knowledge in Lebanon: a single-arm interventional study

ObjectiveThis study aimed to assess the public’s knowledge of stroke before and after viewing an educational video about stroke risk factors, preventive measures, and alarming signs.MethodsA single-arm interventional study was conducted in Lebanon using a 3-minute video-based education about stroke. A pre- and post-structured questionnaire compared the level of knowledge about stroke.ResultsThe study included 685 participants. Knowledge of stroke, risk factors, warning signs, treatment, and preventive measures significantly increased post-educational video sessions. A higher baseline knowledge score was associated with a family history of stroke (Beta = 1.76) and being a healthcare professional (Beta = 3.35). Participants between 25 and 34 years (Beta=-1.39) and those with a high risk of stroke (Beta=-1.03) were significantly associated with a lower knowledge score.ConclusionThis study demonstrated the effectiveness of a video-based educational tool to raise awareness about stroke. Short, targeted audio-visual resources using lay language can convey health education messages and influence behavioral changes. The community can benefit from a large-scale educational campaign that targets different socio-economic statuses to enhance knowledge of stroke and save lives.

Determinants of cognitive health in the elderly: a comprehensive analysis of demographics, health status, and lifestyle factors from NHANES.

This study analyzes data from the National Health and Nutrition Examination Survey (NHANES) to identify factors influencing cognitive performance among the elderly, as measured by the Digit Symbol Substitution Test (DSST). Employing multivariable linear regression, we evaluated the impact of demographic, lifestyle, and health-related factors on cognitive function in U.S. adults aged 60 and older. Our findings indicate that advanced age, particularly in those aged 70-79 and 80 + years, is associated with lower DSST scores. Male gender is linked with reduced cognitive performance, while higher educational attainment appears protective. Lifestyle factors, including current smoking and higher alcohol consumption, negatively impact cognitive outcomes, and excessive sleep duration (over 9h) is also detrimental. Among health conditions, diabetes, chronic heart failure, and a history of stroke were associated with cognitive declines. Furthermore, increasing severity of depression correlates with lower cognitive function. These results underline the need for comprehensive public health strategies that integrate lifestyle modifications and chronic disease management to maintain cognitive health in older adults.

Coagulation hemostasis disorders and elevated lipoprotein (a) levels in patients with arterial hypertension and multifocal atherosclerosis

Introduction. Hemostatic disorders may act as additional risk factors in patients with arterial hypertension (AH) and multifocal atherosclerotic lesion (MFAL). Elevated lipoprotein (a) (Lp(a)) levels may exacerbate procoagulant shifts.Aim. To identify disorders in the coagulation link of hemostasis in patients with AH and MFAL, depending on the level of Lp(a).Materials and methods. The study included 219 patients with hypertension and MFAL, median age 59 (53; 66) years, of which 110 patients with stage I–II controlled hypertension (group 1) and 109 patients with stage III controlled hypertension with a history of ischemic stroke. Depending on the level of Lp(a), patients in each group were divided into 2 subgroups with Lp(a) levels &lt; 50 mg/dl and with Lp(a) levels above 50 mg/dl. Patients of both groups received antihypertensive, lipid-lowering, antiplatelet therapy and had comparable values of blood pressure and lipid spectrum.Results. In group 2 patients, procoagulant shifts were significantly more often recorded, despite the constant use of antiplatelet therapy. Violations of hemostasis parameters depending on the level of Lp(a) were observed in subgroups 1b and 2b. According to the results of multiple a posteriori comparisons, the most significant hypercoagulation changes were observed in patients with stroke, as well as with Lp(a) levels &gt; 50 mg/dl.Conclusions. Thus, in some patients with hypertension and MFAL, despite taking antihypertensive, lipid-lowering and antiplatelet therapy, coagulation hemostasis disorders may occur. Elevated Lp(a) levels are combined with more pronounced hemostatic disorders, especially in the presence of a previous stroke. Intensification of antithrombotic therapy may be considered in such patients to prevent cardiovascular complications.

Sarcopenia's Impact Defined by Grip Strength and Muscle Mass on Post-hepatectomy Outcomes: A Multicenter Analysis.

Sarcopenia is diagnosed based on grip strength and skeletal muscle mass. Although decreased skeletal muscle mass has been reported to be associated with poor outcomes after hepatectomy, a few studies have included data on grip strength in hepatectomy candidates. This multicenter study investigated the clinical factors and postoperative complications associated with sarcopenia by assessing the grip strength and skeletal muscle mass in patients undergoing hepatectomy for hepatocellular carcinoma (HCC). Data from patients who underwent hepatectomy for HCC between January 2020 and March 2022 were retrospectively collected from multi-institutional databases. Sarcopenia was defined as reduced grip strength and skeletal muscle mass. The patients were categorized into the sarcopenia and non-sarcopenia groups, and baseline characteristics and short term outcomes were compared between the two groups. Overall, 253 patients were included, among which 36 (14.2%) had sarcopenia. The sarcopenia group was significantly associated with older age, low body mass index, comorbid heart or chronic pulmonary disease, cerebrovascular accident history, and overall and major postoperative complications compared to the non-sarcopenia group. Among major postoperative complications [Clavien-Dindo classification (CDC) ≥III], the incidence of bile leakage and intra-abdominal abscess were higher in the sarcopenia group than in the non-sarcopenia group. Multivariate analysis revealed that sarcopenia was an independent risk factor for overall and major postoperative complications (CDC ≥III). Sarcopenia, defined by grip strength and skeletal muscle mass, is a predictor of overall and major complications after hepatectomy for HCC.

Comparison of left atrial and left atrial appendage mechanics in patients with ischaemic strokes of different aetiologies

Abstract Background Left atrial (LA) and left atrial appendage (LAA) mechanical dysfunction account for an increase in cardioembolic stroke risk in atrial fibrillation (AF), and more recently in individuals in sinus rhythm (SR). However, the exact contribution of LA and LAA to the pathogenesis of thromboembolic events is not fully understood. Here, we aimed to assess the alterations of LA and LAA mechanics in different stroke subtypes. Methods We recruited three groups of participants: patients with paroxysmal or persistent AF with a history of stroke (AF-stroke, n=69,respectively), individuals in SR with no history of AF but with acute ischaemic stroke(non-AF stroke,n=46); individuals with no history of AF or stroke(control group,n=17). Patients with AF were further categorized into sinus rhythm group (AF-stroke-SR,n=24) and AF rhythm group(AF-stroke-AF, n=45) according to the rhythm at the time of echocardiography. Using speckle-tracking echocardiography, global longitudinal strain (GLS) and mechanical dispersion (MD) of LA and LAA were measured in all patients. Mechanical dispersion was defined as the standard deviation of the time to peak of the regional strain corrected by R-R interval. Results Patients with AF-stroke demonstrated prominently impaired LA and LAA mechanics(LA GLS: 20±6%(AF-stroke-SR),11±4%(AF-stroke-AF); LA MD: 9±3%,11±3%; LAA GLS: 15±3%,11±4% ; LAA MD: 11±4%,12±3% ,respectively) compare with those with non-AF stroke and controls (LA GLS:35±8%, 41±11%;LA MD,6±2%, 4±2%; LAA GLS:21±5%, 23±7%; LAA MD:8±4%, 7±3%,respectively) (all p&amp;lt;0.01). Interestingly, LA and LAA mechanical function was not significantly different between patients with non-AF strokes and the control group. In multivariable analysis, only AF-strokes were independently associated with LA and LAA GLS after adjusting for age and comorbidities (both P&amp;lt;0.01). Conclusions Mechanical dysfunction of LA and LAA might play a greater role in pathogenesis of strokes related to AF rather than non-AF strokes.

Polygenic risk score for prediction of atrial fibrillation according to presence of the hypertrophic cardiomyopathy

Abstract Background The significance of genetic predisposition in predicting atrial fibrillation (AF) is well recognized, yet its role in hypertrophic cardiomyopathy (HCM) patients remains less clear. Objective In this study, we aimed to elucidate the impact of genetic risk on the development of AF in both HCM and non-HCM patients. Methods This retrospective analysis examined 1,180 HCM patients (mean age 61.1±7.1, 63.0% male) and 476,238 non-HCM patients (mean age 57.0±8.1, 45.3% male) from the UK Biobank. Participants were stratified based on their validated polygenic risk score (PRS) for AF: the bottom 10% constituted the low genetic risk group, the top 10% comprised the high genetic risk group, and the remainder fell into the intermediate genetic risk group. We assessed the incidence of AF and major cardiovascular events and analyzed predictors, including genetic risk. Results Among HCM patients, no significant differences in baseline characteristics were observed based on genetic risk, except for the rate of CIED implantation (P=0.036). Conversely, among non-HCM patients, variations in age, gender, and comorbidities were noted according to genetic risk. The HCM patients were categorized into three groups based on risk, with respective AF incidence rates of 2.4, 3.6, and 5.4 events per 100 person-years, respectively. In non-HCM patients, the incidence of AF per 100 person-years was 0.2, 0.5, and 1.0, respectively. Genetic risk emerged as a significant predictor of AF in both HCM and non-HCM patients, although with a higher hazard ratio observed in non-HCM patient (HR, 2.51; 95% CI, 1.59–3.98 vs. HR, 4.77; 95% CI, 4.47–5.09) (P=0.003 for interaction). In non-HCM patients, predictors of AF included age, male sex, body mass index, smoking history, and a history of hypertension, diabetes, heart failure, stroke, and myocardial infarction, in addition to PRS. However, in HCM patients, only age, diabetes, and a history of stroke were identified as independent predictors of AF. Moreover, high genetic risk was significantly associated with the risk of major adverse cardiovascular events. Conclusions In conclusion, our study indicates associations between genetic predisposition and AF occurrence in both HCM and non-HCM patients.

Evaluation of efficacy and safety of simplified procedure for the percutaneous closure of patent foramen ovale: the Ile De France Foramen Ovale Permeable(IDFFOP) prospective, multicenter cohort study

Abstract The superiority of device closure over medical therapy for the prevention of recurrent stroke in patients with cryptogenic stroke and patent foramen ovale (PFO) was reported in several meta –analyses of randomized controlled trials. The growing number of PFO procedures requires to find alternatives to conventional guidance by transoesophageal echocardiography (TOE) needing general anesthesia. The aim of our study was to assess prospectively the efficacy and safety of a simplified procedure based on trans thoracic echocardiography (TTE) and local anesthesia rather than TOE during PFO closure. Methods Design and study oversight. The IDFFOP study was a French prospective, multicenter cohort study performed in four centers expert in TTE-guided device deployment. All patients had a stroke history, a PFO and a large or moderate right to left shunt defined by the number of microbubbles in the left atrium ( large shunt &amp;gt; 30, moderate : 10 to 30 microbubbles). A(Risk of Paradoxical Embolism) score&amp;gt;5 was required to confirm PFO imputability in stroke history. The primary end point was efficacy of TTE during the transcatheter PFO closure defined as the successful implantation of the device without malposition, without need of TOE, and absence of significant residual shunt at 3-month TTE control. Safety was defined as the absence of any periprocedural complications. Results 280 patients were enrolled from January 2018 to October 2020 ( male sex : 59.5%; Average age 57 years old ). Average ROPE score was 7; Cumulative immediate procedural success with the TTE-guided method was 99%, without any device embolization. However, in 2 patients, TOE was needed to guide device deployment. There was no severe vascular complication, or any ischaemic event during or after the procedure. 6 post-procedure groin hematomas occurred but none needed anyblood transfusion .One patient experienced a transient periprocedural atrial fibrillation. At 3 months there were only 8 (2,8%) residual right to left shunts (3 large, 5 moderate). Conclusion A simplified procedure for percutaneous PFO closure based on TTE and local anesthesia is safe and effective. Randomized controlled trials should be performed to confirm these results.

Cardiac amyloidosis and left atrial appendage closure: a multicenter retrospective study

Abstract Background Thromboembolic stroke risk remains a clinical challenge in cardiac amyloidosis (CA) patients with atrial fibrillation because of the increased prevalence of left atrial appendage thrombi irrespective of CHA2DS2-VASc score and a higher prevalence of factors that increase the risk of bleeding with anticoagulation. Left atrial appendage closure (LAAC) is an effective option in patients with atrial fibrillation and high bleeding risk; however, data describing a LAAC strategy for stroke prevention in patients with CA is limited. Among non-CA patients, procedural success and serious complication rates are around 98% and 3% respectively. Purpose In this multicenter retrospective study, we aimed to investigate whether left atrial appendage closure (LAAC) could reduce the risk of bleeding complications and ischemic cerebrovascular events in patients with CA. Methods In an international multi-center retrospective study, patients with CA that underwent LAAC were included. The diagnosis of CA was established on the basis of histologic confirmation or advanced multimodality cardiac imaging as per current consensus statements. Results A total of 28 patients (93% male; 87% ATTR-CA; 13% AL-CA; mean age 80 years) met inclusion criteria. At baseline, mean CHA2DS2-VASc and HAS-BLED scores were 4 and 3 respectively, mean left ventricular ejection fraction was 50%, and mean indexed left atrial volume was 58 mL/m2. 21% of patients had a prior history of ischemic stroke, 14% prior history of hemorrhagic stroke, 7% prior transient ischemic attack, and 54% had a prior history of major or minor bleeding. Procedural success was achieved in 26 patients (93%) with procedural complications occurring in 2 patients (vascular access site bleeding and cardiac tamponade). Regarding in-hospital and follow-up complications, 0% ischemic stroke, 0% hemorrhagic stroke, and major or minor bleeding in 4% of patients. During follow up, device thrombosis occurred in only 1 patient. Conclusion LAAC is a feasible and effective alternative to anticoagulation in patients with CA and excessive bleeding risk, with procedural success and complication rates similar to reported studies of non-CA patients.

Temporal trends and prognostic significance of heart failure after acute myocardial infarction

Abstract Background There are limited and conflicting data regarding the incidence and prognostic impact of in-hospital heart failure (HF) complicating acute myocardial infarction (MI). The aim of this study was to examine temporal trends in the incidence and outcomes of systolic HF after acute MI in a large national cohort in South Korea. Methods The nationwide Korea Acute Myocardial Infarction Registry records baseline characteristics, treatments, and outcome of consecutive patients with acute MI admitted to hospitals capable of primary percutaneous coronary intervention (PCI) in South Korea. Systolic HF was defined as an ejection fraction ≤40% by echocardiography at admission. This study included 68,123 patients admitted for index acute MI between 2005 and 2020 (phase 1: 2005-2007, n=14,735; phase 2: 2008-2011, n=24,656; phase 3: 2012-2015, n=13,104; phase 4: 2016-2020, n=15,628). Results In all patients, the incidence of HF declined from 19.4% in phase 1 to 14.1% in phase 4 (p&amp;lt;0.001). This decrease was more pronounced in patients with ST-segment elevation MI (STEMI, from 20.9% to 15.8%) compared to those with non-ST-segment elevation MI (NSTEMI, from 17.9% to 12.3%). The use of PCI and of statins at discharge increased from 86% to 91.2% and from 75.1% to 92.2%, respectively (p&amp;lt;0.001 for all). Previous history of MI increased from 8.4% to 10.4% (p&amp;lt;0.001) whereas previous history of HF and stroke decreased from 6.3% to 1.3% and from 17.4% to 6.4%, respectively (p&amp;lt;0.001). The median symptom-to-door time decreased from 3.5 hours to 2.1 hours for STEMI and from 6.3 hours to 5.5 hours for NSTEMI (p&amp;lt;0.001). The median door-to-balloon time decreased from 107 min to 64 min for STEMI and from 26 hours to 14 hours for NSTEMI (p&amp;lt;0.001). The in-hospital and 12-month mortality rates for all patients decreased over the years from 5.0% to 3.3% and from 7.6% to 6.1%, respectively (p&amp;lt;0.001). However, in those who developed HF during the index MI, no significant declining trends were observed in in-hospital mortality (phase 1: 8.8%, phase 2: 7.95%, phase 3: 8.3%, phase 4: 7.3%, p=0.123) and 12-month mortality (phase 1: 15.4%, phase 2: 12.6%, phase 3: 19.4%, phase 4: 15.2%, p=0.270). Independent predictors of developing in-hospital HF were age &amp;gt;75 years, body mass index &amp;lt;18.5 kg/m2, symptom-to-door and door-to-balloon times, systolic blood pressure &amp;lt;100 mmHg at presentation, heart rate &amp;gt;90 min at presentation, presence of atrial fibrillation or diabetes, and previous history of MI, HF or stroke. Conclusions A marked reduction was found in the incidence of HF after acute MI between 2005 and 2020 in South Korea. However, in-hospital and 12-month mortality rates in HF patients remain unchanged, warranting intensive post-MI management with more aggressive efforts for secondary prevention.

Prediction of 10-year risk for recurrent atherosclerotic cardiovascular events in a secondary prevention population: Insights from CHART-2 and Suita studies in the Japanese population

Abstract Background Despite the European Society of Cardiology (ESC) guidelines advocating risk prediction models for secondary prevention in established atherosclerotic cardiovascular disease (ASCVD) patients, such models for Japanese individuals remain limited, owing to their comparatively lower ASCVD risk than Western populations. Given this gap, there is a need to develop tailored risk assessment tools for Japanese ASCVD patients to optimize secondary prevention strategies. Purpose Leveraging data from two large-scale, long-term cardiovascular cohorts in Japan, our aim was to develop and externally validate a 10-year risk model predicting recurrent cardiovascular events among patients with established ASCVD. Methods The CHART-2 and Suita studies, large-scale prospective observational multicenter cohort studies in Japan, served as the primary data sources for this investigation. From the CHART-2 study, which comprised 3,560 patients with a history of coronary artery disease or ischemic stroke, we derived our risk model. External validation was conducted using data from the Suita study, which included 445 patients with similar ASCVD backgrounds. The primary outcome of interest was a composite endpoint encompassing cardiovascular death, myocardial infarction, or stroke. Variable selection was performed based on clinically relevant factors previously employed in established risk scores (SMART, REACH, and TRS 2°P risk scores). Logistic regression was utilized for model development, and the predictive performance was assessed using the C-index. Results Over a median follow-up of 10.1 years, the derivation cohort experienced 756 cardiovascular events. Patients in the derivation cohort had an average age of 68.9 ± 10.6 years, with 91% and 24% having a history of coronary artery disease and ischemic stroke, respectively. Using logistic regression, the multivariate model revealed a higher recurrent risk associated with several factors including age, smoking status, systolic blood pressure, diabetes, renal function, number of ASCVD events, atrial fibrillation, lipid levels, left ventricular systolic dysfunction, and statin use. A simple risk score based on these predictors demonstrated a &amp;gt;5-fold gradient of 10-year recurrent risk with a C-index of 0.65 (95% CI 0.63-0.68, Figure). The prediction model was externally validated in the Suita study wit 245 cardiovascular events and a median follow-up of 10.4 years, showing good discriminative ability with a C-index of 0.64 (95% CI 0.60–0.68). Conclusion Our newly developed prediction model offers a valuable tool for identifying individuals at heightened risk of recurrent cardiovascular events over a 10-year period, thereby facilitating more targeted and effective secondary prevention strategies tailored to the unique characteristics of Japanese ASCVD patients.

Novel morphological classification of left atrial appendage using 3-dimensional printer -rock, paper and scissors-

Abstract Background The WATCHMAN device was developed as a permanent implantable device to seal off the LAA to prevent cardiogenic embolism. It has been used in Japan since September 2019 only for patients who are at the high risk of bleeding events. It is known that the LAA diameter of Asians is larger than that of non-Asians. Furthermore, the LAA of the Japanese are more complicated, compared to the Western. Whereas the four classifications from previous reports are widely used in the world, the classification differs with different physicians in the real-world practice. Purpose We aimed to identify the relationship between morphological features of LAA and clinical events such as ischemic stroke in Japanese patients. Methods All LAAC cases in our institution performed between February 2020 and December 2023 were retrospectively analyzed. The three-dimensional printing of LAA was generated from cardiovascular computed tomography imaging data. The shapes of the LAA were classified into 3 morphological types: (1) The LAA with bi lobe was defined as "Scissors" type; (2) The one with complicated peripheral branches was "Paper" type; (3) The simple one was "Rock" type. We examined the between the risk of cardioembolic stroke and the morphological features of the LAA. The left atrial appendage was classified by two cardiologists, and when they made different choices, we used the operator's choice. Results The cohort consisted of 116 patients, excluding 22 patients without CT scans. Of those, 30 (26%), 38 (33%) and 48 (41%) patients were divided into the Rock, Scissors and Paper types, respectively. All groups were identically matched for comorbidities. Table shows the patient characteristics and the results of univariate and multivariate analysis. There were 51 (44%) patients who had a history of cardioembolic stroke (18% vs. 30% vs. 53%; Rock vs. Scissors vs. Paper types, p-value = 0.05). In the multivariate analysis, the Paper type is the potential risk factor of cardioembolic stroke (p-value = 0.01). In addition, of those, 36 (31%), 32 (28%), 28 (24%) and 20 (17%) patients were divided into the Chicken wing, Cactus, Cauliflower and Windsock types, respectively. The four types were not associated with prior cardioembolic stroke events (18% vs. 25% vs. 55%; Chicken wing vs. Cactus vs. Cauliflower vs. Windsock types, p-value = 0.83). The match rate of cardiologists’ choice was 86.2% for the new classification and 44.8% for the classical classification. Conclusions The morphological features of LAA by three-dimensional printing was significantly related to cardioembolic stroke in this population. Patients with Paper type LAA were significantly more likely to have had a history of cardioembolic stroke. These results could have a relevant impact on the antithrombotic management of patients who are at the high risk of embolic and bleeding events and, moreover, LAAC could be the best option for these patients.

High-sensitivity troponin T and risk of stroke in persons with suspected acute coronary syndrome

Abstract Background Serial high-sensitivity troponin (hsTn) concentrations are associated with the risk of recurrent ischemic events and death from any cause. Higher hsTn levels may suggest greater infarct size and possibly, a more pronounced risk of non-coronary atherosclerotic events. Purpose To examine the association between single and serial hsTnT levels and the risk of incident stroke in individuals presenting with suspected acute coronary syndrome. Methods In this Danish nationwide registry-based study, we identified individuals without a history of stroke who presented for myocardial infarction, unstable angina, suspected myocardial infarction, or chest pain from 2013 through 2019, and who underwent serial hsTnT (Roche Diagnostics, Rotkreuz, Switzerland; 99th percentile upper reference limit: 13.5 ng/l) measurements 1-7 hours apart. Subjects were stratified according to their hsTnT level pattern from first to second measurement (main groups: normal, rising, persistently elevated, or falling) and the magnitude of hsTnT level change (secondary groups: &amp;lt;20%, &amp;gt;20 to 50%, or &amp;gt;50% in either direction). Additionally, they were grouped into quartiles based on the initial hsTnT measurement (&amp;lt;=9 ng/l, 10-16 ng/l, 17-68 ng/l, &amp;gt;=69 ng/l). The standardized risk of stroke was computed using multivariable logistic regression with average treatment effect modeling. Results The final study sample consisted of 26867 persons, of whom 10407 (38.7%) were diagnosed with myocardial infarction, 1404 (5.2%) with unstable angina, and 15056 (56.0%) with suspected myocardial infarction or chest pain. Median age was 64.3 years, and 40.1% were women. The prevalences of known cardiovascular disease were as follows: coronary artery disease, 20.2%; prior coronary revascularization, 8.4%; heart failure, 6.4%; and atrial fibrillation, 8.9%. At 30 days, 69 individuals had been diagnosed with a stroke, and an additional 185 individuals were diagnosed from days 31 through 365. The standardized risk of stroke at 30 days was &amp;lt;=0.31% in all main groups and did not meaningfully differ from each other. The risk remained low between days 31-365 (&amp;lt;=0,79%), with no significant between-group difference. The magnitude of hsTnT change within each group did not affect stroke risk, nor did hsTnT quartile based on the first measurement. Conclusions Persons with suspected acute coronary syndrome had a very low overall risk of incident stroke. Single or serial hsTnT levels at presentation did not seem helpful in identifying individuals at an increased risk of stroke.

Ventricular and supraventricular ectopic beats burden is correlated with bone mineral density and osteoporotic fracture risk in postmenopausal females

Abstract Introduction Patients (pts) with osteoporosis (OP) have an increased 10-year cardiovascular death risk. Low bone mineral density (BMD) observed in OP may be associated with arrhythmic presentation of cardiovascular diseases (CVD). Few studies assessed the relationship between OP and arrhythmia. Aim Arrhythmias assessment in pts with OP. Methods A total of 103 postmenopausal female pts (mean age 69 +/- 7), consulted by endocrinologist, were divided into 2 groups according to BMD (assessed by dual energy X-ray absorptiometry). BMD measurements, expressed as T-score (T-sc), were taken from the femoral neck (T-sc Neck), entire total hip (T-sc TH) and/or spine (T-sc L2-L4, L1-L4). Arrhythmia was evaluated using 24-hour Holter-ECG monitoring (HM). Major osteoporotic and total hip fracture risks (MOFR and THFR, respectively) were assessed by the FRAX scale. We compared 51 pts with OP (T-sc ≤ -2.5), with 52 matched controls without OP, including 44 pts with osteopenia (T-sc &amp;gt; -2.5). There were no significant differences between the groups regarding the history of stroke, myocardial infarction, coronary artery disease or arterial hypertension. Exclusion criteria included heart failure NYHA &amp;gt;II and/or LVEF &amp;lt;36%, acute coronary syndrome within the last 6 months, severe valvular disease, cardiac implantable electronic device. Results There was a trend towards a greater number of supraventricular and ventricular arrhythmias in the OP group compared to the controls. Arrhythmic burden was significantly correlated with BMD measures: correlations were observed between 24-hour ventricular ectopic beats (VEB) count with T-sc Neck (r=-0.20, p=0.04), with T-sc TH (r=-0.22, p=0.03). The number of supraventricular ectopic beats (SVEB) in HM was also correlated with BMD parameters: T-sc Neck (r=-0.21, p=0.03), T-sc TH (r=-0.23, p=0.02). Multivariate analysis (linear regression model) revealed that age and T-sc TH were independently related with ectopy: age (0.07; CI: 0.01 - 0.13, p=0.03) and T-sc TH (-0.58; CI: -1.07 - -0.08, p=0.02) were predictors for VEB, and SVEB were related to age (0.07; CI: 0.03 - 0.12, p&amp;lt;0.01) and, with borderline significance with T-sc TH (-0.34; CI: -0.699 - 0.012, p=0.058). Ectopic beats count was also positively correlated with osteoporotic fracture risk: VEB with THFR (r=0.206, p=0.04) and SVEB with MOFR (r=0.21, p=0.04). Conclusions The study showed an increased arrhythmia burden as detected in HM in pts with OP. Beside the T-sc TH, age was identified as an independent factor of increased SVEB / VEB. The main significant negative correlations were observed between the number of VEB / SVEB and BMD in femur (T-sc Neck, T-sc TH). Ectopic beats count was also positively correlated with osteoporotic fracture risk: VEB with THFR and SVEB with MOFR.