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      Predictors of Vascular Events after Ischemic Stroke: The China Ischemic Stroke Registry Study

      research-article
      , , ,
      Neuroepidemiology
      S. Karger AG
      Vascular, Ischemia, Stroke, Prognosis

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          Abstract

          Background/Aims: To measure the risk of vascular event occurrence among postischemic stroke patients in mainland China. Methods: In this multicenter prospective stroke registry study, we enrolled 1,951 patients diagnosed with acute ischemic stroke. Demographic data, prestroke risk factors, severity of neurological deficits and disability graded on the National Institutes of Health Stroke Scale (NIHSS), and modified Rankin Scale scores of each patient were measured and recorded. Patients were followed up regularly for 12 months after recruitment. Clinical endpoints were defined as occurrence of vascular events or death. Results: We detected 103 cases with nonfatal vascular events and 27 cases that died of vascular events. Cumulative incidences of total vascular events, cerebrovascular events, and coronary artery diseases were 7.2, 5.0, and 1.8%, respectively, at 12 months after the initial ischemic stroke. Concomitant atherosclerotic-thrombotic diseases (HR, 1.68; 95% CI, 1.14–2.43) and baseline NIHSS (HR, 1.07; 95% CI, 1.03–1.11) were found to be the best predictors for further occurrence of a vascular event. Antiplatelet therapy (HR, 0.52; 95% CI, 0.35–0.77) is associated with a lower risk of further vascular events. Conclusion: Our study provided valuable data on prognosis of acute ischemic stroke in Chinese patients.

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          Most cited references18

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          Proportion of different subtypes of stroke in China.

          The goal of this article is to clarify the proportion of stroke subtypes in China, where stoke is the most common cause of death. A total of 16,031 first-ever strokes in subjects >or=25 years of age were identified in 1991 to 2000 from 17 Chinese populations through a community-based cardiovascular disease surveillance program in the China Multicenter Collaborative Study of Cardiovascular Epidemiology. World Health Organization diagnosis criteria were used for classification of stroke subtypes. CT scan rate of stroke cases reached a satisfactorily high level only after 1996 in the study populations. In 8268 first-ever stroke events from 10 populations with CT scan rate >75% in 1996 to 2000, 1.8% were subarachnoid hemorrhage, 27.5% were intracerebral hemorrhage, 62.4% were cerebral infarction, and 8.3% were undetermined stroke. The proportion of intracerebral hemorrhage varied from 17.1% to 39.4% and that for cerebral infarction varied from 45.5% to 75.9% from population to population. The ratio of ischemic to hemorrhagic stroke ranged from 1.1 to 3.9 and averaged 2.0). The 28-day fatality rate was 33.3% for subarachnoid hemorrhage, 49.4% for intracerebral hemorrhage, 16.9% for cerebral infarction, and 64.6% for undetermined stroke. In our study, ischemic stroke was more frequent and its proportion was higher than hemorrhagic stroke in Chinese populations. Although hemorrhagic stroke was more frequent in Chinese than in Western populations, the variation in the proportion of stroke subtypes among Chinese populations could be as large as or larger than that between Chinese and Western populations.
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            Incidence and trends of stroke and its subtypes in China: results from three large cities.

            To examine the incidence and trends of stroke and its major subtypes during the 1990s in 3 cities in China. Stroke cases registered between 1991 to 2000 were initially identified through the stroke surveillance networks established in Beijing, Shanghai, and Changsha, and then confirmed by neurologists. The age-standardized incidence rates per 100,000 person years of overall first-ever stroke were 135.0 (95% CI, 126.5 to 144.6) in Beijing, 76.1 (70.6 to 82.6) in Shanghai, and 150.0 (141.3 to 160.0) in Changsha during the 1990s. Incidence of ischemic stroke (IS) was highest in Beijing, followed by Changsha and Shanghai; for intracerebral hemorrhage (ICH), the highest rate was found in Changsha, followed by Beijing and Shanghai. The same order as ICH was also observed for subarachnoid hemorrhage. The age-adjusted incidence of overall stroke and ICH for individuals > or =55 years of age in our populations was generally higher than that from Western populations. During the 1990s, ICH incidence decreased significantly at a rate of 12.0% per year in Beijing, 4.4% in Shanghai, and 7.7% in Changsha; in contrast, except for Changsha, IS incidence increased in Beijing (5.0% per year) and Shanghai (7.7%). There is a geographic variation in the incidence of stroke and its subtypes among these 3 cities, but the incidence of overall and hemorrhagic stroke in China is generally higher than that in the Western countries. Interestingly, the decrease in ICH and increase in IS during the past decade may reflect some underlying changes of risk factors in Chinese populations.
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              Recurrent stroke and cardiac risks after first ischemic stroke: the Northern Manhattan Study.

              Few population-based studies with long-term follow-up have compared risk of recurrent stroke and cardiac events after first ischemic stroke. The relative risk of these two outcomes may inform treatment decisions. In the population-based Northern Manhattan Study, first ischemic stroke patients age 40 or older were prospectively followed for recurrent stroke, myocardial infarction (MI), and cause-specific mortality. Fatal cardiac events were defined as death secondary to MI, congestive heart failure, sudden death/arrhythmia, and cardiopulmonary arrest. Risk of events (with 95% CIs) was calculated using Kaplan-Meier survival analysis and adjusted for sex and age using Cox proportional hazard models. Mean age (n = 655; median follow-up 4.0 years) was 69.7 +/- 12.7 years. The risk of recurrent stroke was more than twice that of cardiac events (including nonfatal MI) at 30 days and approximately twice cardiac risk at 5 years. The age- and sex-adjusted 5-year risk of fatal or nonfatal recurrent stroke was 18.3% (14.8 to 21.7%), and the 5-year risk of MI or fatal cardiac event was 8.6% (6.0 to 11.2%). The adjusted 5-year risk of nonfatal stroke (14.8%, 11.6 to 17.9%) was approximately twice as high as fatal cardiac events (6.4%, 4.1 to 8.6%) and four times higher than risk of fatal stroke (3.7%, 2.1 to 5.4%). Cardiac mortality is nearly twice as high as mortality owing to recurrent stroke, but long-term risk of all stroke, fatal or nonfatal, is approximately twice the risk of all cardiac events. The high risk of nonfatal recurrent stroke reinforces the importance of therapies aimed at preventing stroke recurrence in addition to preventing cardiac events.
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                Author and article information

                Journal
                NED
                Neuroepidemiology
                10.1159/issn.0251-5350
                Neuroepidemiology
                S. Karger AG
                0251-5350
                1423-0208
                2010
                February 2010
                24 December 2009
                : 34
                : 2
                : 110-116
                Affiliations
                Institute of Neurology, WHO Collaborating Center for Research and Training in Neuroscience, Huashan Hospital, Fudan University, Shanghai, China
                Article
                268823 Neuroepidemiology 2010;34:110–116
                10.1159/000268823
                20051694
                56bcec16-3bb5-4f4d-95f2-60b02d9fa15d
                © 2009 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 13 May 2009
                : 03 October 2009
                Page count
                Figures: 1, Tables: 2, References: 29, Pages: 7
                Categories
                Original Paper

                Geriatric medicine,Neurology,Cardiovascular Medicine,Neurosciences,Clinical Psychology & Psychiatry,Public health
                Ischemia,Stroke,Vascular,Prognosis

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