Predictive Value of Pulse Pressure in Acute Ischemic Stroke for Future Major Vascular Events

CRCS-5 Investigators

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: This study aimed to investigate whether pulse pressure (PP) obtained during the acute stage of ischemic stroke can be used as a predictor for future major vascular events.

METHODS: Using a multicenter prospective stroke registry database, patients who were hospitalized for ischemic stroke within 48 hours of onset were enrolled in this study. We analyzed blood pressure (BP) data measured during the first 3 days from onset. Primary and secondary outcomes were time to a composite of stroke recurrence, myocardial infarction, all-cause death, and time to stroke recurrence, respectively.

RESULTS: Of 9840 patients, 4.3% experienced stroke recurrence, 0.2% myocardial infarction, and 7.3% death during a 1-year follow-up period. In Cox proportional hazards models including both linear and quadratic terms of PP, PP had a nonlinear J-shaped relationship with primary (for a quadratic term of PP, P=0.004) and secondary (P<0.001) outcomes. The overall effects of PP and other BP parameters on primary and secondary outcomes were also significant (P<0.05). When predictive power of BP parameters was compared using a statistic of -2 log-likelihood differences, PP was a stronger predictor than systolic BP (8.49 versus 5.91; 6.32 versus 4.56), diastolic BP (11.42 versus 11.05; 10.07 versus 4.56), and mean atrial pressure (8.75 versus 5.91; 7.03 versus 4.56) for the primary and secondary outcomes, respectively.

CONCLUSIONS: Our study shows that PP when measured in the acute period of ischemic stroke has nonlinear J-shaped relationships with major vascular events and stroke recurrence, and may have a stronger predictive power than other commonly used BP parameters.

Original languageEnglish
Pages (from-to)46-53
Number of pages8
JournalStroke
Volume49
Issue number1
DOIs
Publication statusPublished - 2018 Jan 1

Fingerprint

Blood Vessels
Stroke
Blood Pressure
Recurrence
Myocardial Infarction
Atrial Pressure
Proportional Hazards Models
Registries
Cause of Death
Databases

Keywords

  • assessment, patient outcome
  • blood pressure
  • cohort studies
  • pulse pressure
  • stroke

ASJC Scopus subject areas

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

Cite this

Predictive Value of Pulse Pressure in Acute Ischemic Stroke for Future Major Vascular Events. / CRCS-5 Investigators.

In: Stroke, Vol. 49, No. 1, 01.01.2018, p. 46-53.

Research output: Contribution to journalArticle

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title = "Predictive Value of Pulse Pressure in Acute Ischemic Stroke for Future Major Vascular Events",
abstract = "BACKGROUND AND PURPOSE: This study aimed to investigate whether pulse pressure (PP) obtained during the acute stage of ischemic stroke can be used as a predictor for future major vascular events.METHODS: Using a multicenter prospective stroke registry database, patients who were hospitalized for ischemic stroke within 48 hours of onset were enrolled in this study. We analyzed blood pressure (BP) data measured during the first 3 days from onset. Primary and secondary outcomes were time to a composite of stroke recurrence, myocardial infarction, all-cause death, and time to stroke recurrence, respectively.RESULTS: Of 9840 patients, 4.3{\%} experienced stroke recurrence, 0.2{\%} myocardial infarction, and 7.3{\%} death during a 1-year follow-up period. In Cox proportional hazards models including both linear and quadratic terms of PP, PP had a nonlinear J-shaped relationship with primary (for a quadratic term of PP, P=0.004) and secondary (P<0.001) outcomes. The overall effects of PP and other BP parameters on primary and secondary outcomes were also significant (P<0.05). When predictive power of BP parameters was compared using a statistic of -2 log-likelihood differences, PP was a stronger predictor than systolic BP (8.49 versus 5.91; 6.32 versus 4.56), diastolic BP (11.42 versus 11.05; 10.07 versus 4.56), and mean atrial pressure (8.75 versus 5.91; 7.03 versus 4.56) for the primary and secondary outcomes, respectively.CONCLUSIONS: Our study shows that PP when measured in the acute period of ischemic stroke has nonlinear J-shaped relationships with major vascular events and stroke recurrence, and may have a stronger predictive power than other commonly used BP parameters.",
keywords = "assessment, patient outcome, blood pressure, cohort studies, pulse pressure, stroke",
author = "{CRCS-5 Investigators} and Lee, {Keon Joo} and Kim, {Beom Joon} and Han, {Moon Ku} and Kim, {Joon Tae} and Cho, {Ki Hyun} and Shin, {Dong Ick} and Yeo, {Min Ju} and Cha, {Jae Kwan} and Kim, {Dae Hyun} and Nah, {Hyun Wook} and Kim, {Dong Eog} and Ryu, {Wi Sun} and Park, {Jong Moo} and Kyusik Kang and Lee, {Soo Joo} and Oh, {Mi Sun} and Yu, {Kyung Ho} and Lee, {Byung Chul} and Hong, {Keun Sik} and Cho, {Yong Jin} and Choi, {Jay Chol} and Sohn, {Sung Il} and Hong, {Jeong Ho} and Park, {Tai Hwan} and Park, {Sang Soon} and Kwon, {Jee Hyun} and Kim, {Wook Joo} and Jun Lee and Lee, {Ji Sung} and Juneyoung Lee and Gorelick, {Philip B.} and Bae, {Hee Joon}",
year = "2018",
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T1 - Predictive Value of Pulse Pressure in Acute Ischemic Stroke for Future Major Vascular Events

AU - CRCS-5 Investigators

AU - Lee, Keon Joo

AU - Kim, Beom Joon

AU - Han, Moon Ku

AU - Kim, Joon Tae

AU - Cho, Ki Hyun

AU - Shin, Dong Ick

AU - Yeo, Min Ju

AU - Cha, Jae Kwan

AU - Kim, Dae Hyun

AU - Nah, Hyun Wook

AU - Kim, Dong Eog

AU - Ryu, Wi Sun

AU - Park, Jong Moo

AU - Kang, Kyusik

AU - Lee, Soo Joo

AU - Oh, Mi Sun

AU - Yu, Kyung Ho

AU - Lee, Byung Chul

AU - Hong, Keun Sik

AU - Cho, Yong Jin

AU - Choi, Jay Chol

AU - Sohn, Sung Il

AU - Hong, Jeong Ho

AU - Park, Tai Hwan

AU - Park, Sang Soon

AU - Kwon, Jee Hyun

AU - Kim, Wook Joo

AU - Lee, Jun

AU - Lee, Ji Sung

AU - Lee, Juneyoung

AU - Gorelick, Philip B.

AU - Bae, Hee Joon

PY - 2018/1/1

Y1 - 2018/1/1

N2 - BACKGROUND AND PURPOSE: This study aimed to investigate whether pulse pressure (PP) obtained during the acute stage of ischemic stroke can be used as a predictor for future major vascular events.METHODS: Using a multicenter prospective stroke registry database, patients who were hospitalized for ischemic stroke within 48 hours of onset were enrolled in this study. We analyzed blood pressure (BP) data measured during the first 3 days from onset. Primary and secondary outcomes were time to a composite of stroke recurrence, myocardial infarction, all-cause death, and time to stroke recurrence, respectively.RESULTS: Of 9840 patients, 4.3% experienced stroke recurrence, 0.2% myocardial infarction, and 7.3% death during a 1-year follow-up period. In Cox proportional hazards models including both linear and quadratic terms of PP, PP had a nonlinear J-shaped relationship with primary (for a quadratic term of PP, P=0.004) and secondary (P<0.001) outcomes. The overall effects of PP and other BP parameters on primary and secondary outcomes were also significant (P<0.05). When predictive power of BP parameters was compared using a statistic of -2 log-likelihood differences, PP was a stronger predictor than systolic BP (8.49 versus 5.91; 6.32 versus 4.56), diastolic BP (11.42 versus 11.05; 10.07 versus 4.56), and mean atrial pressure (8.75 versus 5.91; 7.03 versus 4.56) for the primary and secondary outcomes, respectively.CONCLUSIONS: Our study shows that PP when measured in the acute period of ischemic stroke has nonlinear J-shaped relationships with major vascular events and stroke recurrence, and may have a stronger predictive power than other commonly used BP parameters.

AB - BACKGROUND AND PURPOSE: This study aimed to investigate whether pulse pressure (PP) obtained during the acute stage of ischemic stroke can be used as a predictor for future major vascular events.METHODS: Using a multicenter prospective stroke registry database, patients who were hospitalized for ischemic stroke within 48 hours of onset were enrolled in this study. We analyzed blood pressure (BP) data measured during the first 3 days from onset. Primary and secondary outcomes were time to a composite of stroke recurrence, myocardial infarction, all-cause death, and time to stroke recurrence, respectively.RESULTS: Of 9840 patients, 4.3% experienced stroke recurrence, 0.2% myocardial infarction, and 7.3% death during a 1-year follow-up period. In Cox proportional hazards models including both linear and quadratic terms of PP, PP had a nonlinear J-shaped relationship with primary (for a quadratic term of PP, P=0.004) and secondary (P<0.001) outcomes. The overall effects of PP and other BP parameters on primary and secondary outcomes were also significant (P<0.05). When predictive power of BP parameters was compared using a statistic of -2 log-likelihood differences, PP was a stronger predictor than systolic BP (8.49 versus 5.91; 6.32 versus 4.56), diastolic BP (11.42 versus 11.05; 10.07 versus 4.56), and mean atrial pressure (8.75 versus 5.91; 7.03 versus 4.56) for the primary and secondary outcomes, respectively.CONCLUSIONS: Our study shows that PP when measured in the acute period of ischemic stroke has nonlinear J-shaped relationships with major vascular events and stroke recurrence, and may have a stronger predictive power than other commonly used BP parameters.

KW - assessment, patient outcome

KW - blood pressure

KW - cohort studies

KW - pulse pressure

KW - stroke

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U2 - 10.1161/STROKEAHA.117.019582

DO - 10.1161/STROKEAHA.117.019582

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VL - 49

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JO - Stroke

JF - Stroke

SN - 0039-2499

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