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  • 1
    Online Resource
    Online Resource
    Ischemia-Modified Albumin in Acute Stroke
    S. Karger AG ; 2007
    In:  Cerebrovascular Diseases Vol. 23, No. 2-3 ( 2007), p. 216-220
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 23, No. 2-3 ( 2007), p. 216-220
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Ischemia-modified albumin (IMA)is a new biological marker of ischemia. Previous studies have found increased serum IMA levels after myocardial ischemia, but no study has investigated the possibility that stroke modifies IMA blood levels. 〈 i 〉 Materials and Methods: 〈 /i 〉 We studied 118 consecutive patients presenting within 3 h of the onset of an acute neurological deficit [84 brain infarctions (BI), 18 brain hemorrhages (ICH) and 16 transient ischemic attacks lasting less than 1 h or epileptic seizures] . Serum samples were obtained for all patients at initial presentation and repeated only in patients with stroke at 6, 12 and 24 h. IMA was measured by the albumin-cobalt-binding test (Ischemia Technologies, Denver, Colo., USA). 〈 i 〉 Results: 〈 /i 〉 The initial median IMA (bootstrap 95% confidence interval, CI) was 83 U/ml (79–86) and 86 U/ml (75–90) in patients with BI and ICH, respectively (p = 0.76), and was 73 U/ml (58–79) in others (p = 0.003 compared with BI, and p = 0.017 with ICH). Baseline IMA levels correlated with the National Institutes of Health Stroke Scale [Spearman correlation coefficient: 0.34 (p = 0.002) in BI, 0.61 (p = 0.008) in ICH]. During the first 24 h, IMA levels increased in BI patients (median, 9.1%; bootstrap 95% CI, 5.2–11.5), whereas no change was observed in ICH patients (median, 1.2%; bootstrap 95% CI, –7.8 to 6.8). 〈 i 〉 Conclusions: 〈 /i 〉 IMA blood levels may be a biomarker for early identification of acute stroke. Further studies are required to investigate the role of IMA in the early detection of acute stroke.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000097644
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2007
    detail.hit.zdb_id: 1482069-9
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  • 2
    Online Resource
    Online Resource
    The Intracranial-B〈sub〉2〈/sub〉LEED〈sub〉3〈/sub〉S Score and the Risk of Intracranial Hemorrhage in Ischemic Stroke Patients Under Antiplatelet Treatment
    S. Karger AG ; 2017
    In:  Cerebrovascular Diseases Vol. 43, No. 3-4 ( 2017), p. 145-151
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 43, No. 3-4 ( 2017), p. 145-151
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Chronic antiplatelet therapy in the post-acute phase of non-cardioembolic ischemic stroke is limited by the risk of intracranial hemorrhage (ICH) complications. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We developed an ICH risk score based on the PERFORM trial cohort (n = 19,100), which included patients with a non-cardioembolic ischemic stroke or transient ischemic attack, and externally validated this score in one contemporary trial of very similar size and inclusion criteria, the PRoFESS trial (n = 20,332 patients). Outcome was ICH over 2 years. A Cox proportional-hazard regression analysis identified risk factors. Discrimination was quantified with c-statistics and calibration was assessed by comparing predicted and observed ICH risk in PERFORM and PRoFESS. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 ICH occurred within 2 years in 263 (1.4%) patients in PERFORM trial and in 246 (1.2%) patients in PRoFESS trial. A 13-point score based on 9 items (Intracranial-B 〈 sub 〉 2 〈 /sub 〉 LEED 〈 sub 〉 3 〈 /sub 〉 S score - low body mass index, blood pressure, lacune, elderly, Asian ethnicity, coronary artery or cerebrovascular disease history, dual antithrombotic agent or oral anticoagulant, gender) was derived from the PERFORM trial. In PERFORM, the observed 2-year ICH risk varied from 0.75% in low-risk (score ≤2) to 2.44% in high-risk patients (score ≥5) with an acceptable calibration but a low discrimination both in PERFORM (c-statistic 0.64, 95% CI 0.61-0.68) and on external validation in PRoFESS (0.58, 95% CI 0.55-0.62). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 The Intracranial-B 〈 sub 〉 2 〈 /sub 〉 LEED 〈 sub 〉 3 〈 /sub 〉 S score helps identify patients who are at a high risk of bleeding. However, other variables need to be identified to improve the score (e.g., microbleeds) (Clinical Trial Registration Information ISRCTN66157730). URL: http://www.isrctn.com/ISRCTN66157730?totalResults=5 & amp;pageSize=10 & amp;page=1 & amp;searchType=basic-search & amp;offset=3 & amp;q= & amp;filters=conditionCategory%3ACirculatory+System%2CrecruitmentCountry%3ATaiwan%2CrecruitmentCountry%3AAustria & amp;sort=.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000453459
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2017
    detail.hit.zdb_id: 1482069-9
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  • 3
    Online Resource
    Online Resource
    Specificities of Ischemic Stroke Risk Factors in Arab-Speaking Countries
    S. Karger AG ; 2017
    In:  Cerebrovascular Diseases Vol. 43, No. 3-4 ( 2017), p. 169-177
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 43, No. 3-4 ( 2017), p. 169-177
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Stroke is largely preventable, and therefore, a better understanding of risk factors is an essential step in reducing the population stroke rate and resulting disease burden in Arab countries. 〈 b 〉 〈 i 〉 Summary: 〈 /i 〉 〈 /b 〉 We performed 2 separate analyses in 2 similar populations of patients with noncardioembolic ischemic stroke. This first involved 3,635 patients in the Outcomes in Patients with TIA and Cerebrovascular disease (OPTIC) registry (followed for 2 years), with baseline collection of the usual risk factors and 5 socioeconomic variables (unemployment status, residence in rural area, living in fully serviced accommodation, no health-insurance coverage, and low educational level). The second involved patients in the PERFORM trial ( 〈 i 〉 n 〈 /i 〉 = 19,100 followed up for 2 years), with baseline collection of the usual risk factors and 1 socioeconomic variable (low educational level). The primary outcome was a composite of nonfatal stroke, nonfatal myocardial infarction, or cardiovascular death. Stroke risk factors were more prevalent in patients in Arab countries. The incidence of major cardiovascular events (MACE; age- and gender-adjusted) was higher in Arab countries (OPTIC, 18.5 vs. 13.3%; PERFORM, 18.4 vs. 9.7%; both 〈 i 〉 p 〈 /i 〉 ≤ 0.0001). These results remained significant after adjustment on risk factors and were attenuated in OPTIC after further adjustment on socioeconomic variables (hazard ratio 1.24; 95% CI 0.98-1.55; 〈 i 〉 p 〈 /i 〉 = 0.07). 〈 b 〉 〈 i 〉 Key Messages: 〈 /i 〉 〈 /b 〉 Patients with ischemic stroke living in Arab countries had a lower mean socioeconomic status, a much higher prevalence of diabetes mellitus, and a higher rate of MACE compared with patients from non-Arab countries. This finding is partly explained by a higher prevalence of risk factors and also by a high prevalence of poverty and low educational level.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000454776
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2017
    detail.hit.zdb_id: 1482069-9
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