Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

Cerebrovascular disease mortality in Mexico, 2000-2008: A call for action [Mortalidad por enfermedad vascular cerebral en México, 2000-2008: Una exhortación a la acción]

Introduction: Cerebrovascular disease (CVD) is a growing health problem in countries living the epidemiological transition. In Mexico, population data on this issue is scarce. Objective: To describe the changing pattern on CVD mortality in Mexico, during the period 2000 to 2008. Methods: We consulted the Mexican Health Ministry database provided by the National System on Health Information. Data on the period 2000 to 2008 (the only available) was extracted. Crude CVD deaths, annualized population mortality rates and proportions attributed to CVD among other mortality causes are here presented. Results: By the year 2000 a total of 435,486 deaths were registered in Mexico (general mortality rate: 4.42/100,000; total population: 98,438,557 inhabitants), increasing to 538,288 in 2008 (general mortality rate: 5.05/100,000; total population: 106,682,518 inhabitants), which coincided with an increment in the population aged ≥ 65 years specifically (year 2000: 4,591,319; year 2008: 5,983,927). Specific CVD mortality also showed a growing pattern from 2000 (annualized mortality rate: 25.21/100,000) to 2008 (annualized mortality rate: 28.30/ 100,000). By 2008, the Mexican state with the highest CVD mortality rate was Veracruz (annualized mortality rate: 36.3/100,000), followed by Oaxaca (annualized mortality rate: 36.2/100,000) and the Federal District (annualized mortality rate: 34.9/100,000). Of note, a decreasing annualized mortality rate was observed in the population aged ≥ 65 years, at expense of a higher frequency at younger ages. Conclusions: CVD mortality has increased in Mexico, particularly in persons aged < 65 years. Comprehensive population studies on fatal and non-fatal CVD incidence by specific clinical types are urgently needed

Cerebrovascular disease mortality in Mexico, 2000-2008: A call for action [Mortalidad por enfermedad vascular cerebral en México, 2000-2008: Una exhortación a la acción]

Introduction: Cerebrovascular disease (CVD) is a growing health problem in countries living the epidemiological transition. In Mexico, population data on this issue is scarce. Objective: To describe the changing pattern on CVD mortality in Mexico, during the period 2000 to 2008. Methods: We consulted the Mexican Health Ministry database provided by the National System on Health Information. Data on the period 2000 to 2008 (the only available) was extracted. Crude CVD deaths, annualized population mortality rates and proportions attributed to CVD among other mortality causes are here presented. Results: By the year 2000 a total of 435,486 deaths were registered in Mexico (general mortality rate: 4.42/100,000; total population: 98,438,557 inhabitants), increasing to 538,288 in 2008 (general mortality rate: 5.05/100,000; total population: 106,682,518 inhabitants), which coincided with an increment in the population aged ? 65 years specifically (year 2000: 4,591,319; year 2008: 5,983,927). Specific CVD mortality also showed a growing pattern from 2000 (annualized mortality rate: 25.21/100,000) to 2008 (annualized mortality rate: 28.30/ 100,000). By 2008, the Mexican state with the highest CVD mortality rate was Veracruz (annualized mortality rate: 36.3/100,000), followed by Oaxaca (annualized mortality rate: 36.2/100,000) and the Federal District (annualized mortality rate: 34.9/100,000). Of note, a decreasing annualized mortality rate was observed in the population aged ? 65 years, at expense of a higher frequency at younger ages. Conclusions: CVD mortality has increased in Mexico, particularly in persons aged < 65 years. Comprehensive population studies on fatal and non-fatal CVD incidence by specific clinical types are urgently needed

Lupus erythematosus in a multicenter hospital-based registry on acute cerebrovascular disease in Mexico: The RENAMEVASC study [Lupus eritematoso generalizado en un registro hospitalario multicéntrico de enfermedad cerebrovascular aguda en México: Estudio RENAMEVASC]

Introduction: Little is known about the frequency and clinical outcome of cases with lupus-associated acute cerebrovascular disease in Mexico. Objective: To describe the prevalence and short-term outcome of lupus erythematosus in patients with the major forms of acute cerebrovascular disease in the Mexican multicenter registry RENAMEVASC. Methods: A total of 2000 patients were studied in the RENAMEVASC registry in 25 hospitals from 14 states of Mexico: 100 (5%) with transient ischemic attack (TIA), 992 (49.6%) with acute cerebral infarction (ACI), 580 (29%) with intracerebral hemorrhage (ICH), 269 (13.5%) with subarachnoid hemorrhage (SAH), and 59 (3%) with cerebral venous thrombosis (CVT). Results: In all, the prevalence of lupus erythematosus was 1.3% (95% confidence interval: 0.8-1.9%), significantly higher among cases with CVT (3.4%), than in SAH patients (0.4%, p = 0.03), but not higher than ICH (0.9%, p = 0.07), ICT (2%, p = 0.59) or ACI (1.6%, p = 0.31) cases. Compared with patients without lupus, those with this condition were significantly younger, with a high proportion of the female gender and antiphospholipid syndrome (in all, p 3 at dischrage (modified Rankin scale > 3, 11.5% vs. 49.4%, respectively; p < 0.001) and at 30-day follow-up (11.5 vs. 43%, respectively; p = 0.001). Conclusion: In Mexico, the frequency of lupus erythematosus in patients with acute cerebrovascular disease is < 2% and with shortterm mortality < 10%. © Copyright Indice Mexicano de Revistas Biomédicas Latinoamericanas 1998 - 2011

Lupus erythematosus in a multicenter hospital-based registry on acute cerebrovascular disease in Mexico: The RENAMEVASC study [Lupus eritematoso generalizado en un registro hospitalario multic�ntrico de enfermedad cerebrovascular aguda en M�xico: Estudio RENAMEVASC]

Introduction: Little is known about the frequency and clinical outcome of cases with lupus-associated acute cerebrovascular disease in Mexico. Objective: To describe the prevalence and short-term outcome of lupus erythematosus in patients with the major forms of acute cerebrovascular disease in the Mexican multicenter registry RENAMEVASC. Methods: A total of 2000 patients were studied in the RENAMEVASC registry in 25 hospitals from 14 states of Mexico: 100 (5%) with transient ischemic attack (TIA), 992 (49.6%) with acute cerebral infarction (ACI), 580 (29%) with intracerebral hemorrhage (ICH), 269 (13.5%) with subarachnoid hemorrhage (SAH), and 59 (3%) with cerebral venous thrombosis (CVT). Results: In all, the prevalence of lupus erythematosus was 1.3% (95% confidence interval: 0.8-1.9%), significantly higher among cases with CVT (3.4%), than in SAH patients (0.4%, p = 0.03), but not higher than ICH (0.9%, p = 0.07), ICT (2%, p = 0.59) or ACI (1.6%, p = 0.31) cases. Compared with patients without lupus, those with this condition were significantly younger, with a high proportion of the female gender and antiphospholipid syndrome (in all, p 3 at dischrage (modified Rankin scale > 3, 11.5% vs. 49.4%, respectively; p < 0.001) and at 30-day follow-up (11.5 vs. 43%, respectively; p = 0.001). Conclusion: In Mexico, the frequency of lupus erythematosus in patients with acute cerebrovascular disease is < 2% and with shortterm mortality < 10%. � Copyright Indice Mexicano de Revistas Biom�dicas Latinoamericanas 1998 - 2011

Optical characterization of the 62 cm telescope at severo díaz galindo observatory in Guadalajara

BACKGROUND AND PURPOSE - Hypertensive intracerebral hemorrhage (ICH) in young people has been the object of only succinct analyses. Therefore, it is unclear whether extrapolation of the information obtained from older patients is also valid for the young. Here we describe young persons with hypertensive ICH and compare them with their older counterparts to determine whether age-related clinical differences exist. METHODS - From 1988 to 2004, we studied 35 consecutive young patients with ICH (60% men; mean age, 33 years; range, 15 to 40 years) for whom the etiology of the brain hemorrhage was hypertension. For clinical comparisons, sex-matched persons with hypertensive ICH, aged >40 years, were randomly selected by a factor of 3:1 (n=105). RESULTS - Essential hypertension was present in 26 (74%) young patients and secondary hypertension in 9 (26%), with renovascular hypertension being the most common cause (n=5, 55%). Compared with older patients, the young had higher blood pressures, smaller hemorrhage volumes, lower rates of ventricular extensions (for all, P<0.05), and different distribution pattern of ICHs (P=0.05), without cerebellar and lobar locations. Thirty-day mortality was markedly lower in the young than in older persons (P=0.001), nevertheless at the expense of more incapacitating disabilities. CONCLUSIONS - Young people presenting with hypertensive ICH differ in clinical characteristics and have a different prognosis when compared with their older counterparts. These findings suggest underlying age-related differences in disease pathogenesis. " 2006 American Heart Association, Inc.",,,,,,"10.1161/01.STR.0000248766.22741.4b",,,"http://hdl.handle.net/20.500.12104/42017","http://www.scopus.com/inward/record.url?eid=2-s2.0-33845448891&partnerID=40&md5=6a58ca3f5ba9b4baecca668d81751058",,,,,,"12",,"Stroke",,"294

Aneurysmal Subarachnoid Hemorrhage in a Mexican Multicenter Registry of Cerebrovascular Disease: The RENAMEVASC Study

Background: Information on risk factors and outcome of persons with aneurysmal subarachnoid hemorrhage (SAH) in Mexico is unknown. We sought to describe the clinical characteristics, risk factors, and outcome at discharge of Mexican patients with aneurysmal SAH. Methods: A first-step surveillance system was conducted on consecutive cases confirmed by 4-vessel angiography from November 2002 to October 2004 in 25 tertiary referral centers. Age- and sex-matched control subjects were randomly selected by a 1:1 factor, for multivariate analysis on risk factors. Results: We studied 231 patients (66% women; mean age 52 years, range 16-90 years). In 92%, the aneurysms were in the anterior circulation, and 15% had more than two aneurysms. After multivariate analysis, hypertension (odds ratio 2.46, 95% confidence interval 1.59-3.81) and diabetes mellitus (odds ratio 0.34, 95% confidence interval 0.17-0.68) were directly and inversely associated with aneurysmal SAH, respectively. Median hospital stay was 23 days (range 2-98 days). Invasive treatment was performed in 159 (69%) patients: aneurysm clipping in 126 (79%), endovascular coiling in 29 (18%), and aneurysm wrapping in 4 (2%). The in-hospital mortality was 20% (mostly due to neurologic causes), and 25% of patients were discharged with a modified Rankin score of 4 or 5. Conclusions: Hypertension is the main risk factor for aneurysmal SAH in hospitalized patients from Mexico. The female:male ratio is 2:1. A relatively low in-hospital mortality and a high frequency of invasive interventions are observed. However, a high proportion of patients are discharged with important neurologic impairment. Zapotitlán 2009 National Stroke Association

Hypertensive intracerebral hemorrhage in young people: Previously unnoticed age-related clinical differences

BACKGROUND AND PURPOSE - Hypertensive intracerebral hemorrhage (ICH) in young people has been the object of only succinct analyses. Therefore, it is unclear whether extrapolation of the information obtained from older patients is also valid for the young. Here we describe young persons with hypertensive ICH and compare them with their older counterparts to determine whether age-related clinical differences exist. METHODS - From 1988 to 2004, we studied 35 consecutive young patients with ICH (60% men; mean age, 33 years; range, 15 to 40 years) for whom the etiology of the brain hemorrhage was hypertension. For clinical comparisons, sex-matched persons with hypertensive ICH, aged >40 years, were randomly selected by a factor of 3:1 (n=105). RESULTS - Essential hypertension was present in 26 (74%) young patients and secondary hypertension in 9 (26%), with renovascular hypertension being the most common cause (n=5, 55%). Compared with older patients, the young had higher blood pressures, smaller hemorrhage volumes, lower rates of ventricular extensions (for all, P<0.05), and different distribution pattern of ICHs (P=0.05), without cerebellar and lobar locations. Thirty-day mortality was markedly lower in the young than in older persons (P=0.001), nevertheless at the expense of more incapacitating disabilities. CONCLUSIONS - Young people presenting with hypertensive ICH differ in clinical characteristics and have a different prognosis when compared with their older counterparts. These findings suggest underlying age-related differences in disease pathogenesis. © 2006 American Heart Association, Inc

Acute cerebrovascular disease discharges from public institutions of the Mexican Ministry of Health: An analysis on 5.3 millions of hospitalizations in 2010 [Egresos por enfermedad vascular cerebral aguda en instituciones p�blicas del sector salud de M�xico: Un an�lisis de 5.3 millones de hospitalizaciones en 2010]

Introduction: Cerebrovascular disease (CVD) mortality in Mexico has shown a growing pattern in recent years. It is not known whether data obtained in the important multicenter CVD Mexican registries adequately represent all the hospital units of the health system. Objective: To describe the frequency of acute CVD subtypes and shortterm outcome in discharge registries from public institutions of the Mexican health system, during the year 2010. Methods: We consulted the Mexican public health system database of hospital discharges corresponding to the year 2010 (Secretar�a de Salud, IMSS, IMSS Oportunidades, ISSSTE, PEMEX, SEMAR y SEDENA). CVD registries were identified with the International Classification of Diseases 10th revision codes (ICD-10). Specified CVD was defined as the existence of ICD-10 codes describing precise CVD subtypes. Results: In 2010, a total of 5,314,132 hospital discharges were registered in the Mexican public health system. Of them, 46,247 (0.9%) were acute CVD including: acute ischemic stroke (AIS) 20,298 (43.9%), intracerebral hemorrhage (ICH) 6,005 (13.0%), subarachnoid hemorrhage 2,655 (5.7%), cerebral venous thrombosis (CVT) 194 (0.4%) and non-specified CVD 17,095 (37.0%). Among specified CVD discharges (n=29,152), 69.6% corresponded to AIS, 20.6% to ICH, 9.1% to SAH and 0.7% to CVT. The global 30-day case fatality rate was 17.1% (18.8% among specified subtypes); higher for ICH (33.6%), followed by SAH (29.3%) and AIS (13.9%) (p < 0.001). Conclusions: The relative frequency of acute CVD subtypes by the year 2010 was similar to that of the previous Mexican multicenter registries. Short-term mortality is higher in hemorrhagic forms of CVD, as compared with ischemic stroke

Cerebral venous thrombosis in a Mexican multicenter registry of acute cerebrovascular disease: The RENAMEVASC study

Background: Cerebral venous thrombosis (CVT) is a rare form of cerebrovascular disease that is usually not mentioned in multicenter registries on all-type acute stroke. We aimed to describe the experience on hospitalized patients with CVT in a Mexican multicenter registry on acute cerebrovascular disease. Methods: CVT patients were selected from the RENAMEVASC registry, which was conducted between 2002 and 2004 in 25 Mexican hospitals. Risk factors, neuroimaging, and 30-day outcome as assessed by the modified Rankin scale (mRS) were analyzed. Results: Among 2000 all-type acute stroke patients, 59 (3%; 95% CI, 2.3-3.8%) had CVT (50 women; female:male ratio, 5:1; median age, 31 years). Puerperium (42%), contraceptive use (18%), and pregnancy (12%) were the main risk factors in women. In 67% of men, CVT was registered as idiopathic, but thrombophilia assessment was suboptimal. Longitudinal superior sinus was the most frequent thrombosis location (78%). Extensive (>5 cm) venous infarction occurred in 36% of patients. Only 81% of patients received anticoagulation since the acute phase, and 3% needed decompressive craniectomy. Mechanical ventilation (13.6%), pneumonia (10.2%) and systemic thromboembolism (8.5%) were the main in-hospital complications. The 30-day case fatality rate was 3% (2 patients; 95% CI, 0.23-12.2%). In a Cox proportional hazards model, only age <40 years was associated with a mRS score of 0 to 2 (functional independence; rate ratio, 3.46; 95% CI, 1.34-8.92). Conclusions: The relative frequency of CVT and the associated in-hospital complications were higher than in other registries. Thrombophilia assessment and acute treatment was suboptimal. Young age is the main determinant of a good short-term outcome. � 2012 by National Stroke Association