Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
In-hospital prognosis of first-ever noncardiogenic ischemic stroke in patients with and without indication for prestroke antiplatelet therapy: Chinese Stroke Center Alliance
First author：Yu-Yuan Xu
Corresponding author：Yong-Jun Wang
essential_information
- Person in charge：Yu-Yuan Xu
- Data Sources： CSCA
- Number of papers：CSCA20190990
- Published time：2021-04-30
2021-04-30
Published articles
Journal：Annals of Translational Medicine
Publication type: Original Contributions
IF(IF): 3.932
PMID: PMC8106102 Link To Pubmed Full text Download
Background And Purpose
a
Method
We derived data from the Chinese Stroke Center Alliance (CSCA) database. Patients with acute ischemic stroke of LAA subtype (based on TOAST) are included in this analysis. NIHSS score at presentation was used as index of stroke severity and a mRS score at discharge as index of functional outcome. Patients were categorized according to their prestroke antiplatelet use as antiplatelet-inclusive (AI) and no antiplatelet (NA). Demographic data, risk factors, pertinent laboratory tests, and other medications were controlled for across the two groups using multivariate logistic regression. Cox proportional hazards model was used to assess the treatment-by-subgroup interaction effect.
Conclusion
Patients with indications of prestroke antiplatelet use were more likely to have unfavorable outcomes than those without. Prestroke antiplatelet might be associated with lower mortality, less disability, and less stroke severity in certain population groups. Future studies to improve risk prediction rules are needed to guide effective primary prevention for ischemic stroke.
Main results
Among 436,660 first-ever noncardiogenic ischemic stroke patients, 42,409 patients (9.7%) had a documented previous vascular indication and 394,251 (90.3%) did not. Compared to those without, patients with the indication were associated with increased prevalence of in-hospital morbid conditions, including stroke severity (OR 2.71; 95% CI: 2.62–2.81; P<0.0001), length of stay >14 days (OR 1.16; 95% CI: 1.13– 1.19; P<0.0001), mortality (OR 2.20; 95% CI: 1.96–2.46, P<0.0001), and recurrence of ischemic stroke and transient ischemic attack (TIA) (OR 1.5; 95% CI: 1.43–1.59, P<0.0001). Among patients without indication, prestroke antiplatelet use was associated with lower mortality (OR 0.73, 95% CI: 0.56–0.96; P=0.0221); while among patients with indication, those receiving prestroke antiplatelet had lower odds ratios in stroke severity (P<0.0001) and disability (P=0.0003) than those who not.