Keon-Joo Lee1, Beom Joon Kim1, Moon-Ku Han1, Joon-Tae Kim1, Ki-Hyun Cho1, Dong-Ick Shin1, Min-Ju Yeo1, Jae-Kwan Cha1, Dae-Hyun Kim1, Hyun-Wook Nah1, Dong-Eog Kim1, Wi-Sun Ryu1, Jong-Moo Park1, Kyusik Kang1, Soo Joo Lee1, Mi-Sun Oh1, Kyung-Ho Yu1, Byung-Chul Lee1, Keun-Sik Hong1, Yong-Jin Cho1, Jay Chol Choi1, Sung Il Sohn1, Jeong-Ho Hong1, Tai Hwan Park1, Sang-Soon Park1, Jee-Hyun Kwon1, Wook-Joo Kim1, Jun Lee1, Ji Sung Lee1, Juneyoung Lee1, Philip B Gorelick1, Hee-Joon Bae2. 1. From the Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (K.-J.L., B.J.K., M.-K.H., H.-J.B.); Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K., K.-H.C.); Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea (D.-I.S., M.-J.Y.); Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K., H.-W.N.); Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea (D.-E.K., W.-S.R.); Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea (J.-M.P., K.K.); Department of Neurology, Eulji University Hospital, Daejeon, Korea (S.J.L.); Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (M.-S.O., K.-H.Y., B.-C.L.); Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea (K.-S.H., Y.-J.C.); Department of Neurology, Jeju National University Hospital, Korea (J.C.C.); Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea (S.I.S., J.-H.H.); Department of Neurology, Seoul Medical Center, Korea (T.H.P., S.-S.P.); Department of Neurology, Ulsan University Hospital, Korea (J.-H.K., W.-J.K.); Department of Neurology, Yeungnam University Medical Center, Daegu, Korea (J.L.); Clinical Research Center, Asan Medical Center, Seoul, Korea (J.S.L.); Department of Biostatistics, Korea University, Seoul (J.L.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.). 2. From the Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (K.-J.L., B.J.K., M.-K.H., H.-J.B.); Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (J.-T.K., K.-H.C.); Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea (D.-I.S., M.-J.Y.); Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C., D.-H.K., H.-W.N.); Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea (D.-E.K., W.-S.R.); Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea (J.-M.P., K.K.); Department of Neurology, Eulji University Hospital, Daejeon, Korea (S.J.L.); Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea (M.-S.O., K.-H.Y., B.-C.L.); Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea (K.-S.H., Y.-J.C.); Department of Neurology, Jeju National University Hospital, Korea (J.C.C.); Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea (S.I.S., J.-H.H.); Department of Neurology, Seoul Medical Center, Korea (T.H.P., S.-S.P.); Department of Neurology, Ulsan University Hospital, Korea (J.-H.K., W.-J.K.); Department of Neurology, Yeungnam University Medical Center, Daegu, Korea (J.L.); Clinical Research Center, Asan Medical Center, Seoul, Korea (J.S.L.); Department of Biostatistics, Korea University, Seoul (J.L.); and Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine and Mercy Health Hauenstein Neurosciences, Grand Rapids (P.B.G.). braindoc@snu.ac.kr.
Abstract
BACKGROUND AND PURPOSE: This study aimed to investigate whether pulse pressure (PP) obtained during the acute stage of ischemic stroke can be used as a predictor for future major vascular events. METHODS: Using a multicenter prospective stroke registry database, patients who were hospitalized for ischemic stroke within 48 hours of onset were enrolled in this study. We analyzed blood pressure (BP) data measured during the first 3 days from onset. Primary and secondary outcomes were time to a composite of stroke recurrence, myocardial infarction, all-cause death, and time to stroke recurrence, respectively. RESULTS: Of 9840 patients, 4.3% experienced stroke recurrence, 0.2% myocardial infarction, and 7.3% death during a 1-year follow-up period. In Cox proportional hazards models including both linear and quadratic terms of PP, PP had a nonlinear J-shaped relationship with primary (for a quadratic term of PP, P=0.004) and secondary (P<0.001) outcomes. The overall effects of PP and other BP parameters on primary and secondary outcomes were also significant (P<0.05). When predictive power of BP parameters was compared using a statistic of -2 log-likelihood differences, PP was a stronger predictor than systolic BP (8.49 versus 5.91; 6.32 versus 4.56), diastolic BP (11.42 versus 11.05; 10.07 versus 4.56), and mean atrial pressure (8.75 versus 5.91; 7.03 versus 4.56) for the primary and secondary outcomes, respectively. CONCLUSIONS: Our study shows that PP when measured in the acute period of ischemic stroke has nonlinear J-shaped relationships with major vascular events and stroke recurrence, and may have a stronger predictive power than other commonly used BP parameters.
BACKGROUND AND PURPOSE: This study aimed to investigate whether pulse pressure (PP) obtained during the acute stage of ischemic stroke can be used as a predictor for future major vascular events. METHODS: Using a multicenter prospective stroke registry database, patients who were hospitalized for ischemic stroke within 48 hours of onset were enrolled in this study. We analyzed blood pressure (BP) data measured during the first 3 days from onset. Primary and secondary outcomes were time to a composite of stroke recurrence, myocardial infarction, all-cause death, and time to stroke recurrence, respectively. RESULTS: Of 9840 patients, 4.3% experienced stroke recurrence, 0.2% myocardial infarction, and 7.3% death during a 1-year follow-up period. In Cox proportional hazards models including both linear and quadratic terms of PP, PP had a nonlinear J-shaped relationship with primary (for a quadratic term of PP, P=0.004) and secondary (P<0.001) outcomes. The overall effects of PP and other BP parameters on primary and secondary outcomes were also significant (P<0.05). When predictive power of BP parameters was compared using a statistic of -2 log-likelihood differences, PP was a stronger predictor than systolic BP (8.49 versus 5.91; 6.32 versus 4.56), diastolic BP (11.42 versus 11.05; 10.07 versus 4.56), and mean atrial pressure (8.75 versus 5.91; 7.03 versus 4.56) for the primary and secondary outcomes, respectively. CONCLUSIONS: Our study shows that PP when measured in the acute period of ischemic stroke has nonlinear J-shaped relationships with major vascular events and stroke recurrence, and may have a stronger predictive power than other commonly used BP parameters.
Authors: Hugo J Aparicio; Laura M Tarko; David Gagnon; Lauren Costa; Ashley Galloway; Serkalem Demissie; Luc Djousse; Sudha Seshadri; Kelly Cho; Peter W F Wilson Journal: Stroke Date: 2021-11-03 Impact factor: 7.914