Long-Term Survival After Stroke According to Reperfusion Therapy, Cardiovascular Therapy and Gender

Abstract

Background A wide variety of factors influence stroke prognosis, including age, stroke severity and comorbid conditions; but most current information about outcomes and safety is derived from patients at 3 - 12 months and mostly coming from the hospital activity. The aim of this study is to evaluate whether treatment strategies have a differential impact on long-survival after acute ischemic stroke among men versus women. Methods Acute ischemic stroke patients identified from the population-based register between January 1, 2011 and December 31, 2012 were included, and they were classified into: 1) Acute ischemic stroke + intravenous thrombolysis (group I); 2) Acute ischemic stroke + mechanical thrombectomy with or without intravenous thrombolysis (group II); 3) Acute ischemic stroke + medical therapy alone (no reperfusion therapies) (group III). Follow-up went through up until December 2016. The probability of survival was estimated by the Kaplan-Meier method, and the hazard ratio was obtained by using the Cox proportional hazard regression models. Mortality was interpreted as overall mortality. Results A total of 14,368 cases (men 50.1%), 77.1 ± 11.0 years old were included. There was higher survival among those treated with intravenous thrombolysis (P < 0.001); women treated with thrombectomy (P < 0.001); and women < 80 years old without reperfusion therapy. The most common medications were antiplatelets (52.8%), associated with lower survival (P < 0.001); and statins (46.5%), associated with higher survival. The regression model produced the following independent outcome variables associated to mortality: anticoagulant hazard ratio (HR) 1.53 (95% confidence interval (95% CI): 1.44 - 1.63, P < 0.001), diuretics HR 1.71 (95% CI: 1.63 - 1.79, P < 0.001), antiplatelet HR 1.49 (95% CI: 1.42 - 1.56, P < 0.001), statins HR 0.73 (95% CI: 0.70 - 0.77; P < 0.001), angiotensin II receptor antagonists HR 0.93 (95% CI: 0.89 - 0.98, P = 0.008) and reperfusion therapy HR 0.88 (95% CI: 0.81 - 0.97, P = 0.009). Conclusions Men and women have different prognoses after revascularization treatment for acute ischemic stroke. Under 80 years old the women appear to have a better outcome than men when treated with thrombolysis therapy and/or catheter-based thrombectomy. The chronic cardiovascular pharmacotherapy must be evaluated whether they should be included as factors in the decision to reperfusion.

Complex chronic patients as an emergent group with high risk of intracerebral haemorrhage: an observational cohort study

“…The results of the present study indicate a higher incidence of ICH in an emerging and vulnerable population subgroup, such as CCPs, than in both general and elderly populations. Data on time trends for ICH in the general population indicate no significant changes in the incidence of ICH over the last two decades [6,15], but the incidence density of ICH was 5to-60-fold higher than that observed in the general population, both within the study area and worldwide (Table 6) [6,[16][17][18][19][20][21][22][23][24]. Comparisons between studies are difficult due to several interacting and overlapping emerging risk factors and aetiologies, new imaging techniques, demographic changes, comorbidities and associated treatments, different target populations, and the lack of a standardized methodology for data recording and exploitation, which makes it impossible to make adjustments to the incidences for different series of patients.…”

Quantified health and cost effects of faster endovascular treatment for large vessel ischemic stroke patients in the Netherlands

“…23 29 Observed values were similar to simulated values of 3-hour delay to groin puncture. Mortality (mRS 6; online supplemental figure S2C) at 5= year follow-up was higher in the simulated data compared with the study by Clua-Espuny et al 30…”

“…23 29 30 In the external validation the proportion of patients with good functional outcome (mRS ≤2), poor functional outcome but not deceased (mRS 3-5), or death (mRS 6) were compared with follow-up results from REVASCAT (1 year), 29 MR CLEAN (2 years), 23 and a study by Clua-Espuny et al (5 years). 30…”

C-Reactive Protein and White Blood Cell Count in Non-Infective Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

“…Many factors, including age, comorbidities and severity as measured with the National Institute of Health Stroke Scale (NIHSS) affect long-term prognosis after AIS treated with IVT [ 20 ]. There is still a need for other markers which could help predict long-term prognosis among AIS patients.…”