Cryptogenic mechanism in ischaemic stroke patients is a predictor of 5-year survival: A population-based study

Introduction The present study sought to identify factors affecting mortality beyond 28 days in ischaemic stroke patients with whatever ischaemic mechanism. Patients and methods A prospective population-based registry was set up in Brest County, Brittany, France. Demographic data, clinical presentation, vascular risk factors and mortality were collected from January 2008 to December 2012. At “home without help” was used as a surrogate marker for low Rankin (0–1) at discharge from the hospital. IS was classified on the TOAST classification. Overall mortality was calculated using the Kaplan–Meier method. Multivariate analysis of mortality beyond 28 days was implemented, using a Cox model, on significant risk factors identified on univariate analysis. Results About 3024 IS cases were followed up beyond 28 days. Overall mortality beyond 28 days was 38.49% at 60 months. On multivariate analysis, age (10 years: HR = 1.84; [1.66–2.02]), coronary artery disease (HR = 1.28; [1.05–1.56]), cardiac arrhythmia (HR = 1.36; [1.11–1.67]), peripheral artery disease (HR = 1.66 [1.29–2.13]) and incomplete assessment (HR = 1.39; [1.12–1.74]) were associated with higher mortality risk, whereas female gender (HR = 0.80; [0.68–0.94]), high Glasgow Coma Scale score (GCS &gt; 12) (HR = 0.58; [0.45–0.76]), lacunar syndrome (HR = 0.82; [0.68–0.99], being ‘at home without help’ (HR = 0.50; [0.41–0.59]) and negative assessment (HR = 0.75; [0.58–0.97], compared to cardioembolism) were associated with better survival probability. Discussion Initial clinical status, prior cardiovascular diseases and age was associated with more risk of death: an increment of 10 years almost doubled mortality. Women had more survival probability than men, controlling for age. Ischaemic stroke mechanisms were predictors of late 5-year mortality. Conclusion Patients with negative assessment, i.e. representing truly cryptogenic ischaemic stroke, had the best survival probability probably due to fewer atherosclerotic markers. </jats:sec

Estimated GFR and the Effect of Intensive Blood Pressure Lowering after Acute Intracerebral Hemorrhage

\ua9 2016 The Authors. Background: The kidney-brain interaction has been a topic of growing interest. Past studies of the effect of kidney function on intracerebral hemorrhage (ICH) outcomes have yielded inconsistent findings. Although the second, main phase of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2) suggests the effectiveness of early intensive blood pressure (BP) lowering in improving functional recovery after ICH, the balance of potential benefits and harms of this treatment in those with decreased kidney function remains uncertain. Study Design: Secondary analysis of INTERACT2, which randomly assigned patients with ICH with elevated systolic BP (SBP) to intensive (target SBP &lt; 140 mm Hg) or contemporaneous guideline-based (target SBP &lt; 180 mm Hg) BP management. Setting &amp; Participants: 2,823 patients from 144 clinical hospitals in 21 countries. Predictors Admission estimated glomerular filtration rates (eGFRs) of patients were categorized into 3 groups based on the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation: normal or high, mildly decreased, and moderately to severely decreased (&gt;90, 60-90, and &lt;60 mL/min/1.73 m2, respectively). Outcomes: The effect of admission eGFR on the primary outcome of death or major disability at 90 days (defined as modified Rankin Scale scores of 3-6) was analyzed using a multivariable logistic regression model. Potential effect modification of intensive BP lowering treatment by admission eGFR was assessed by interaction terms. Results: Of 2,623 included participants, 912 (35%) and 280 (11%) had mildly and moderately/severely decreased eGFRs, respectively. Patients with moderately/severely decreased eGFRs had the greatest risk for death or major disability at 90 days (adjusted OR, 1.82; 95% CI, 1.28-2.61). Effects of early intensive BP lowering were consistent across different eGFRs (P = 0.5 for homogeneity). Limitations: Generalizability issues arising from a clinical trial population. Conclusions: Decreased eGFR predicts poor outcome in acute ICH. Early intensive BP lowering provides similar treatment effects in patients with ICH with decreased eGFRs