Suhail Al Rukn1, Michael V Mazya2,3, Faycal Hentati4, Samia Ben Sassi4, Fatma Nabli4, Zakharia Said4, Belahsen Faouzi5, Husnain Hashim1, Foad Abd-Allah6, Benhan Mansouri7, Selma Kesraoui8, Souheil Gebeily9, Husen Abdulrahman10, Naveed Akhtar11, Niaz Ahmed2,3, Nils Wahlgren2,3, Hany Aref12, Mohammed Almekhlafi13, Tiago Moreira2,3. 1. Department of Neurology, Rashid Hospital, Dubai Health Authority, Dubai, UAE. 2. Department of Neurology, Karolinska University Hospital, Stockholm, Sweden. 3. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. 4. Department of Neurology; Mongi Ben Hamida National Institute of Neurology, Tunis, Tunisia. 5. Department of Neurology, Hassan II University Hospital, Fez, Morocco. 6. Cairo University, Cairo, Egypt. 7. Imam Husain Hospital (IRHUS), Tehran, Iran. 8. CHU de Blida, hôpital Franz Fanon, Blida, Algeria. 9. Neurosciences Research Center, Faculty of Medical Sciences, The Lebanese University, Hadath, Lebanon. 10. Department of Neurology, King Abdulaziz Medical City, Riyadh, Saudi Arabia. 11. Hamad General Hospital (QAHMG), Doha, Qatar. 12. Stroke unit, Ain Shams University, Cairo, Egypt. 13. Department of Neurology, King Abdulaziz University, Jeddah, Saudi Arabia.
Abstract
BACKGROUND AND METHODS: Stroke incidence and mortality are reported to have increased in the Middle-East and North African (MENA) countries during the last decade. This was a prospective observational study to examine the baseline characteristics of stroke patients in the MENA region and to compare the MENA vs. the non-MENA stroke cohort in the Safe Implementation of Treatments in Stroke (SITS) International Registry. RESULTS: Of the 13,822 patients with ischemic and hemorrhagic stroke enrolled in the SITS-All Patients Protocol between June 2014 and May 2016, 5897 patients (43%) were recruited in MENA. The median onset-to-door time was 5 h (IQR: 2:20-13:00), National Institutes of Health Stroke Scale (NIHSS) score was 8 (4-13) and age was 65 years (56-76). Hypertension (66%) and diabetes (38%) were the prevailing risk factors; large artery stenosis > 50% (25.3%) and lacunar strokes (24.1%) were the most common ischemic stroke etiologies. In comparison, non-MENA countries displayed an onset-to-door time of 5:50 h (2:00-18:45), a median of NIHSS 6 (3-14), and a median age of 66 (56-76), with other large vessel disease and cardiac embolism as the main ischemic stroke etiologies. Hemorrhagic strokes (10%) were less common compared to non-MENA countries (13.9%). In MENA, only a low proportion of patients (21%) was admitted to stroke units. CONCLUSIONS: MENA patients are slightly younger, have a higher prevalence of diabetes and slightly more severe ischemic strokes, commonly of atherosclerotic or microvascular etiology. Admission into stroke units and long-term follow-up need to be improved. It is suspected that cardiac embolism and atrial fibrillation are currently underdiagnosed in MENA countries.
BACKGROUND AND METHODS: Stroke incidence and mortality are reported to have increased in the Middle-East and North African (MENA) countries during the last decade. This was a prospective observational study to examine the baseline characteristics of strokepatients in the MENA region and to compare the MENA vs. the non-MENA stroke cohort in the Safe Implementation of Treatments in Stroke (SITS) International Registry. RESULTS: Of the 13,822 patients with ischemic and hemorrhagic stroke enrolled in the SITS-All Patients Protocol between June 2014 and May 2016, 5897 patients (43%) were recruited in MENA. The median onset-to-door time was 5 h (IQR: 2:20-13:00), National Institutes of Health Stroke Scale (NIHSS) score was 8 (4-13) and age was 65 years (56-76). Hypertension (66%) and diabetes (38%) were the prevailing risk factors; large artery stenosis > 50% (25.3%) and lacunar strokes (24.1%) were the most common ischemic stroke etiologies. In comparison, non-MENA countries displayed an onset-to-door time of 5:50 h (2:00-18:45), a median of NIHSS 6 (3-14), and a median age of 66 (56-76), with other large vessel disease and cardiac embolism as the main ischemic stroke etiologies. Hemorrhagic strokes (10%) were less common compared to non-MENA countries (13.9%). In MENA, only a low proportion of patients (21%) was admitted to stroke units. CONCLUSIONS: MENA patients are slightly younger, have a higher prevalence of diabetes and slightly more severe ischemic strokes, commonly of atherosclerotic or microvascular etiology. Admission into stroke units and long-term follow-up need to be improved. It is suspected that cardiac embolism and atrial fibrillation are currently underdiagnosed in MENA countries.
Authors: Abdullah M Al Alawi; Ikhlas Al Busaidi; Emaad Al Shibli; Al-Reem Al-Senaidi; Shahd Al Manwari; Ibtisam Al Busaidi; Fatema Muhanna; Ahmed Al Qassabi Journal: Ann Saudi Med Date: 2022-08-04 Impact factor: 1.707