Analysis of Mortality in Intracerebral Hemorrhage Patients with Hyperacute Ischemic Stroke Treated Using Thrombolytic Therapy: A Nationwide Population-based Cohort Study in South Korea

Choi, Hyun Young; Cho, Yongil; Kim, Wonhee; Minn, Yang-Ki; Kang, Gu-Hyun; Jang, Yong-Soo; Lee, Yoonje; Kim, Jae Guk; Kim, Jihoon; Cho, Youngsuk; Shin, Hyungoo; Moon, Shinje; Ahn, Chiwon; Lee, Juncheol; Shin, Dong-Geum; Park, Jae Keun

doi:10.3390/jpm12081260

Cited by 4 publications

(5 citation statements)

References 33 publications

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“…The time window for rt-PA administration and stroke severity varied across studies, potentially impacting the incidence of ICH differently. (4) It has been well established that PH is strongly associated with an elevated likelihood of unfavorable outcomes. (17,22,23) Hematoma expansion is a mortal predictor among patients with ICH.…”

Section: Discussionmentioning

confidence: 99%

“…The cumulative 12-month risk of death among patients with postthrombolytic ICH was increased approximately three fold. (3,4) Based on related studies regarding the relationship between ICH subtypes and poststroke complications, the primary focus has been on studying outcomes related to mortality and disability. (5)(6)(7) However, limited information remains concerning the specific association between ICH subtypes, as classified by radiographic classifications according to the European Cooperative Acute Stroke Study II (ECASS II) and the occurrence of postthrombolytic severe complications across different fields.…”

Section: Introductionmentioning

confidence: 99%

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Association of the Type of Intracerebral Hemorrhage With Serious Complications and Predictive Factors for Hemorrhagic Transformation After Thrombolytic Treatment in Patients With Acute Ischemic Stroke

Krongsut,

Naraphong,

Srikaew

et al. 2024

J Southeast Asian Med Res

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Background: Accurate classification of postthrombolytic intracerebral hemorrhage (ICH) subtypes is vital for predicting stroke outcomes and managing ICH. Currently, the recommended classification criteria are the European Cooperative Acute Stroke Study III criteria, including two primary categories: hemorrhagic infarction (HI) and parenchymal hematoma (PH). Objectives: The primary objective of this study was to assess the contribution of various ICH subtypes to serious complications, with the secondary aim to identify associated predictors.Methods: The study examined medical records of patients with acute ischemic stroke receiving thrombolysis at Saraburi Hospital from 2014 to 2022. The logit model with the margins command assessed the association of ICH subtypes with serious complications, and multinomial logistic regression identified potential predictors for HI and PH. Results: Among 345 patients, HI-1, HI-2, PH-1 and PH-2 had prevalence rates of 3.2, 7.8, 4.9 and 7.5%, respectively, while 76.5% did not have ICH. PH-2 demonstrated the strongest correlation with inhospital mortality (adjusted risk ratio [RR] 2.83, 95% CI 1.56-5.13), invasive mechanical ventilator requirement (adjusted RR 3.93, 95% CI 2.09-7.39) and hematoma evacuation (adjusted RR 4.58, 95% CI 1.17-17.95) compared with patients of non-ICH. HI demonstrated a significant prolongation of hospitalization. (adjusted RR 3.30, 95% CI 1.53-7.12). Multinomial logistic regression analysis revealed that prior use of antiplatelet drugs, antihypertensive treatment before rt-PA, white blood cell count ≥11,750 cells/mm3 and baseline Alberta stroke program early CT scores ≤7 were independent predictors for PH. The adjusted odds ratios were 3.06 (95% CI, 1.23-7.57), 6.95 (95% CI, 2.62-18.45), 6.01 (95% CI, 2.17-16.65) and 5.01 (95% CI, 2.00-12.60), respectively. Conclusion: The PH-2 subtype was associated with the highest mortality, while our study demonstrated that the HI subtype, previously considered relatively benign with successful early recanalization, showed a significant prolongation of hospitalization compared with that of patients of non-ICH. High-risk patients of ICH require intensive monitoring to reduce complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of the Type of Intracerebral Hemorrhage With Serious Complications and Predictive Factors for Hemorrhagic Transformation After Thrombolytic Treatment in Patients With Acute Ischemic Stroke

Krongsut,

Naraphong,

Srikaew

et al. 2024

J Southeast Asian Med Res

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“…[19,[26][27][28][29][30] The risk of death after stroke was reported in 12 articles. [8][9][10]16,26,[31][32][33][34][35][36][37] Most studies of stroke risk in COPD adjusted for risk factors such as age, sex, and comorbidities, and only 2 studies had single-factor regression analysis data. [17,38] Four studies provided separate data on the risk of ischemic stroke, [17][18][19][20] and 4 studies provided separate risk data for hemorrhagic stroke.…”

Section: Basic Characteristics Of Included Studiesmentioning

confidence: 99%

“…[9,10,16,33,36,37] A total of 10 cohorts in 8 publications provided data on the risk of death at more than 1 year of follow-up after stroke. [8,9,26,[31][32][33][34][35] Among the prognostic studies, 1 study provided data on the risk of stroke prognosis for COPD with different diagnostic modalities. [8] Therefore, the conclusions of the included studies were adjusted for risk factors such as age, sex, and comorbidities.…”

Section: Basic Characteristics Of Included Studiesmentioning

confidence: 99%

Stroke risk of COPD patients and death risk of COPD patients following a stroke: A systematic review and meta-analysis

Ding,

Wang,

Gong

et al. 2023

Medicine

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Objective: Chronic obstructive pulmonary disease (COPD) is closely related to the development and progression of cardiovascular disease. The purpose of this study is to clarify the answers to the following questions through systematic evaluation: the risk of stroke in COPD patients; the risk of stroke in acute exacerbations of COPD (AECOPD) patients; and the risk of death after stroke in COPD patients. Methods: Two reviewers independently searched EMbase, PubMed, and the Cochrane Library for relevant literature from the date of creation to February 17, 2023, for studies relating COPD to stroke patients. Of the 8039 publications retrieved, we identified 27 articles that met our selection criteria. Fixed-effects or random-effects models were used to calculate ORs and 95% confidence intervals for the combined risk. Results: combining studies on stroke risk in COPD patients by random-effects model suggested that COPD was an independent risk factor for stroke-associated pneumonia (OR 1.40, 95% CI: 1.24–1.59, I 2 = 98.4%, P = .000), with significant heterogeneity in the results, and subgroup analysis did not find a source of heterogeneity. In the combined 7 AECOPD studies, a significantly higher risk of stroke was found (OR 1.53, 95% CI: 1.44–1.63, I 2 = 49.2%, P = .066). In the combined 6 short- term prognostic studies, the relationship between COPD and risk of death was not highly significant (OR 1.12, 95% CI: 1.08–1.16, I 2 = 37.4%, P = .131). In 10 long-term observational prognosis studies, COPD was suggested to be associated with death after stroke by combining data using a random-effects model (OR 1.20, 95% CI: 1.13–1.27, I 2 = 56.8%, P = .014), and there was moderate heterogeneity in the combination, with subgroup analysis showing that stroke type may be a source of heterogeneity and the risk of death from ischemic stroke: OR 1.23, 95% CI: 1.17–1.29, I 2 = 45.0%, P = .191 and the risk of death from both types of stroke: OR 1.12, 95% CI: 1.07–1.18, I 2 =18.9%, P = .291. Conclusion: COPD is an independent risk factor for stroke. The risk of stroke is significantly increased, especially during AECOPD. In addition, the association between COPD and short-term death in stroke patients is insignificant, while it is more associated with fatal events in the long-term prognosis.

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“…An alarming revelation was that within the 12-month window post-treatment, the mortality rate in the ICH cohort was more than double that of their counterparts (42.8% vs. 17.5%). This suggests that ICH post-thrombolysis can drastically heighten the risk of mortality in hyperacute ischemic stroke patients, amplifying it nearly threefold [182,183].…”

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confidence: 99%

Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations

Saceleanu,

Toader,

Ples

et al. 2023

Biomedicines

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Among the high prevalence of cerebrovascular diseases nowadays, acute ischemic stroke stands out, representing a significant worldwide health issue with important socio-economic implications. Prompt diagnosis and intervention are important milestones for the management of this multifaceted pathology, making understanding the various stroke-onset symptoms crucial. A key role in acute ischemic stroke management is emphasizing the essential role of a multi-disciplinary team, therefore, increasing the efficiency of recognition and treatment. Neuroimaging and neuroradiology have evolved dramatically over the years, with multiple approaches that provide a higher understanding of the morphological aspects as well as timely recognition of cerebral artery occlusions for effective therapy planning. Regarding the treatment matter, the pharmacological approach, particularly fibrinolytic therapy, has its merits and challenges. Endovascular thrombectomy, a game-changer in stroke management, has witnessed significant advances, with technologies like stent retrievers and aspiration catheters playing pivotal roles. For select patients, combining pharmacological and endovascular strategies offers evidence-backed benefits. The aim of our comprehensive study on acute ischemic stroke is to efficiently compare the current therapies, recognize novel possibilities from the literature, and describe the state of the art in the interdisciplinary approach to acute ischemic stroke. As we aspire for holistic patient management, the emphasis is not just on medical intervention but also on physical therapy, mental health, and community engagement. The future holds promising innovations, with artificial intelligence poised to reshape stroke diagnostics and treatments. Bridging the gap between groundbreaking research and clinical practice remains a challenge, urging continuous collaboration and research.

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Analysis of Mortality in Intracerebral Hemorrhage Patients with Hyperacute Ischemic Stroke Treated Using Thrombolytic Therapy: A Nationwide Population-based Cohort Study in South Korea

Cited by 4 publications

References 33 publications

Association of the Type of Intracerebral Hemorrhage With Serious Complications and Predictive Factors for Hemorrhagic Transformation After Thrombolytic Treatment in Patients With Acute Ischemic Stroke

Association of the Type of Intracerebral Hemorrhage With Serious Complications and Predictive Factors for Hemorrhagic Transformation After Thrombolytic Treatment in Patients With Acute Ischemic Stroke

Stroke risk of COPD patients and death risk of COPD patients following a stroke: A systematic review and meta-analysis

Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations

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