Standard Medical Management in Secondary Prevention of Ischemic Stroke in China (SMART)

Peng, Bin; Zhu, Yi-Cheng; Ni, Jun; Xu, Wei-Hai; Zhou, Lixin; Yao, Ming; Chen, Lin; Wang, Jianming; Wang, Yongjun; Pu, Chuanqiang

doi:10.1111/j.1747-4949.2011.00648.x

Cited by 11 publications

(9 citation statements)

References 15 publications

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“…Data were collected from SMART study, which was a multicenter, randomized controlled trial to evaluate the feasibility and efficacy of a guideline-based program in secondary stroke prevention across 47 hospitals in China. A detailed description of study protocol and main results of SMART has been published elsewhere ( 13 , 14 ). A total of 3821 participants with a first-ever ischemic stroke within 30 days were enrolled in SMART study between April 2008 and December 2010.…”

Section: Methodsmentioning

confidence: 99%

Atherosclerosis Might Be Responsible for Branch Artery Disease: Evidence From White Matter Hyperintensity Burden in Acute Isolated Pontine Infarction

et al. 2018

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Objective: To investigate an MRI-based etiological classification for acute isolated pontine infarcts and to assess differences in vascular risk factors, clinical characteristics and WMH burden among the etiological subtypes.Methods: All participants from SMART cohort with DWI-proven acute isolated pontine infarcts (AIPI) were included and categorized into 3 groups: large-artery-occlusive disease (LAOD), basilar artery branch disease (BAD), and small vessel disease (SVD), according to basilar artery atherosclerosis severity and lesion extent of the transverse axial plane. The vascular risk factors and 6-month functional outcome was analyzed among 3 groups.Results: Of the 1129 patients enrolled, 175 had AIPI. BAD was the most frequent subtype of AIPI (46.3%), followed by SVD (36.0%) and LAOD (17.7%). Neurological impairment on admission was more severe in the LAOD group, followed by BAD. The BAD group had greater frequencies of female sex, hypertension, diabetes mellitus compared to the SVD group (P < 0.05). NIHSS on admission were significantly higher in the BAD group as compared with the SVD group (P < 0.001), but no difference was found between BAD and LAOD group. Poor outcome (mRS≥3) was found in only 13.7% of patients at 6-month post-stroke and there was no difference among 3 groups. WMH severity was significant higher in the SVD group compared to the BAD group for the deep subcortical region; however, there was no difference for the periventricualr region. There was no significant difference in either DWMH or PVWMH severity between the BAD and LAOD groups.Conclusion: BAD is the most frequent etiology of AIPI followed by SVD and LAOD. WMH burden, vascular risk factors and clinical characteristics in BAD group were more similar to the LAOD group, rather than to the SVD group, suggesting the atherothrombotic nature of BAD.

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Section: Methodsmentioning

confidence: 99%

Atherosclerosis Might Be Responsible for Branch Artery Disease: Evidence From White Matter Hyperintensity Burden in Acute Isolated Pontine Infarction

et al. 2018

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“…Data were collected from SMART, which was a multicenter, randomized controlled trial to evaluate the feasibility and efficacy of a guideline-based program in secondary stroke prevention across 47 hospitals in mainland China. A detailed description of study protocol and main results of SMART have been published elsewhere ( 21 , 22 ). In brief, the participants were randomized to either a structured care group or a usual care group for secondary stroke prevention.…”

Section: Methodsmentioning

confidence: 99%

“…Based on a multi-center database [SMART, Standard medical management in secondary prevention of ischemic stroke in China ( 21 )], we sought to clarify the lesion pattern of MI. The lesion-etiology correlations based on angiography and lesion topography were also assessed, with particular emphasis on distinction between large artery atherosclerosis and small vessel occlusion.…”

Section: Introductionmentioning

confidence: 99%

Lesion Topography and Its Correlation With Etiology in Medullary Infarction: Analysis From a Multi-Center Stroke Study in China

et al. 2018

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Objectives: The lesion topography of medullary infarction (MI) is heterogeneous and its correlation with stroke etiology remains elusive. We aim to clarify the lesion pattern of MI and to assess its correlation with stroke etiology.Material and Methods: Of 1129 subjects with available DWI in SMART study (a multi-center trial concerning secondary stroke prevention in China) between April 2008 and December 2010, 43 patients with DWI confirmed MI (3.8%) were retrospectively evaluated. Lesions were categorized as lateral and medial medullary infarction (LMI and MMI, 33 and 10 subjects respectively) at 3 levels rostro-caudally and correlated with the stroke etiology. Clinical profiles and long-term prognosis were analyzed.Results: Large artery atherosclerosis, small vessel occlusion, cardiogenic embolism and artery dissection accounted for 29, 11, 1, and 2 infarcts, respectively. Large artery disease was the most common cause in LMI (24 of 33, 72.7%) whereas small vessel occlusion was not uncommon in MMI (5 of 10, 50.0%). Though the difference of infarct pattern between large artery atherosclerosis and small vessel occlusion was insignificant, two distinct lesion patterns were considered to be relevant: (1) Rostral MMI with continuous medial pontine infarctions were more likely attributed to small vessel occlusion than large artery atherosclerosis. Kameda et al. (2) MMI with ventral to dorsal extension were more often caused by large artery disease than small vessel occlusion. Median NIHSS at admission was 4. During a median follow-up of 17 months, 2 patients died and 2 experienced recurrent ischemic events, 39 of 41 subjects (95.1%) were functional independent (mRS 0–2).Conclusions: This multi-center study demonstrates that MI has distinct lesion pattern depending on various stroke etiologies and mechanisms. Future investigations with larger sample size should establish the lesion pattern of MI and validate its correlation with the stroke etiology and mechanisms, which might improve stroke management.

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“…Data were obtained from SMART study, which is a large prospective nationwide multi-center and cluster-randomized controlled trial to assess the effectiveness of a guideline-based structured care program for secondary stroke prevention, as opposed to usual care treatment, in China. Complete design and main results of the SMART study has been detailed elsewhere [ 20 , 21 ]. In brief, measures of intervention in SMART group was in line with the current guidelines for the secondary prevention of AIS, comprised of pharmaceutical treatment, lifestyle modification and patient education, while the usual care group received only interventions chosen by their physicians based on their knowledge or experiences.Glucose levels were determined by plasma venous FBG drawn within 24 hours after admission.…”

Section: Methodsmentioning

confidence: 99%

Elevated Fasting Blood Glucose Is Predictive of Poor Outcome in Non-Diabetic Stroke Patients: A Sub-Group Analysis of SMART

Yao

Zhou

et al. 2016

PLoS ONE

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BackgroundAlthough increasing evidence suggests that hyperglycemia following acute stroke adversely affects clinical outcome, whether the association between glycaemia and functional outcome varies between stroke patients with\without pre-diagnosed diabetes remains controversial. We aimed to investigate the relationship between the fasting blood glucose (FBG) and the 6-month functional outcome in a subgroup of SMART cohort and further to assess whether this association varied based on the status of pre-diagnosed diabetes.MethodsData of 2862 patients with acute ischemic stroke (629 with pre-diagnosed diabetics) enrolled from SMART cohort were analyzed. Functional outcome at 6-month post-stroke was measured by modified Rankin Scale (mRS) and categorized as favorable (mRS:0–2) or poor (mRS:3–5). Binary logistic regression model, adjusting for age, gender, educational level, history of hypertension and stroke, baseline NIHSS and treatment group, was used in the whole cohort to evaluate the association between admission FBG and functional outcome. Stratified logistic regression analyses were further performed based on the presence/absence of pre-diabetes history.ResultsIn the whole cohort, multivariable logistical regression showed that poor functional outcome was associated with elevated FBG (OR1.21 (95%CI 1.07–1.37), p = 0.002), older age (OR1.64 (95% CI1.38–1.94), p<0.001), higher NIHSS (OR2.90 (95%CI 2.52–3.33), p<0.001) and hypertension (OR1.42 (95%CI 1.13–1.98), p = 0.04). Stratified logistical regression analysis showed that the association between FBG and functional outcome remained significant only in patients without pre-diagnosed diabetes (OR1.26 (95%CI 1.03–1.55), p = 0.023), but not in those with premorbid diagnosis of diabetes (p = 0.885).ConclusionThe present results demonstrate a significant association between elevated FBG after stroke and poor functional outcome in patients without pre-diagnosed diabetes, but not in diabetics. This finding confirms the importance of glycemic control during acute phase of ischemic stroke especially in patients without pre-diagnosed diabetes. Further investigation for developing optimal strategies to control blood glucose level in hyperglycemic setting is therefore of great importance.Trial RegistrationClinicalTrials.gov NCT00664846

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Standard Medical Management in Secondary Prevention of Ischemic Stroke in China (SMART)

Cited by 11 publications

References 15 publications

Atherosclerosis Might Be Responsible for Branch Artery Disease: Evidence From White Matter Hyperintensity Burden in Acute Isolated Pontine Infarction

Atherosclerosis Might Be Responsible for Branch Artery Disease: Evidence From White Matter Hyperintensity Burden in Acute Isolated Pontine Infarction

Lesion Topography and Its Correlation With Etiology in Medullary Infarction: Analysis From a Multi-Center Stroke Study in China

Elevated Fasting Blood Glucose Is Predictive of Poor Outcome in Non-Diabetic Stroke Patients: A Sub-Group Analysis of SMART

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