Role of Prestroke Vascular Pathology in Long-Term Prognosis After Stroke

Portegies, Marileen L.P.; Bos, Michiel J.; Hofman, Albert; Heeringa, Jan; Franco, Oscar H.; Koudstaal, Peter J.; Ikram, M. Arfan

doi:10.1161/strokeaha.115.011256

Cited by 14 publications

(11 citation statements)

References 46 publications

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“…Moreover, patients from PROSCIS-M were better educated, which at least partly explains the higher impact of education on poor outcome. All prognostic factors for death or functional impairment after first-ever ischemic stroke in our cohort are in line with those found in previous studies [ 1 – 5 , 28 – 32 ]. Furthermore, we found similar magnitudes of average PAR for age≥75 years (average PAR in PROSCIS-B: 17.29%, PROSCIS-M 20.89%), compared to previous studies applying the same PAR estimation methodology [ 3 , 4 ].…”

Section: Discussionsupporting

confidence: 91%

“…PAR is a methodological tool to prioritize targets for modification according to their assumed contribution to reduce the outcome of interest, in our case patient’s mortality and morbidity. While different estimation methods were used in previous studies [ 3 , 5 – 7 ], to the best of our knowledge, this is the first publication that simultaneously assesses and directly compares PAR values obtained by different statistical approaches in a real-life data set. In our analysis, the ranking by magnitudes of PAR was almost similar for all methods.…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies identify prognostic factors for death or poor functional outcome after stroke [ 1 – 5 ]. Most studies report these associations using rate ratios, odds ratios or hazard ratios, hereby estimating risk increase for exposed compared to non-exposed patients.…”

Section: Introductionmentioning

confidence: 99%

“…Population attributable risk (PAR), as a function of risk factor prevalence and relative risk, is used to calculate the amount of poor outcome that is attributable to a prognostic factor [ 8 , 9 ]. The few recent studies on mortality and functional outcome after ischemic stroke providing PAR estimates have used diverse estimation approaches [ 3 , 5 – 7 ]. It is known that the use of diverse methodology affects the magnitudes of the resulting estimates [ 10 ], which restricts the comparability of PAR estimates from different studies applying different methodologies.…”

Section: Introductionmentioning

confidence: 99%

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Outcome after stroke attributable to baseline factors—The PROSpective Cohort with Incident Stroke (PROSCIS)

et al. 2018

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BackgroundThe impact of risk factors on poor outcome after ischemic stroke is well known, but estimating the amount of poor outcome attributable to single factors is challenging in presence of multimorbidity. We aim to compare population attributable risk estimates obtained from different statistical approaches regarding their consistency. We use a real-life data set from the PROSCIS study to identify predictors for mortality and functional impairment one year after first-ever ischemic stroke and quantify their contribution to poor outcome using population attributable risks.MethodsThe PROSpective Cohort with Incident Stroke (PROSCIS) is a prospective observational hospital-based cohort study of patients after first-ever stroke conducted independently in Berlin (PROSCIS-B) and Munich (PROSCIS-M). The association of baseline factors with poor outcome one year after stroke in PROSCIS-B was analysed using multiple logistic regression analysis and population attributable risks were calculated, which were estimated using sequential population attributable risk based on a multiple generalized additive regression model, doubly robust estimation, as well as using average sequential population attributable risk. Findings were reproduced in an independent validation sample from PROSCIS-M.ResultsOut of 507 patients with available outcome information after 12 months in PROSCIS-B, 20.5% suffered from poor outcome. Factors associated with poor outcome were age, pre-stroke physical disability, stroke severity (NIHSS), education, and diabetes mellitus. The order of risk factors ranked by magnitudes of population attributable risk was almost similar for all methods, but population attributable risk estimates varied markedly between the methods. In PROSCIS-M, incidence of poor outcome and distribution of baseline parameters were comparable. The multiple logistic regression model could be reproduced for all predictors, except pre-stroke physical disability. Similar to PROSCIS-B, the order of risk factors ranked by magnitudes of population attributable risk was almost similar for all methods, but magnitudes of population attributable risk differed markedly between the methods.ConclusionsRanking of risk factors by population impact is not affected by the different statistical approaches. Thus, for a rational decision on which risk factor to target in disease interventions, population attributable risk is a supportive tool. However, population attributable risk estimates are difficult to interpret and are not comparable when they origin from studies applying different methodology. The predictors for poor outcome identified in PROSCIS-B have a relevant impact on mortality and functional impairment one year after first-ever ischemic stroke.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcome after stroke attributable to baseline factors—The PROSpective Cohort with Incident Stroke (PROSCIS)

et al. 2018

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“…[ 4 , 5 ] Inflammatory proteins might play a significant role in the pathogenesis of stroke. [ 6 ] Intuitively, it seems that inflammation mediators may play an important role in atherothrombotic stroke. Numerous evidence suggested that matrix metalloproteinases (MMPs) are fundamental players in stroke recovery.…”

Section: Introductionmentioning

confidence: 99%

Matrix metalloproteinase-2 gene polymorphisms are associated with ischemic stroke in a Hainan population

et al. 2018

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Ischemic stroke is a complex vascular disease, which has become 1 of the major causes of morbidity and mortality worldwide. More and more data showed that matrix metalloproteinases (MMPs), in particular, MMP-2 are deleterious after ischaemic stroke. This study investigated the relationship between MMP-2 and stroke risk in the Southern Chinese population.We evaluated single nucleotide polymorphisms (SNP) of MMP-2 in stroke patients in an association study using a case-control design. Six SNPs of MMP2 were selected and genotyped by Agena MassARRAY. SNPStats, Haploview was used to analyze genetic data.Two SNPs in the MMP-2 gene were significantly associated with stroke risk.For rs1132896 (C versus G allele), the C allele was significantly reduced stroke risk (OR = 0.56, 95% confidence intervals [95% CI] = 0.39–0.81, P = .002). The effect of the T allele of rs243849 was IS risk according to an additive genetic model (OR = 0.67, 95% CI = 0.47–0.96, P = .028). We did not found any strong linkage between the six SNPs (rs1132896, rs1053605, rs243849, rs243847, rs243832, rs7201)The results presented strongly indicate that MMP-2 genetic variants are an important mediator of stroke risk.

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A nomogram predicting the relationship between recanalization time and successful endovascular recanalization of non-acute internal carotid artery occlusion in a Chinese population

Ma,

Zhou,

et al. 2024

Neurosurg Rev

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Role of Prestroke Vascular Pathology in Long-Term Prognosis After Stroke

Cited by 14 publications

References 46 publications

Outcome after stroke attributable to baseline factors—The PROSpective Cohort with Incident Stroke (PROSCIS)

Outcome after stroke attributable to baseline factors—The PROSpective Cohort with Incident Stroke (PROSCIS)

Matrix metalloproteinase-2 gene polymorphisms are associated with ischemic stroke in a Hainan population

A nomogram predicting the relationship between recanalization time and successful endovascular recanalization of non-acute internal carotid artery occlusion in a Chinese population

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