Document Detail


Risk of vascular events after nondisabling small and large vessel cerebral ischemia.
MedLine Citation:
PMID:  24135529     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background: Small- and large-vessel disease (SVD and LVD, respectively) might have a different pathogenesis and prognosis but the long-term risk of death and recurrent stroke appears to be similar in previous studies. In this study, we investigated the long-term vascular prognosis of patients with LVD and SVD in a large cohort of well-documented patients. Methods: We included 971 patients with transient ischemic attack (TIA) or nondisabling ischemic stroke of atherosclerotic origin referred to a university hospital in the Netherlands between 1994 and 2005 and followed them for the occurrence of vascular events or death. The primary outcome was a composite of stroke, myocardial infarction and vascular death, whichever happened first. Classification of SVD/LVD was primarily based on brain imaging. We used regression analyses to generate hazard ratios (HRs) with 95% confidence intervals (CIs). Sensitivity analyses were performed in subsets of the population, i.e. patients with subtype classification based on imaging, excluding TIA patients, first-ever stroke patients and LVD patients without a symptomatic carotid stenosis. Results: During a mean follow-up of 6.3 years, new vascular events occurred in 56 of 312 SVD patients (3.3%/year) and in 128 of 659 LVD patients (2.9%/year). These were ischemic strokes in 33 of the 56 events in SVD patients (2.0%/year) and 54 of the 128 events in LVD patients (1.2%/year). The corresponding age- and sex-adjusted HR for all new vascular events for LVD versus SVD was 0.76 (95% CI 0.56-1.05) for the total follow-up period. When this risk was split into early risk (<1 year) and late risk (>1 year), it was not significantly different for the 1-year risk of vascular events (HR 1.04, 95% CI 0.57-1.91); however, after 1 year of follow-up, LVD patients had fewer outcome events compared with SVD patients (HR 0.66, 95% CI 0.46-0.96). For ischemic strokes, the overall HR was 0.60 (95% CI 0.39-0.94). As with the primary outcome, here also the 1-year risk was not significantly different from >1-year risk (HR 1.31, 95% CI 0.62-2.81, and HR 0.36, 95% CI 0.21-0.63, respectively). The sensitivity analyses showed virtually the same results. Conclusion: In patients with nondisabling cerebrovascular disease, we found, despite no differences at baseline in terms of vascular risk factors, a better long-term prognosis for patients with LVD for all vascular events, especially for recurrent strokes. Our observations support a different pathogenesis in SVD and LVD patients, and optimal prevention is indicated for patients with what was formerly regarded as 'benign' SVD stroke.
Authors:
S Achterberg; D M O Pruissen; L J Kappelle; A Algra
Related Documents :
23033299 - Comparison of foam dressings with silver versus foam dressings without silver in the ca...
23475019 - Differences in the peak cough flow among stroke patients with and without dysphagia.
23210949 - Acne and skin bleaching in lomé, togo.
23159099 - Epicardial adipose tissue volume and cardiovascular disease in hemodialysis patients.
23210049 - Subarachnoid hemorrhage with negative baseline digital subtraction angiography: is repe...
22945689 - Serum tumor necrosis factor-α and interleukin-10 levels as markers to predict outcome o...
15090359 - Treatment considerations for vertebroplasty in men.
24995249 - Underlying kidney disease and duration of hemodialysis: an assessment of its effect on ...
1864099 - Cardiac biopsy in patients with "primary" atrial fibrillation. histologic evidence of o...
Publication Detail:
Type:  Journal Article     Date:  2013-10-12
Journal Detail:
Title:  Cerebrovascular diseases (Basel, Switzerland)     Volume:  36     ISSN:  1421-9786     ISO Abbreviation:  Cerebrovasc. Dis.     Publication Date:  2013  
Date Detail:
Created Date:  2013-10-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9100851     Medline TA:  Cerebrovasc Dis     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  190-5     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 S. Karger AG, Basel.
Affiliation:
Department of Neurology, Utrecht Stroke Center, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Genetic susceptibility for ischemic infarction and arteriolosclerosis based on neuropathologic evalu...
Next Document:  Safety, Tolerability and Pharmacokinetics of MCI-186 in Patients with Acute Ischemic Stroke: New For...