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- Åsberg, Signild, 1972-, et al.
(författare)
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Non-cardioembolic TIA and ischemic stroke : Implications of severity
- 2018
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 138:4, s. 369-376
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Our purpose was to explore major vascular and bleeding outcomes in relation to risk and severity scores (ABCD2 or NIHSS) in patients with transient ischemic attack (TIA) or acute ischemic stroke (AIS).Methods: This nationwide observational study was based on data from 4 national registries. Outcomes were assessed by Kaplan-Meier and Cox regression analyses.Results: The total cohort comprised 21268 patients (median age 73years, 47.6% females). Based on ABCD2-score, the TIA-population (n=10174) was divided into low-risk (0-3 p, n=3463) and high-risk (4-7 p, n=6711). Based on NIHSS-score, the AIS-population (n=11454) was divided into minor (0-5 p, n=8596), moderate (6-10 p, n=1630) and severe (11 p, n=1228). During follow-up (mean 1.7years), the composite endpoint of stroke, myocardial infarction or death occurred in 3572 (16.5%) of all the patients, and major bleeding in 668 (3.1%) patients. Using low-risk TIA as reference, the adjusted hazard ratios (HR, 95% CI) of the composite endpoint were 1.41 (1.23-1.62) for high-risk TIA, 1.94 (1.70-2.22) for minor, 2.86 (2.45-3.34) for moderate and 4.18 (3.57-4.90) for severe stroke. When analyzed separately, the association with increased risk remained significant for stroke and death, but not for myocardial infarction. The HR of major bleeding were 1.31 (0.99-1.73) for high-risk TIA, 1.49 (1.13-1.95) for minor, 1.54 (1.08-2.21) for moderate and 2.10 (1.44-3.05) for severe stroke.Conclusions: This study confirms the association between severity of the index ischemic stroke and risk of future major vascular and bleeding events, and highlights the increased risk also for patients with high-risk TIA.
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- Appelros, P, et al.
(författare)
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A national stroke quality register : 12 years experience from a participating hospital
- 2007
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Ingår i: European Journal of Neurology. - : Wiley. - 1351-5101 .- 1468-1331. ; 14:8, s. 890-894
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Tidskriftsartikel (refereegranskat)abstract
- Registration of all hospitalized stroke patients is practiced in Sweden in order to assess care quality. Data in this register, Riks-Stroke (RS), may be biased due to incomplete registration. The purpose of this paper was to report changes in stroke outcome in relation to fluctuations in registration. Patients registered in RS at a hospital during the period 1994-2005 were analyzed. Case fatality at 28 days, living conditions, and activities of daily living (ADL) performance at 3 months were correlated to the number of patients registered and follow-up frequency. A total of 4994 stroke cases were registered during the period. A high annual registration rate was significantly correlated to a high case fatality ratio. A low annual follow-up rate was associated with a low proportion of patients living in their own home without any need of help. Quality parameters are sensible for selection bias, which make them difficult to compare over time and between hospitals. We suggest that by weighing outcome data against stroke severity, safer conclusions may be drawn. Additionally, hospitals considering setting up quality registers should make every effort to attain complete case ascertainment at all times, including patients managed outside the hospital, in order to avoid selection bias.
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- Appelros, P, et al.
(författare)
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Lacunar infarcts: functional and cognitive outcomes at five years in relation to MRI findings
- 2005
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Ingår i: Cerebrovascular diseases (Basel, Switzerland). - : S. Karger AG. - 1015-9770 .- 1421-9786. ; 20:1, s. 34-40
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Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> There are few long-term follow-up studies of patients with lacunar infarcts (LIs). The purpose of this 5-year follow-up study was to assess functional and cognitive outcome in relation to MRI findings. <i>Methods:</i> 81 patients with a first-ever LI were followed for 5 years with respect to mortality, stroke recurrence, functional and cognitive outcome. T<sub>2</sub>-weighted MRI was performed at baseline and at 5 years. The presence of basal ganglia lesions and white matter lesions was scored according to the European Task Force rating scale. Functional outcome was assessed with the Oxford Handicap Scale (OHP). Cognition was assessed with the Mini Mental State Examination (MMSE). <i>Results:</i> The 5-year mortality was 19%. Predictors for death were age (OR = 1.07, 95% CI 1.03–1.11), ischemic heart disease (OR = 2.1, 95% CI 1.1–4.1) and impairment score (OR = 1.16, 95% CI 1.02–1.32). 30% of the patients had a recurrent stroke. Predictors for recurrent stroke were diabetes mellitus (OR = 1.7, 95% CI 1.2–7.4) and amount of white matter lesions (OR = 1.7, 95% CI 1.2–2.7). 36% of the patients were functionally dependent (defined as OHP >2). Predictors for functional dependency were impairment score (OR = 1.71, 95% CI 1.12–2.59), MMSE (OR = 0.55, 95% CI 0.33–0.91) and stroke recurrence (OR = 84, 95% CI 9.4–745). 16% of the patients had cognitive impairment (defined as MMSE <24). Stroke recurrence and white matter score, but not basal ganglia score, were correlated to cognitive impairment. <i>Conclusions:</i> Many LI patients have a good functional outcome at 5 years. For older patients, for patients with an initial severe stroke, and with additional vascular risk factors, however, the prognosis is more severe, with an increased risk for mortality, stroke recurrence, and physical and cognitive decline.
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