scholarly journals Consultations Decline for Stroke, Transient Ischemic Attack, and Myocardial Infarction during the COVID-19 Pandemic in Germany

2021 ◽  
pp. 1-8
Author(s):  
Christian Tanislav ◽  
Louis Jacob ◽  
Karel Kostev
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Vascular Events ◽  
Medical Care System ◽  
Number Of Patients ◽  
General Practices ◽  
Baseline Characteristics ◽  
Ischemic Attack ◽  
Age Category

<b><i>Background:</i></b> The coronavirus disease 2019 (COVID-19) pandemic raises the concern that other non-COVID conditions will be affected by a decline in care. Therefore, we aimed to investigate the decline in ambulatory presentations for vascular events (stroke, transient ischemic attack [TIA], and myocardial infarction [MI]) during the COVID-19 pandemic. <b><i>Methods:</i></b> Patients with a diagnosis of ischemic stroke, TIA, or MI documented anonymously in 1,262 general practices in Germany were included. We studied the differences between 2019 and 2020 (between April and June) in terms of rates and baseline characteristics by comparing monthly absolute frequencies. <b><i>Results:</i></b> A total of 3,496 patients with stroke (mean age: 72.2 years), 1,608 patients with TIA (mean age: 71.5 years), and 2,385 patients with MI (mean age: 66.8 years) were identified between April and June 2020, indicating a decrease of 10% (stroke), 16% (TIA), and 9% (MI) compared to 2019. For patients with stroke, the decrease in men was 13% (women: −6%) but reached 17% in the age category 51–60 years. For MI, the decrease was only obvious in males (14%). The largest decrease in stroke (−17%) and MI (−19%) was noted in April, while that for TIA occurred in May (−22%). In June for all 3 conditions, the previous year’s level was achieved. Only in TIA, the age differs between 2019 and 2020 (mean age: 69.9 vs. 71.5 years; <i>p</i> &#x3c; 0.05). In patients with stroke and MI, the proportions of men were lower in 2019 than in 2020 (stroke: 54.8–50.5%, <i>p</i> &#x3c; 0.05 and MI: 64–60.2%, <i>p</i> &#x3c; 0.05). <b><i>Conclusion:</i></b> Although the decline in the number of patients presenting with stroke, TIA, and MI was not as noticeable in the ambulatory sector as it was in the area of emergency hospital-based care, our data indicate that the COVID-19 pandemic affected all sectors within the medical care system.

scholarly journals Essen Risk Score in Prediction of Myocardial Infarction After Transient Ischemic Attack or Ischemic Stroke Without Prior Coronary Artery Disease

Stroke ◽  
2019 ◽  
Vol 50 (12) ◽  
pp. 3393-3399 ◽  
Author(s):  
Marion Boulanger ◽  
Linxin Li ◽  
Shane Lyons ◽  
Nicola G. Lovett ◽  
Magdalena M. Kubiak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Ischemic Stroke ◽  
Coronary Artery ◽  
Risk Score ◽  
Transient Ischemic Attack ◽  
Artery Disease ◽  
Ischemic Attack

scholarly journals The decrease in hospitalizations for transient ischemic attack and ischemic stroke, especially in mild cases, during the COVID-19 epidemic in Japan

2020 ◽  
Author(s):  
Hiroyuki Nagano ◽  
Daisuke Takada ◽  
Jung-ho Shin ◽  
Tetsuji Morishita ◽  
Susumu Kunisawa ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Hemorrhagic Stroke ◽  
Hospital Admissions ◽  
Health Care Systems ◽  
Number Of Patients ◽  
Stroke Diagnosis ◽  
Before And After ◽  
Ischemic Attack ◽  
The Impact

AbstractBackground and PurposeThe epidemic of the coronavirus disease 2019 (COVID-19) has affected health care systems globally. The aim of our study was to assess the impact of the COVID-19 epidemic on hospital admissions for stroke in Japan.MethodsWe analyzed administrative (Diagnosis Procedure Combination) data for cases of inpatients aged 18 years and older who were diagnosed with stroke (ischemic stroke, transient ischemic attack (TIA), hemorrhagic stroke, or subarachnoid hemorrhage (SAH)) and discharged from hospital during the period July 1, 2018 to June 30, 2020. The number of patients with each stroke diagnosis, various patient characteristics, and treatment approaches were compared before and after the epidemic. Changes in the trend of the monthly number of inpatients with each stroke diagnosis were assessed using interrupted time-series analyses.ResultsA total of 111,922 cases (ischemic stroke: 74,897 cases; TIA: 5,374 cases; hemorrhagic stroke: 24,779 cases; SAH: 6,872 cases) in 253 hospitals were included. The number of cases for all types of stroke decreased (ischemic stroke: -13.9%; TIA: -21.4%; hemorrhagic stroke: -9.9%; SAH: -15.2%) in April and May 2020, compared to the number of cases in 2019. Ischemic stroke and TIA cases, especially mild cases (modified Rankin Scale = 0), decreased, with a statistically significant change in trend between the before- and after-epidemic periods.ConclusionsThese data showed a marked reduction in the number of hospital admissions due to stroke during the COVID-19 epidemic. The change in Ischemic stroke and TIA cases, especially mild cases, was statistically significant.

scholarly journals Hemoglobin Concentration and Clinical Outcomes After Acute Ischemic Stroke or Transient Ischemic Attack

2021 ◽  
Author(s):  
Runhua Zhang ◽  
Qin Xu ◽  
Anxin Wang ◽  
Yong Jiang ◽  
Xia Meng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Clinical Outcomes ◽  
Transient Ischemic Attack ◽  
Stroke Recurrence ◽  
Vascular Events ◽  
Poor Functional Outcome ◽  
Ischemic Attack ◽  
The Relationship

Background Anemia or low hemoglobin can increase the risk of stroke. However, the association between hemoglobin and outcomes after stroke is uncertain. In this study, we aimed to investigate the association between hemoglobin and clinical outcomes, including mortality, poor functional outcome, stroke recurrence, and composite vascular events at 1 year. Methods and Results We included the patients diagnosed with acute ischemic stroke or transient ischemic attack from the Third China National Stroke Registry. We used the Cox model for mortality, stroke recurrence, and composite vascular events and the logistic model for the poor functional outcome to examine the relationship between hemoglobin and clinical outcomes. In addition, we used the restricted cubic spline to evaluate the nonlinear relationship. This study included 14 159 patients with acute ischemic stroke or transient ischemic attack. After adjusted for potential cofounders, both anemia and high hemoglobin were associated with the higher risk of mortality (hazard ratio [HR], 1.73; 95% CI, 1.39–2.15; HR, 2.71; 95% CI, 1.95–3.76) and poor functional outcome (odds ratio [OR], 1.36; 95% CI, 1.18–1.57; OR, 1.42; 95% CI, 1.07–1.87). High hemoglobin, but not anemia, increased the risk of stroke recurrence (HR, 1.37; 95% CI, 1.05–1.79) and composite vascular events (HR, 1.41; 95% CI, 1.08–1.83). There was a U‐shaped relationship between hemoglobin and mortality and poor functional outcome. Conclusions Abnormal hemoglobin was associated with a higher risk of all‐cause mortality, poor functional outcome, stroke recurrence, and composite vascular events. More well‐designed clinical studies are needed to confirm the relationship between hemoglobin and clinical outcomes after stroke.

Lower Serum Potassium Levels at Admission are Associated with the Risk of Recurrent Stroke in Patients with Acute Ischemic Stroke or Transient Ischemic Attack

2021 ◽  
pp. 1-9
Author(s):  
Anxin Wang ◽  
Shuang Cao ◽  
Xue Tian ◽  
Yingting Zuo ◽  
Xia Meng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Serum Potassium ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Vascular Events ◽  
Lower Serum ◽  
Increased Risk ◽  
Ischemic Attack

<b><i>Introduction:</i></b> Serum potassium abnormality is a risk factor of incident stroke, but whether it is associated with recurrent stroke in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) remains unknown. This study aimed to investigate the association of serum potassium with the risk of recurrent stroke in patients with AIS or TIA. <b><i>Methods:</i></b> We included 12,425 patients from the China National Stroke Registry III. Patients were classified into 3 groups according to tertiles of potassium. The outcomes were recurrence of stroke and combined vascular events at 1 year. Cox proportional hazards regression was adopted to explore the associations by calculating hazard ratios (HRs) and their 95% confidence intervals (CIs). <b><i>Results:</i></b> Among 12,425 enrolled patients, the median (interquartile range) of potassium was 3.92 (3.68–4.19) mmol/L. Compared with the highest tertile, after adjusted for confounding factors, the lowest tertile potassium was associated with increased risk of recurrent stroke at 1 year. The adjusted HR with 95% CI was 1.21 (1.04–1.41). There was an independent, linear association between serum potassium and stroke recurrence. Per 1 mmol/L decrease of potassium was associated with 19% higher risk of recurrent stroke (HR, 1.19; 95% CI, 1.04–1.37). Similar trends were found in ischemic stroke and combined vascular events. <b><i>Conclusions:</i></b> Lower serum potassium level was independently associated with elevated risk of recurrent stroke in patients with AIS or TIA. The finding suggested that monitoring serum potassium may help physicians to identify patients at high risk of recurrent stroke and to stratify risk for optimal management.

scholarly journals Risk of Myocardial Infarction and Vascular Death After Transient Ischemic Attack and Ischemic Stroke

Stroke ◽  
2005 ◽  
Vol 36 (12) ◽  
pp. 2748-2755 ◽  
Author(s):  
Emmanuel Touzé ◽  
Olivier Varenne ◽  
Gilles Chatellier ◽  
Séverine Peyrard ◽  
Peter M. Rothwell ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Vascular Death ◽  
Ischemic Attack

scholarly journals Ticagrelor Added to Aspirin in Acute Nonsevere Ischemic Stroke or Transient Ischemic Attack of Atherosclerotic Origin

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3504-3513
Author(s):  
Pierre Amarenco ◽  
Hans Denison ◽  
Scott R. Evans ◽  
Anders Himmelmann ◽  
Stefan James ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Absolute Risk ◽  
Hazard Ratio ◽  
Number Needed To Treat ◽  
Severe Bleeding ◽  
Vascular Events ◽  
End Point ◽  
Atherosclerotic Stenosis ◽  
Ischemic Attack

Background and Purpose: Among patients with a transient ischemic attack or minor ischemic strokes, those with ipsilateral atherosclerotic stenosis of cervicocranial vasculature have the highest risk of recurrent vascular events. Methods: In the double-blind THALES (The Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death) trial, we randomized patients with a noncardioembolic, nonsevere ischemic stroke, or high-risk transient ischemic attack to ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2–30) or placebo added to aspirin (300–325 mg on day 1 followed by 75–100 mg daily for days 2–30) within 24 hours of symptom onset. The present paper reports a prespecified analysis in patients with and without ipsilateral, potentially causal atherosclerotic stenosis ≥30% of cervicocranial vasculature. The primary end point was time to the occurrence of stroke or death within 30 days. Results: Of 11 016 randomized patients, 2351 (21.3%) patients had an ipsilateral atherosclerotic stenosis. After 30 days, a primary end point occurred in 92/1136 (8.1%) patients with ipsilateral stenosis randomized to ticagrelor and in 132/1215 (10.9%) randomized to placebo (hazard ratio 0.73 [95% CI, 0.56–0.96], P =0.023) resulting in a number needed to treat of 34 (95% CI, 19–171). In patients without ipsilateral stenosis, the corresponding event rate was 211/4387 (4.8%) and 230/4278 (5.4%), respectively (hazard ratio, 0.89 [95% CI, 0.74–1.08]; P =0.23, P interaction =0.245). Severe bleeding occurred in 4 (0.4%) and 3 (0.2%) patients with ipsilateral atherosclerotic stenosis on ticagrelor and on placebo, respectively ( P =NS), and in 24 (0.5%) and 4 (0.1%), respectively, in 8665 patients without ipsilateral stenosis (hazard ratio=5.87 [95% CI, 2.04–16.9], P =0.001). Conclusions: In this exploratory analysis comparing ticagrelor added to aspirin to aspirin alone, we found no treatment by ipsilateral atherosclerosis stenosis subgroup interaction but did identify a higher absolute risk and a greater absolute risk reduction of stroke or death at 30 days in patients with ipsilateral atherosclerosis stenosis than in those without. In this easily identified population, ticagrelor added to aspirin provided a clinically meaningful benefit with a number needed to treat of 34 (95% CI, 19–171). Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03354429.

scholarly journals Copeptin and Long-Term Risk of Recurrent Vascular Events After Transient Ischemic Attack and Ischemic Stroke

Stroke ◽  
2015 ◽  
Vol 46 (11) ◽  
pp. 3117-3123 ◽  
Author(s):  
Stefan Greisenegger ◽  
Helen C. Segal ◽  
Annette I. Burgess ◽  
Debbie L. Poole ◽  
Ziyah Mehta ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Vascular Events ◽  
Ischemic Attack

Preoperative Use of Statins in Carotid Artery Stenting: A Systematic Review and Meta-analysis

2018 ◽  
Vol 25 (5) ◽  
pp. 624-631 ◽  
Author(s):  
Pavlos Texakalidis ◽  
Stefanos Giannopoulos ◽  
Anil K. Jonnalagadda ◽  
Rohan V. Chitale ◽  
Pascal Jabbour ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Regression Analysis ◽  
Carotid Artery ◽  
Transient Ischemic Attack ◽  
Meta Analysis ◽  
Statin Treatment ◽  
Baseline Characteristics ◽  
Meta Regression ◽  
Meta Regression Analysis ◽  
Ischemic Attack

Purpose: To determine through meta-analysis whether administration of statins before carotid artery stenting (CAS) is associated with fewer periprocedural adverse events. Methods: All randomized and observational English-language studies of periprocedural statin administration prior to CAS that reported the outcomes of interest (stroke, transient ischemic attack, myocardial infarction, and death at 30 days) were included in a random-effects meta-analysis. The I2 statistic was used to assess heterogeneity. Meta-regression analysis was performed to determine whether an association of statin treatment with risk of outcome events was influenced by other trial-level baseline characteristics of statin-treated and untreated patients. Results: Eleven studies comprising 4088 patients were included. Patients who received statins prior to CAS had a significantly lower risk of stroke (OR 0.39, 95% CI 0.27 to 0.58, p<0.01; I2=0%) and death (OR 0.30, 95% CI 0.10 to 0.96, p=0.042; I2=0%). Statin use was not associated with a reduced risk of transient ischemic attack or myocardial infarction. In meta-regression analysis, other trial-level baseline characteristics had no significant influence on the association of statin treatment with death or stroke. Conclusion: Statin therapy prior to CAS is associated with decreased risk of perioperative stroke and death without any effect on the rates of transient ischemic attack or myocardial infarction.

scholarly journals Baseline characteristics of the 3096 patients recruited into the ‘Triple Antiplatelets for Reducing Dependency after Ischemic Stroke’ trial

2016 ◽  
Vol 12 (5) ◽  
pp. 524-538 ◽  
Author(s):  
Philip MW Bath ◽  
Jason P Appleton ◽  
Maia Beridze ◽  
Hanne Christensen ◽  
Robert A Dineen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Transient Ischemic Attack ◽  
Stroke Severity ◽  
Vascular Events ◽  
Risk Of Recurrence ◽  
Triple Antiplatelet Therapy ◽  
Ischemic Attack ◽  
Stroke Trial

Background The risk of recurrence following ischemic stroke or transient ischemic attack is highest immediately after the event. Antiplatelet agents are effective in reducing the risk of recurrence and two agents are superior to one in the early phase after ictus. Design The triple antiplatelets for reducing dependency after ischemic stroke trial was an international multicenter prospective randomized open-label blinded-endpoint trial that assessed the safety and efficacy of short-term intensive antiplatelet therapy with three agents (combined aspirin, clopidogrel and dipyridamole) as compared with guideline treatment in acute ischemic stroke or transient ischemic attack. The primary outcome was stroke recurrence and its severity, measured using the modified Rankin Scale at 90 days. Secondary outcomes included recurrent vascular events, functional measures (cognition, disability, mood, quality of life), and safety (bleeding, death, serious adverse events). Data are number (%) or mean (standard deviation, SD). Results Recruitment ran from April 2009 to March 2016; 3096 patients were recruited from 106 sites in four countries (Denmark 1.6%, Georgia 2.7%, New Zealand 0.2%, UK 95.4%). Randomization characteristics included: age 69.0 (10.1) years; male 1945 (62.8%); time onset to randomization 29.4 (11.9) h; stroke severity (National Institutes for Health Stroke Scale) 2.8 (3.6); blood pressure 143.5 (18.2)/79.5 (11.4) mmHg; IS 2143 (69.2%), transient ischemic attack 953 (30.8%). Conclusion Triple antiplatelets for reducing dependency after ischemic stroke was a large trial of intensive/triple antiplatelet therapy in acute ischemic stroke and transient ischemic attack, and included participants from four predominantly Caucasian countries who were representative of patients in many western stroke services.

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