Burden and Outcome of Prevalent Ischemic Brain Disease in a National Acute Stroke Registry

Abstract

Background and Purpose-Previous overt stroke and subclinical stroke are frequent in patients with stroke; yet, their clinical significance and effects on stroke outcome are not clear. We studied the burden and outcome after acute ischemic stroke by prevalent ischemic brain disease in a national registry of hospitalized patients with acute stroke. Methods-Patients with ischemic stroke in the National Acute Stroke Israeli prospective hospital-based registry (February to March 2004, March to April 2007, and April to May 2010 with information on previous overt stroke and subclinical stroke per computed tomography/MRI (n=3757) were included. Of them, a subsample (n=787) was followed up at 3 months. Logistic regression models were computed for outcomes in patients with prior overt stroke or subclinical stroke, compared with patients with first stroke, adjusting for age, sex, vascular risk factors, stroke severity, and clinical classification. Results-Two-thirds of patients had a prior overt stroke or subclinical stroke. Death rates were similar for patients with and without prior stroke.

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“…Ischaemic conditions: Conditions such as vessel occlusion or thrombotic events as a consequence of atherosclerosis can cause ischaemic heart disease, also known as myocardial infarction, whereas thrombosis or emboli are the most common causes of ischaemic brain injury also known as stroke. Myocardial infarction (Moran et al, 2014) and stroke (Koton et al, 2013;Chin & Vora, 2014) contribute to a significant socioeconomic burden and have been proposed to become the leading causes of death and disability worldwide by 2020 (Fuster, 2014). Ischaemia results from restriction of blood supply to tissues, limiting oxygen and glucose availability.…”

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“…Israeli-Arabs fall victim to stroke at younger ages than Israeli Jews and more of them suffer severer strokes than Israeli Jews, significantly because they score much higher on the risk factors for stroke (smoking, healthy lifestyle, etc.) and the background illnesses which frequently accompany stroke [13] and because they have lower awareness of stroke symptoms and their urgency. Thus, the state of affairs in Israel's North region might be fairly summarized thus: The Israeli-Arab population in the North is exceptionally vulnerable to stroke but lives in an area which is served by a stroke treatment system objectively much inferior to that in the country's centre on all treatment components, from prehospital ambulance service thought to post-discharge rehabilitation.…”

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“…El ictus isquémico, también conocido como trombosis isquémica y apoplejía, se ubica entre las tres primeras causas de mortalidad, la primera causa de discapacidad resultante y la segunda de demencia en sujetos de edad media y avanzada, con una tasa anual creciente como resultado del aumento de las expectativas de vida y las mejoras en los servicios de salud, que favorece que los pacientes sobrevivan a la presentación del primer evento [137], representando enormes costos para los sistemas de salud [138]. La posibilidad de recurrencia a un año de haber sufrido el primer ictus isquémico es del 12% y después de los cinco años de un 30% [139][140][141][142].…”