Takeo Sato1, Shoichiro Sato2, Hiroshi Yamagami3, Teppei Komatsu4, Tadataka Mizoguchi2, Takeshi Yoshimoto2, Masahito Takagi2, Masafumi Ihara5, Masatoshi Koga2, Hiroyoshi Iwata6, Masato Matsushima6, Kazunori Toyoda7, Yasuyuki Iguchi4. 1. Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan. 2. Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 3. Division of Stroke Care Unit, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 4. Department of Neurology, The Jikei University School of Medicine, Tokyo, Japan. 5. Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. 6. Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan. 7. Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. Electronic address: toyoda@ncvc.go.jp.
Abstract
OBJECTIVE: To determine the predictors of unfavorable outcomes in acute minor ischemic stroke patients with large vessel occlusion. METHODS: The derivation cohort included ischemic stroke patients admitted to a comprehensive stroke center within 7 days after onset with large vessel occlusion and an initial National Institutes of Health Stroke Scale score of 5 or less. An unfavorable outcome was defined as dependency (modified Rankin Scale score of 3 to 6) at 3 months from the onset. The predictive values of factors related to an unfavorable outcome were evaluated. External validation was performed from a stroke registry of a tertiary medical center. RESULTS: In the derivation cohort, 3839 consecutive patients were screened; a total of 130 patients were included. Twenty-four (18%) patients had unfavorable outcomes. In multivariate analysis, D-dimer ≥1900 μg/l (odds ratio (OR) 3.31, 95% confidence interval (CI) 1.14-9.61, p = .028) and age (OR 2.01, 95% CI 1.05-3.86, p = .035) were independently associated with an unfavorable outcome. No significant differences were observed regarding occluded vessel sites. In the validation cohort, 850 consecutive patients were screened; a total of 74 patients were included. D-dimer ≥1900 μg/l (OR 8.78, 95% CI 1.41-54.61, p = .020) was the only factor independently associated with an unfavorable outcome, as in the derivation cohort. CONCLUSIONS: A high D-dimer level on admission could help predict unfavorable outcomes in patients with a minor ischemic stroke with large vessel occlusion.
OBJECTIVE: To determine the predictors of unfavorable outcomes in acute minor ischemic strokepatients with large vessel occlusion. METHODS: The derivation cohort included ischemic strokepatients admitted to a comprehensive stroke center within 7 days after onset with large vessel occlusion and an initial National Institutes of Health Stroke Scale score of 5 or less. An unfavorable outcome was defined as dependency (modified Rankin Scale score of 3 to 6) at 3 months from the onset. The predictive values of factors related to an unfavorable outcome were evaluated. External validation was performed from a stroke registry of a tertiary medical center. RESULTS: In the derivation cohort, 3839 consecutive patients were screened; a total of 130 patients were included. Twenty-four (18%) patients had unfavorable outcomes. In multivariate analysis, D-dimer ≥1900 μg/l (odds ratio (OR) 3.31, 95% confidence interval (CI) 1.14-9.61, p = .028) and age (OR 2.01, 95% CI 1.05-3.86, p = .035) were independently associated with an unfavorable outcome. No significant differences were observed regarding occluded vessel sites. In the validation cohort, 850 consecutive patients were screened; a total of 74 patients were included. D-dimer ≥1900 μg/l (OR 8.78, 95% CI 1.41-54.61, p = .020) was the only factor independently associated with an unfavorable outcome, as in the derivation cohort. CONCLUSIONS: A high D-dimer level on admission could help predict unfavorable outcomes in patients with a minor ischemic stroke with large vessel occlusion.
Authors: Abu Saleh Md Moin; Manjula Nandakumar; Ahmed Al-Qaissi; Thozhukat Sathyapalan; Stephen L Atkin; Alexandra E Butler Journal: Front Mol Biosci Date: 2021-12-01