Cerebral Microbleeds are Associated with Higher Mortality Among Ischemic Stroke Patients

Ramin Zand, Shima Shahjouei, Georgios Tsivgoulis, Mantinderpreet Singh, Michael McCormack, Nariman Noorbakhsh-Sabet, Nitin Goyal, Andrei Alexandrov

Research output: Contribution to journalArticle

Abstract

Background: Several studies have shown that cerebral microbleeds (CMBs) increase the risk of long-term stroke-related mortality. The purpose of this study was to determine if the existence and burden of CMBs are a predictor of in-hospital death among patients with acute ischemic stroke (AIS). Methods: We studied consecutive ischemic stroke patients who admitted to our tertiary center over a 2-year period (2013-2014). Patients who underwent thrombolysis were excluded. Baseline characteristics of patients, number and topography of CMBs, white matter lesions, and spontaneous symptomatic hemorrhagic transformation were recorded. Outcome measure in our study was in-hospital death. Results: Out of 1126 consecutive AIS patients evaluated in this study, 772 patients included in the study (mean age 61.9 ± 14.2 years [18-95 years], 51.6% men, and 58.2% African American). CMBs were present on the magnetic resonance imaging (MRI) sequences of 124 (16.1%) patients. The overall rate of in-hospital mortality was 4.1%. The presence or absence of CMBs was not predictive of in-hospital mortality (P =.058). After adjusting for potential confounders, the presence of ≥4 CMBs on T2*-weighted MRI was independently (P =.004) associated with a higher likelihood of in-hospital death (odds ratio: 6.6, 95% confidential interval: 2.50 and 17.46) in multivariable logistic regression analyses. Older age, higher National Institute of Health stroke scale, and history of atrial fibrillation were also associated with greater chance of in-hospital death. Conclusions: The presence or absence of CMBs was not predictive of in-hospital mortality. However, the presence of multiple CMBs was associated with a higher in-hospital mortality rate among AIS patients.

Original languageEnglish (US)
Pages (from-to)3036-3042
Number of pages7
JournalJournal of Stroke and Cerebrovascular Diseases
Volume27
Issue number11
DOIs
StatePublished - Nov 1 2018

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Stroke
Mortality
Hospital Mortality
Magnetic Resonance Imaging
National Institutes of Health (U.S.)
African Americans
Atrial Fibrillation
Logistic Models
Odds Ratio
Regression Analysis
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

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

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Cerebral Microbleeds are Associated with Higher Mortality Among Ischemic Stroke Patients. / Zand, Ramin; Shahjouei, Shima; Tsivgoulis, Georgios; Singh, Mantinderpreet; McCormack, Michael; Noorbakhsh-Sabet, Nariman; Goyal, Nitin; Alexandrov, Andrei.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 27, No. 11, 01.11.2018, p. 3036-3042.

Research output: Contribution to journalArticle

Zand, Ramin ; Shahjouei, Shima ; Tsivgoulis, Georgios ; Singh, Mantinderpreet ; McCormack, Michael ; Noorbakhsh-Sabet, Nariman ; Goyal, Nitin ; Alexandrov, Andrei. / Cerebral Microbleeds are Associated with Higher Mortality Among Ischemic Stroke Patients. In: Journal of Stroke and Cerebrovascular Diseases. 2018 ; Vol. 27, No. 11. pp. 3036-3042.
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abstract = "Background: Several studies have shown that cerebral microbleeds (CMBs) increase the risk of long-term stroke-related mortality. The purpose of this study was to determine if the existence and burden of CMBs are a predictor of in-hospital death among patients with acute ischemic stroke (AIS). Methods: We studied consecutive ischemic stroke patients who admitted to our tertiary center over a 2-year period (2013-2014). Patients who underwent thrombolysis were excluded. Baseline characteristics of patients, number and topography of CMBs, white matter lesions, and spontaneous symptomatic hemorrhagic transformation were recorded. Outcome measure in our study was in-hospital death. Results: Out of 1126 consecutive AIS patients evaluated in this study, 772 patients included in the study (mean age 61.9 ± 14.2 years [18-95 years], 51.6{\%} men, and 58.2{\%} African American). CMBs were present on the magnetic resonance imaging (MRI) sequences of 124 (16.1{\%}) patients. The overall rate of in-hospital mortality was 4.1{\%}. The presence or absence of CMBs was not predictive of in-hospital mortality (P =.058). After adjusting for potential confounders, the presence of ≥4 CMBs on T2*-weighted MRI was independently (P =.004) associated with a higher likelihood of in-hospital death (odds ratio: 6.6, 95{\%} confidential interval: 2.50 and 17.46) in multivariable logistic regression analyses. Older age, higher National Institute of Health stroke scale, and history of atrial fibrillation were also associated with greater chance of in-hospital death. Conclusions: The presence or absence of CMBs was not predictive of in-hospital mortality. However, the presence of multiple CMBs was associated with a higher in-hospital mortality rate among AIS patients.",
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T1 - Cerebral Microbleeds are Associated with Higher Mortality Among Ischemic Stroke Patients

AU - Zand, Ramin

AU - Shahjouei, Shima

AU - Tsivgoulis, Georgios

AU - Singh, Mantinderpreet

AU - McCormack, Michael

AU - Noorbakhsh-Sabet, Nariman

AU - Goyal, Nitin

AU - Alexandrov, Andrei

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Background: Several studies have shown that cerebral microbleeds (CMBs) increase the risk of long-term stroke-related mortality. The purpose of this study was to determine if the existence and burden of CMBs are a predictor of in-hospital death among patients with acute ischemic stroke (AIS). Methods: We studied consecutive ischemic stroke patients who admitted to our tertiary center over a 2-year period (2013-2014). Patients who underwent thrombolysis were excluded. Baseline characteristics of patients, number and topography of CMBs, white matter lesions, and spontaneous symptomatic hemorrhagic transformation were recorded. Outcome measure in our study was in-hospital death. Results: Out of 1126 consecutive AIS patients evaluated in this study, 772 patients included in the study (mean age 61.9 ± 14.2 years [18-95 years], 51.6% men, and 58.2% African American). CMBs were present on the magnetic resonance imaging (MRI) sequences of 124 (16.1%) patients. The overall rate of in-hospital mortality was 4.1%. The presence or absence of CMBs was not predictive of in-hospital mortality (P =.058). After adjusting for potential confounders, the presence of ≥4 CMBs on T2*-weighted MRI was independently (P =.004) associated with a higher likelihood of in-hospital death (odds ratio: 6.6, 95% confidential interval: 2.50 and 17.46) in multivariable logistic regression analyses. Older age, higher National Institute of Health stroke scale, and history of atrial fibrillation were also associated with greater chance of in-hospital death. Conclusions: The presence or absence of CMBs was not predictive of in-hospital mortality. However, the presence of multiple CMBs was associated with a higher in-hospital mortality rate among AIS patients.

AB - Background: Several studies have shown that cerebral microbleeds (CMBs) increase the risk of long-term stroke-related mortality. The purpose of this study was to determine if the existence and burden of CMBs are a predictor of in-hospital death among patients with acute ischemic stroke (AIS). Methods: We studied consecutive ischemic stroke patients who admitted to our tertiary center over a 2-year period (2013-2014). Patients who underwent thrombolysis were excluded. Baseline characteristics of patients, number and topography of CMBs, white matter lesions, and spontaneous symptomatic hemorrhagic transformation were recorded. Outcome measure in our study was in-hospital death. Results: Out of 1126 consecutive AIS patients evaluated in this study, 772 patients included in the study (mean age 61.9 ± 14.2 years [18-95 years], 51.6% men, and 58.2% African American). CMBs were present on the magnetic resonance imaging (MRI) sequences of 124 (16.1%) patients. The overall rate of in-hospital mortality was 4.1%. The presence or absence of CMBs was not predictive of in-hospital mortality (P =.058). After adjusting for potential confounders, the presence of ≥4 CMBs on T2*-weighted MRI was independently (P =.004) associated with a higher likelihood of in-hospital death (odds ratio: 6.6, 95% confidential interval: 2.50 and 17.46) in multivariable logistic regression analyses. Older age, higher National Institute of Health stroke scale, and history of atrial fibrillation were also associated with greater chance of in-hospital death. Conclusions: The presence or absence of CMBs was not predictive of in-hospital mortality. However, the presence of multiple CMBs was associated with a higher in-hospital mortality rate among AIS patients.

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U2 - 10.1016/j.jstrokecerebrovasdis.2018.06.037

DO - 10.1016/j.jstrokecerebrovasdis.2018.06.037

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SP - 3036

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JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

SN - 1052-3057

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