Clinical outcomes of posterior versus anterior circulation infarction with low national institutes of health stroke scale scores

Joon Tae Kim, Man Seok Park, Kang Ho Choi, Beom Joon Kim, Moon Ku Han, Tai Hwan Park, Sang Soon Park, Kyung Bok Lee, Byung Chul Lee, Kyung Ho Yu, Mi Sun Oh, Jae Kwan Cha, Dae Hyun Kim, Hyun Wook Nah, Jun Lee, Soo Joo Lee, Youngchai Ko, Jae Guk Kim, Jong Moo Park, Kyusik Kang & 13 others Yong Jin Cho, Keun Sik Hong, Jay Chol Choi, Dong Eog Kim, Wi Sun Ryu, Dong Ick Shin, Min Ju Yeo, Wook Joo Kim, Juneyoung Lee, Ji Sung Lee, Hee Joon Bae, Jeffrey L. Saver, Ki Hyun Cho

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background and Purpose - We compared baseline characteristics and outcomes at 3 months between patients with minor anterior circulation infarction (ACI) versus minor posterior circulation infarction (PCI), including the influence of large vessel disease on outcomes. Methods - This study is an analysis of a prospective multicenter registry database in South Korea. Eligibility criteria were patients with ischemic stroke admitted within 7 days of stroke onset, lesions in either anterior or posterior circulation, and National Institutes of Health Stroke Scale score of ≤4 at baseline. Patients were divided into 4 groups for further analysis: Minor ACI with and without internal carotid artery/middle cerebral artery large vessel disease and minor PCI with and without vertebrobasilar large vessel disease. Results - A total of 7178 patients (65.2±12.6 years) were analyzed in this study, and 2233 patients (31.1%) had disability (modified Rankin Scale score 2-6) at 3 months. Disability was 32.3% in minor PCI and 30.3% in minor ACI (P=0.07), and death was 1.3% and 1.5%, respectively (P=0.82). In a multivariable logistic regression analysis, minor PCI was significantly associated with disability at 3 months when compared with minor ACI (odds ratio, 1.23; 95% confidence interval, 1.09-1.37; P<0.001). In pairwise comparisons, minor PCI with vertebrobasilar large vessel disease was independently associated with disability at 3 months, compared with the other 3 groups. Conclusions - Our study showed that minor PCI exhibited more frequent disability at 3 months than minor ACI. Especially, the presence of vertebrobasilar large vessel disease in minor PCI had a substantially higher risk of disability. Our results suggest that minor PCI with vertebrobasilar large vessel disease could require more meticulous care and are important targets for further study.

Original languageEnglish
Pages (from-to)55-62
Number of pages8
JournalStroke
Volume48
Issue number1
DOIs
Publication statusPublished - 2017 Jan 1

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National Institutes of Health (U.S.)
Infarction
Stroke
Republic of Korea
Middle Cerebral Artery
Internal Carotid Artery
Registries
Logistic Models
Odds Ratio
Regression Analysis

Keywords

  • basilar artery
  • cerebral infarction
  • ischemic attack, transient
  • risk
  • stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

Cite this

Clinical outcomes of posterior versus anterior circulation infarction with low national institutes of health stroke scale scores. / Kim, Joon Tae; Park, Man Seok; Choi, Kang Ho; Kim, Beom Joon; Han, Moon Ku; Park, Tai Hwan; Park, Sang Soon; Lee, Kyung Bok; Lee, Byung Chul; Yu, Kyung Ho; Oh, Mi Sun; Cha, Jae Kwan; Kim, Dae Hyun; Nah, Hyun Wook; Lee, Jun; Lee, Soo Joo; Ko, Youngchai; Kim, Jae Guk; Park, Jong Moo; Kang, Kyusik; Cho, Yong Jin; Hong, Keun Sik; Choi, Jay Chol; Kim, Dong Eog; Ryu, Wi Sun; Shin, Dong Ick; Yeo, Min Ju; Kim, Wook Joo; Lee, Juneyoung; Lee, Ji Sung; Bae, Hee Joon; Saver, Jeffrey L.; Cho, Ki Hyun.

In: Stroke, Vol. 48, No. 1, 01.01.2017, p. 55-62.

Research output: Contribution to journalArticle

Kim, JT, Park, MS, Choi, KH, Kim, BJ, Han, MK, Park, TH, Park, SS, Lee, KB, Lee, BC, Yu, KH, Oh, MS, Cha, JK, Kim, DH, Nah, HW, Lee, J, Lee, SJ, Ko, Y, Kim, JG, Park, JM, Kang, K, Cho, YJ, Hong, KS, Choi, JC, Kim, DE, Ryu, WS, Shin, DI, Yeo, MJ, Kim, WJ, Lee, J, Lee, JS, Bae, HJ, Saver, JL & Cho, KH 2017, 'Clinical outcomes of posterior versus anterior circulation infarction with low national institutes of health stroke scale scores', Stroke, vol. 48, no. 1, pp. 55-62. https://doi.org/10.1161/STROKEAHA.116.013432
Kim, Joon Tae ; Park, Man Seok ; Choi, Kang Ho ; Kim, Beom Joon ; Han, Moon Ku ; Park, Tai Hwan ; Park, Sang Soon ; Lee, Kyung Bok ; Lee, Byung Chul ; Yu, Kyung Ho ; Oh, Mi Sun ; Cha, Jae Kwan ; Kim, Dae Hyun ; Nah, Hyun Wook ; Lee, Jun ; Lee, Soo Joo ; Ko, Youngchai ; Kim, Jae Guk ; Park, Jong Moo ; Kang, Kyusik ; Cho, Yong Jin ; Hong, Keun Sik ; Choi, Jay Chol ; Kim, Dong Eog ; Ryu, Wi Sun ; Shin, Dong Ick ; Yeo, Min Ju ; Kim, Wook Joo ; Lee, Juneyoung ; Lee, Ji Sung ; Bae, Hee Joon ; Saver, Jeffrey L. ; Cho, Ki Hyun. / Clinical outcomes of posterior versus anterior circulation infarction with low national institutes of health stroke scale scores. In: Stroke. 2017 ; Vol. 48, No. 1. pp. 55-62.
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abstract = "Background and Purpose - We compared baseline characteristics and outcomes at 3 months between patients with minor anterior circulation infarction (ACI) versus minor posterior circulation infarction (PCI), including the influence of large vessel disease on outcomes. Methods - This study is an analysis of a prospective multicenter registry database in South Korea. Eligibility criteria were patients with ischemic stroke admitted within 7 days of stroke onset, lesions in either anterior or posterior circulation, and National Institutes of Health Stroke Scale score of ≤4 at baseline. Patients were divided into 4 groups for further analysis: Minor ACI with and without internal carotid artery/middle cerebral artery large vessel disease and minor PCI with and without vertebrobasilar large vessel disease. Results - A total of 7178 patients (65.2±12.6 years) were analyzed in this study, and 2233 patients (31.1{\%}) had disability (modified Rankin Scale score 2-6) at 3 months. Disability was 32.3{\%} in minor PCI and 30.3{\%} in minor ACI (P=0.07), and death was 1.3{\%} and 1.5{\%}, respectively (P=0.82). In a multivariable logistic regression analysis, minor PCI was significantly associated with disability at 3 months when compared with minor ACI (odds ratio, 1.23; 95{\%} confidence interval, 1.09-1.37; P<0.001). In pairwise comparisons, minor PCI with vertebrobasilar large vessel disease was independently associated with disability at 3 months, compared with the other 3 groups. Conclusions - Our study showed that minor PCI exhibited more frequent disability at 3 months than minor ACI. Especially, the presence of vertebrobasilar large vessel disease in minor PCI had a substantially higher risk of disability. Our results suggest that minor PCI with vertebrobasilar large vessel disease could require more meticulous care and are important targets for further study.",
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AU - Kim, Joon Tae

AU - Park, Man Seok

AU - Choi, Kang Ho

AU - Kim, Beom Joon

AU - Han, Moon Ku

AU - Park, Tai Hwan

AU - Park, Sang Soon

AU - Lee, Kyung Bok

AU - Lee, Byung Chul

AU - Yu, Kyung Ho

AU - Oh, Mi Sun

AU - Cha, Jae Kwan

AU - Kim, Dae Hyun

AU - Nah, Hyun Wook

AU - Lee, Jun

AU - Lee, Soo Joo

AU - Ko, Youngchai

AU - Kim, Jae Guk

AU - Park, Jong Moo

AU - Kang, Kyusik

AU - Cho, Yong Jin

AU - Hong, Keun Sik

AU - Choi, Jay Chol

AU - Kim, Dong Eog

AU - Ryu, Wi Sun

AU - Shin, Dong Ick

AU - Yeo, Min Ju

AU - Kim, Wook Joo

AU - Lee, Juneyoung

AU - Lee, Ji Sung

AU - Bae, Hee Joon

AU - Saver, Jeffrey L.

AU - Cho, Ki Hyun

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N2 - Background and Purpose - We compared baseline characteristics and outcomes at 3 months between patients with minor anterior circulation infarction (ACI) versus minor posterior circulation infarction (PCI), including the influence of large vessel disease on outcomes. Methods - This study is an analysis of a prospective multicenter registry database in South Korea. Eligibility criteria were patients with ischemic stroke admitted within 7 days of stroke onset, lesions in either anterior or posterior circulation, and National Institutes of Health Stroke Scale score of ≤4 at baseline. Patients were divided into 4 groups for further analysis: Minor ACI with and without internal carotid artery/middle cerebral artery large vessel disease and minor PCI with and without vertebrobasilar large vessel disease. Results - A total of 7178 patients (65.2±12.6 years) were analyzed in this study, and 2233 patients (31.1%) had disability (modified Rankin Scale score 2-6) at 3 months. Disability was 32.3% in minor PCI and 30.3% in minor ACI (P=0.07), and death was 1.3% and 1.5%, respectively (P=0.82). In a multivariable logistic regression analysis, minor PCI was significantly associated with disability at 3 months when compared with minor ACI (odds ratio, 1.23; 95% confidence interval, 1.09-1.37; P<0.001). In pairwise comparisons, minor PCI with vertebrobasilar large vessel disease was independently associated with disability at 3 months, compared with the other 3 groups. Conclusions - Our study showed that minor PCI exhibited more frequent disability at 3 months than minor ACI. Especially, the presence of vertebrobasilar large vessel disease in minor PCI had a substantially higher risk of disability. Our results suggest that minor PCI with vertebrobasilar large vessel disease could require more meticulous care and are important targets for further study.

AB - Background and Purpose - We compared baseline characteristics and outcomes at 3 months between patients with minor anterior circulation infarction (ACI) versus minor posterior circulation infarction (PCI), including the influence of large vessel disease on outcomes. Methods - This study is an analysis of a prospective multicenter registry database in South Korea. Eligibility criteria were patients with ischemic stroke admitted within 7 days of stroke onset, lesions in either anterior or posterior circulation, and National Institutes of Health Stroke Scale score of ≤4 at baseline. Patients were divided into 4 groups for further analysis: Minor ACI with and without internal carotid artery/middle cerebral artery large vessel disease and minor PCI with and without vertebrobasilar large vessel disease. Results - A total of 7178 patients (65.2±12.6 years) were analyzed in this study, and 2233 patients (31.1%) had disability (modified Rankin Scale score 2-6) at 3 months. Disability was 32.3% in minor PCI and 30.3% in minor ACI (P=0.07), and death was 1.3% and 1.5%, respectively (P=0.82). In a multivariable logistic regression analysis, minor PCI was significantly associated with disability at 3 months when compared with minor ACI (odds ratio, 1.23; 95% confidence interval, 1.09-1.37; P<0.001). In pairwise comparisons, minor PCI with vertebrobasilar large vessel disease was independently associated with disability at 3 months, compared with the other 3 groups. Conclusions - Our study showed that minor PCI exhibited more frequent disability at 3 months than minor ACI. Especially, the presence of vertebrobasilar large vessel disease in minor PCI had a substantially higher risk of disability. Our results suggest that minor PCI with vertebrobasilar large vessel disease could require more meticulous care and are important targets for further study.

KW - basilar artery

KW - cerebral infarction

KW - ischemic attack, transient

KW - risk

KW - stroke

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