Greater stroke severity predominates over all other factors for the worse outcome of cardioembolic stroke

Keun Sik Hong, Juneyoung Lee, Hee Joon Bae, Ji Sung Lee, Dong Wha Kang, Kyung Ho Yu, Moon Ku Han, Yong Jin Cho, Pamela Song, Jong Moo Park, Mi Sun Oh, Jaseong Koo, Byung Chul Lee

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Cardioembolic (CE) strokes are more disabling and more fatal than non-CE strokes. Multiple prognostic factors have been recognized, but the magnitude of their relative contributions has not been well explored. Methods: Using a prospective stroke outcome database, we compared the 3-month outcomes of CE and non-CE strokes. We assessed the relative contribution of each prognostic factor of initial stroke severity, poststroke complications, and baseline characteristics with multivariable analyses and model fitness improvement using -2 log-likelihood and Nagelkerke R2. Results: This study included 1233 patients with acute ischemic stroke: 193 CE strokes and 1040 non-CE strokes. Compared with the non-CE group, CE group had less modified Rankin Scale (mRS) 0-2 outcomes (47.2% versus 68.5%; odds ratio [95% confidence interval],.41 [.30-.56]), less mRS 0-1 outcomes (33.7% versus 53.5%;.44 [.32-.61]), more mRS 5-6 outcomes (32.1% versus 10.9%; 3.88 [2.71-5.56]), and higher mortality (19.2% versus 5.2%; 4.33 [2.76-6.80]) at 3 months. When adjusting either baseline characteristics or poststroke complications, the outcome differences between the 2 groups remained significant. However, adjusting initial National Institute of Health Stroke Scale (NIHSS) score alone abolished all outcome differences except for mortality. For mRS 0-2 outcomes, the decrement of -2 log-likelihood and the Nagelkerke R2 of the model adjusting initial NIHSS score alone approached 70.2% and 76.7% of the fully adjusting model. Conclusion: Greater stroke severity predominates over all other factors for the worse outcome of CE stroke. Primary prevention and more efficient acute therapy for stroke victims should be given top priorities to reduce the burden of CE strokes.

Original languageEnglish
JournalJournal of Stroke and Cerebrovascular Diseases
Volume22
Issue number8
DOIs
Publication statusPublished - 2013 Nov 1

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Stroke
National Institutes of Health (U.S.)
Mortality
Primary Prevention
Odds Ratio
Databases
Confidence Intervals

Keywords

  • Cardioembolism
  • outcome
  • prognostic factor
  • stroke severity

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Greater stroke severity predominates over all other factors for the worse outcome of cardioembolic stroke. / Hong, Keun Sik; Lee, Juneyoung; Bae, Hee Joon; Lee, Ji Sung; Kang, Dong Wha; Yu, Kyung Ho; Han, Moon Ku; Cho, Yong Jin; Song, Pamela; Park, Jong Moo; Oh, Mi Sun; Koo, Jaseong; Lee, Byung Chul.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 22, No. 8, 01.11.2013.

Research output: Contribution to journalArticle

Hong, Keun Sik ; Lee, Juneyoung ; Bae, Hee Joon ; Lee, Ji Sung ; Kang, Dong Wha ; Yu, Kyung Ho ; Han, Moon Ku ; Cho, Yong Jin ; Song, Pamela ; Park, Jong Moo ; Oh, Mi Sun ; Koo, Jaseong ; Lee, Byung Chul. / Greater stroke severity predominates over all other factors for the worse outcome of cardioembolic stroke. In: Journal of Stroke and Cerebrovascular Diseases. 2013 ; Vol. 22, No. 8.
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abstract = "Background: Cardioembolic (CE) strokes are more disabling and more fatal than non-CE strokes. Multiple prognostic factors have been recognized, but the magnitude of their relative contributions has not been well explored. Methods: Using a prospective stroke outcome database, we compared the 3-month outcomes of CE and non-CE strokes. We assessed the relative contribution of each prognostic factor of initial stroke severity, poststroke complications, and baseline characteristics with multivariable analyses and model fitness improvement using -2 log-likelihood and Nagelkerke R2. Results: This study included 1233 patients with acute ischemic stroke: 193 CE strokes and 1040 non-CE strokes. Compared with the non-CE group, CE group had less modified Rankin Scale (mRS) 0-2 outcomes (47.2{\%} versus 68.5{\%}; odds ratio [95{\%} confidence interval],.41 [.30-.56]), less mRS 0-1 outcomes (33.7{\%} versus 53.5{\%};.44 [.32-.61]), more mRS 5-6 outcomes (32.1{\%} versus 10.9{\%}; 3.88 [2.71-5.56]), and higher mortality (19.2{\%} versus 5.2{\%}; 4.33 [2.76-6.80]) at 3 months. When adjusting either baseline characteristics or poststroke complications, the outcome differences between the 2 groups remained significant. However, adjusting initial National Institute of Health Stroke Scale (NIHSS) score alone abolished all outcome differences except for mortality. For mRS 0-2 outcomes, the decrement of -2 log-likelihood and the Nagelkerke R2 of the model adjusting initial NIHSS score alone approached 70.2{\%} and 76.7{\%} of the fully adjusting model. Conclusion: Greater stroke severity predominates over all other factors for the worse outcome of CE stroke. Primary prevention and more efficient acute therapy for stroke victims should be given top priorities to reduce the burden of CE strokes.",
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AU - Hong, Keun Sik

AU - Lee, Juneyoung

AU - Bae, Hee Joon

AU - Lee, Ji Sung

AU - Kang, Dong Wha

AU - Yu, Kyung Ho

AU - Han, Moon Ku

AU - Cho, Yong Jin

AU - Song, Pamela

AU - Park, Jong Moo

AU - Oh, Mi Sun

AU - Koo, Jaseong

AU - Lee, Byung Chul

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Y1 - 2013/11/1

N2 - Background: Cardioembolic (CE) strokes are more disabling and more fatal than non-CE strokes. Multiple prognostic factors have been recognized, but the magnitude of their relative contributions has not been well explored. Methods: Using a prospective stroke outcome database, we compared the 3-month outcomes of CE and non-CE strokes. We assessed the relative contribution of each prognostic factor of initial stroke severity, poststroke complications, and baseline characteristics with multivariable analyses and model fitness improvement using -2 log-likelihood and Nagelkerke R2. Results: This study included 1233 patients with acute ischemic stroke: 193 CE strokes and 1040 non-CE strokes. Compared with the non-CE group, CE group had less modified Rankin Scale (mRS) 0-2 outcomes (47.2% versus 68.5%; odds ratio [95% confidence interval],.41 [.30-.56]), less mRS 0-1 outcomes (33.7% versus 53.5%;.44 [.32-.61]), more mRS 5-6 outcomes (32.1% versus 10.9%; 3.88 [2.71-5.56]), and higher mortality (19.2% versus 5.2%; 4.33 [2.76-6.80]) at 3 months. When adjusting either baseline characteristics or poststroke complications, the outcome differences between the 2 groups remained significant. However, adjusting initial National Institute of Health Stroke Scale (NIHSS) score alone abolished all outcome differences except for mortality. For mRS 0-2 outcomes, the decrement of -2 log-likelihood and the Nagelkerke R2 of the model adjusting initial NIHSS score alone approached 70.2% and 76.7% of the fully adjusting model. Conclusion: Greater stroke severity predominates over all other factors for the worse outcome of CE stroke. Primary prevention and more efficient acute therapy for stroke victims should be given top priorities to reduce the burden of CE strokes.

AB - Background: Cardioembolic (CE) strokes are more disabling and more fatal than non-CE strokes. Multiple prognostic factors have been recognized, but the magnitude of their relative contributions has not been well explored. Methods: Using a prospective stroke outcome database, we compared the 3-month outcomes of CE and non-CE strokes. We assessed the relative contribution of each prognostic factor of initial stroke severity, poststroke complications, and baseline characteristics with multivariable analyses and model fitness improvement using -2 log-likelihood and Nagelkerke R2. Results: This study included 1233 patients with acute ischemic stroke: 193 CE strokes and 1040 non-CE strokes. Compared with the non-CE group, CE group had less modified Rankin Scale (mRS) 0-2 outcomes (47.2% versus 68.5%; odds ratio [95% confidence interval],.41 [.30-.56]), less mRS 0-1 outcomes (33.7% versus 53.5%;.44 [.32-.61]), more mRS 5-6 outcomes (32.1% versus 10.9%; 3.88 [2.71-5.56]), and higher mortality (19.2% versus 5.2%; 4.33 [2.76-6.80]) at 3 months. When adjusting either baseline characteristics or poststroke complications, the outcome differences between the 2 groups remained significant. However, adjusting initial National Institute of Health Stroke Scale (NIHSS) score alone abolished all outcome differences except for mortality. For mRS 0-2 outcomes, the decrement of -2 log-likelihood and the Nagelkerke R2 of the model adjusting initial NIHSS score alone approached 70.2% and 76.7% of the fully adjusting model. Conclusion: Greater stroke severity predominates over all other factors for the worse outcome of CE stroke. Primary prevention and more efficient acute therapy for stroke victims should be given top priorities to reduce the burden of CE strokes.

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