Joon-Tae Kim1, Man-Seok Park2, Kang-Ho Choi2, Beom Joon Kim2, Moon-Ku Han2, Tai Hwan Park2, Sang-Soon Park2, Kyung Bok Lee2, Byung-Chul Lee2, Kyung-Ho Yu2, Mi Sun Oh2, Jae Kwan Cha2, Dae-Hyun Kim2, Hyun-Wook Nah2, Jun Lee2, Soo Joo Lee2, Youngchai Ko2, Jae Guk Kim2, Jong-Moo Park2, Kyusik Kang2, Yong-Jin Cho2, Keun-Sik Hong2, Jay Chol Choi2, Dong-Eog Kim2, Wi-Sun Ryu2, Dong-Ick Shin2, Min-Ju Yeo2, Wook-Joo Kim2, Juneyoung Lee2, Ji Sung Lee2, Hee-Joon Bae2, Jeffrey L Saver2, Ki-Hyun Cho2. 1. From the Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea (J.-T.K., M.-S.P., K.-H. Choi, K.-H. Cho); Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea (B.J.K., M.-K.H., H.-J.B.); Department of Neurology, Seoul Medical Center, Republic of Korea (T.H.P., S.-S.P.); Department of Neurology, Soonchunhyang University Hospital Seoul, Republic of Korea (K.B.L.); Department of Neurology, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea (B.-C.L., K.-H.Y., M.S.O.); Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea (J.K.C., D.-H.K., H.-W.N.); Department of Neurology, Yeungnam University Medical Center, Daegu, Republic of Korea (Jun Lee); Department of Neurology, Eulji University Hospital, Daejeon, Republic of Korea (S.J.L., Y.K., J.G.K.); Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Republic of Korea (J.-M.P., K.K.); Department of Neurology, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Republic of Korea (Y.-J.C., K.-S.H.); Department of Neurology, Jeju National University Hospital, Republic of Korea (J.C.C.); Department of Neurology, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea (D.-E.K., W.-S.R.); Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.-I.S., M.-J.Y.); Department of Neurology, Ulsan University Hospital, Republic of Korea (W.-J.K.); Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea (Juneyoung Lee); Clinical Trial Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.); and Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.). alldelight2@jnu.ac.kr. 2. From the Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea (J.-T.K., M.-S.P., K.-H. Choi, K.-H. Cho); Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea (B.J.K., M.-K.H., H.-J.B.); Department of Neurology, Seoul Medical Center, Republic of Korea (T.H.P., S.-S.P.); Department of Neurology, Soonchunhyang University Hospital Seoul, Republic of Korea (K.B.L.); Department of Neurology, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea (B.-C.L., K.-H.Y., M.S.O.); Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea (J.K.C., D.-H.K., H.-W.N.); Department of Neurology, Yeungnam University Medical Center, Daegu, Republic of Korea (Jun Lee); Department of Neurology, Eulji University Hospital, Daejeon, Republic of Korea (S.J.L., Y.K., J.G.K.); Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Republic of Korea (J.-M.P., K.K.); Department of Neurology, Inje University Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Republic of Korea (Y.-J.C., K.-S.H.); Department of Neurology, Jeju National University Hospital, Republic of Korea (J.C.C.); Department of Neurology, Dongguk University Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea (D.-E.K., W.-S.R.); Department of Neurology, Chungbuk National University Hospital, Cheongju, Republic of Korea (D.-I.S., M.-J.Y.); Department of Neurology, Ulsan University Hospital, Republic of Korea (W.-J.K.); Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea (Juneyoung Lee); Clinical Trial Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.); and Stroke Center and Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.).
Abstract
BACKGROUND AND PURPOSE: We compared baseline characteristics and outcomes at 3 months between patients with minor anterior circulation infarction (ACI) versus minor posterior circulation infarction (PCI), including the influence of large vessel disease on outcomes. METHODS: This study is an analysis of a prospective multicenter registry database in South Korea. Eligibility criteria were patients with ischemic stroke admitted within 7 days of stroke onset, lesions in either anterior or posterior circulation, and National Institutes of Health Stroke Scale score of ≤4 at baseline. Patients were divided into 4 groups for further analysis: minor ACI with and without internal carotid artery/middle cerebral artery large vessel disease and minor PCI with and without vertebrobasilar large vessel disease. RESULTS: A total of 7178 patients (65.2±12.6 years) were analyzed in this study, and 2233 patients (31.1%) had disability (modified Rankin Scale score 2-6) at 3 months. Disability was 32.3% in minor PCI and 30.3% in minor ACI (P=0.07), and death was 1.3% and 1.5%, respectively (P=0.82). In a multivariable logistic regression analysis, minor PCI was significantly associated with disability at 3 months when compared with minor ACI (odds ratio, 1.23; 95% confidence interval, 1.09-1.37; P<0.001). In pairwise comparisons, minor PCI with vertebrobasilar large vessel disease was independently associated with disability at 3 months, compared with the other 3 groups. CONCLUSIONS: Our study showed that minor PCI exhibited more frequent disability at 3 months than minor ACI. Especially, the presence of vertebrobasilar large vessel disease in minor PCI had a substantially higher risk of disability. Our results suggest that minor PCI with vertebrobasilar large vessel disease could require more meticulous care and are important targets for further study.
BACKGROUND AND PURPOSE: We compared baseline characteristics and outcomes at 3 months between patients with minor anterior circulation infarction (ACI) versus minor posterior circulation infarction (PCI), including the influence of large vessel disease on outcomes. METHODS: This study is an analysis of a prospective multicenter registry database in South Korea. Eligibility criteria were patients with ischemic stroke admitted within 7 days of stroke onset, lesions in either anterior or posterior circulation, and National Institutes of Health Stroke Scale score of ≤4 at baseline. Patients were divided into 4 groups for further analysis: minor ACI with and without internal carotid artery/middle cerebral artery large vessel disease and minor PCI with and without vertebrobasilar large vessel disease. RESULTS: A total of 7178 patients (65.2±12.6 years) were analyzed in this study, and 2233 patients (31.1%) had disability (modified Rankin Scale score 2-6) at 3 months. Disability was 32.3% in minor PCI and 30.3% in minor ACI (P=0.07), and death was 1.3% and 1.5%, respectively (P=0.82). In a multivariable logistic regression analysis, minor PCI was significantly associated with disability at 3 months when compared with minor ACI (odds ratio, 1.23; 95% confidence interval, 1.09-1.37; P<0.001). In pairwise comparisons, minor PCI with vertebrobasilar large vessel disease was independently associated with disability at 3 months, compared with the other 3 groups. CONCLUSIONS: Our study showed that minor PCI exhibited more frequent disability at 3 months than minor ACI. Especially, the presence of vertebrobasilar large vessel disease in minor PCI had a substantially higher risk of disability. Our results suggest that minor PCI with vertebrobasilar large vessel disease could require more meticulous care and are important targets for further study.
Authors: Tae Jung Kim; Ji Sung Lee; Jae Sun Yoon; Mi Sun Oh; Ji Woo Kim; Keun Hwa Jung; Kyung Ho Yu; Byung Chul Lee; Sang Bae Ko; Byung Woo Yoon Journal: J Korean Med Sci Date: 2020-06-01 Impact factor: 2.153