P N Sylaja1, Jeyaraj Durai Pandian2, Subhash Kaul2, M V Padma Srivastava2, Dheeraj Khurana2, Lee H Schwamm2, Praveen Kesav2, Deepti Arora2, Aman Pannu2, Tijy K Thankachan2, Aneesh B Singhal2. 1. From the Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India (P.N.S., P.K.); Department of Neurology, Christian Medical College and Hospital, Ludhiana, India (J.P., D.A., A.P.); Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India (S.K.); Department of Neurology, All-India Institutes of Medical Sciences, New Delhi (M.V.P.S.); Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India (D.K.); and Department of Neurology, Massachusetts General Hospital, Boston (L.H.S., T.T., A.B.S.). sylajapn@hotmail.com. 2. From the Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India (P.N.S., P.K.); Department of Neurology, Christian Medical College and Hospital, Ludhiana, India (J.P., D.A., A.P.); Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India (S.K.); Department of Neurology, All-India Institutes of Medical Sciences, New Delhi (M.V.P.S.); Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India (D.K.); and Department of Neurology, Massachusetts General Hospital, Boston (L.H.S., T.T., A.B.S.).
Abstract
BACKGROUND AND PURPOSE: The Indo-US Collaborative Stroke Project was designed to characterize ischemic stroke across 5 high-volume academic tertiary hospitals in India. METHODS: From January 2012 to August 2014, research coordinators and physician coinvestigators prospectively collected data on 2066 patients with ischemic stroke admitted <2 weeks after onset. Investigator training and supervision and data monitoring were conducted by the US site (Massachusetts General Hospital, Boston). RESULTS: The mean age was 58.3±14.7 years, 67.2% men. The median admission National Institutes of Health Stroke Scale score was 10 (interquartile range, 5-15) and 24.5% had National Institutes of Health Stroke Scale ≥16. Hypertension (60.8%), diabetes mellitus (35.7%), and tobacco use (32.2%, including bidi/smokeless tobacco) were common risk factors. Only 4% had atrial fibrillation. All patients underwent computed tomography or magnetic resonance imaging; 81% had cerebrovascular imaging. Stroke etiologic subtypes were large artery (29.9%), cardiac (24.9%), small artery (14.2%), other definite (3.4%), and undetermined (27.6%, including 6.7% with incomplete evaluation). Intravenous or intra-arterial thrombolysis was administered in 13%. In-hospital mortality was 7.9%, and 48% achieved modified Rankin Scale score 0 to 2 at 90 days. On multivariate analysis, diabetes mellitus predicted poor 3-month outcome and younger age, lower admission National Institutes of Health Stroke Scale and small-artery etiology predicted excellent 3-month outcome. CONCLUSIONS: These comprehensive and novel clinical imaging data will prove useful in refining stroke guidelines and advancing stroke care in India.
BACKGROUND AND PURPOSE: The Indo-US Collaborative Stroke Project was designed to characterize ischemic stroke across 5 high-volume academic tertiary hospitals in India. METHODS: From January 2012 to August 2014, research coordinators and physician coinvestigators prospectively collected data on 2066 patients with ischemic stroke admitted <2 weeks after onset. Investigator training and supervision and data monitoring were conducted by the US site (Massachusetts General Hospital, Boston). RESULTS: The mean age was 58.3±14.7 years, 67.2% men. The median admission National Institutes of Health Stroke Scale score was 10 (interquartile range, 5-15) and 24.5% had National Institutes of Health Stroke Scale ≥16. Hypertension (60.8%), diabetes mellitus (35.7%), and tobacco use (32.2%, including bidi/smokeless tobacco) were common risk factors. Only 4% had atrial fibrillation. All patients underwent computed tomography or magnetic resonance imaging; 81% had cerebrovascular imaging. Stroke etiologic subtypes were large artery (29.9%), cardiac (24.9%), small artery (14.2%), other definite (3.4%), and undetermined (27.6%, including 6.7% with incomplete evaluation). Intravenous or intra-arterial thrombolysis was administered in 13%. In-hospital mortality was 7.9%, and 48% achieved modified Rankin Scale score 0 to 2 at 90 days. On multivariate analysis, diabetes mellitus predicted poor 3-month outcome and younger age, lower admission National Institutes of Health Stroke Scale and small-artery etiology predicted excellent 3-month outcome. CONCLUSIONS: These comprehensive and novel clinical imaging data will prove useful in refining stroke guidelines and advancing stroke care in India.
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