Atherosclerotic burden and early mortality in acute ischemic stroke

Jaume Roquer, Angel Ois, Ana Rodríguez-Campello, Meritxell Gomis, Elvira Munteis, Jordi Jiménez-Conde, Elisa Cuadrado-Godia, José E Martínez-Rodríguez
Archives of Neurology 2007, 64 (5): 699-704

BACKGROUND: The influence that previous clinical expressions of systemic atherosclerosis may have on evolution and early mortality in patients with acute ischemic stroke is not known.

OBJECTIVE: To evaluate the influence that atherosclerotic burden (ATB), assessed by a simple clinical scale, has on the 30-day mortality in patients with first-ever ischemic stroke.

DESIGN: Retrospective review of case series from a prospective stroke record. An ATB score ranging from 0 to 2 was created using the history of ischemic heart disease and peripheral arterial disease. The impact of this score on the 30-day mortality was analyzed by multivariate regression analysis.

SETTING: Tertiary university hospital. Patients A total of 1527 patients with first-ever ischemic stroke. Main Outcome Measure Thirty-day mortality.

RESULTS: The 30-day mortality rate was 13.8%. Multivariate regression analysis showed an association between the ATB score and the 30-day mortality (P<.001). Comparing patients having no previous ATB with those with an ATB score of 1 or 2, the odds ratio (OR) for 30-day mortality increased from 1.71 (95% confidence interval [CI], 1.06-2.75) for patients with an ATB score of 1 to 5.90 (95% CI, 2.48-14.04) for those with an ATB score of 2. Age (OR, 1.05; 95% CI, 1.03-1.08), National Institutes of Health Stroke Scale score at admission (OR, 1.22; 95% CI, 1.18-1.25), atrial fibrillation (OR, 1.61; 95% CI, 1.10-2.35), hyperlipidemia as protector (OR, 0.39; 95% CI, 0.25-0.60), and glycemia at admission (OR, 1.07; 95% CI, 1.02-1.12) were also predictors of 30-day mortality.

CONCLUSION: Previous symptomatic atherosclerotic disease evaluated by a simple clinical score is an independent predictor of early mortality in patients with first-ever ischemic stroke.

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