22. European Stroke Conference 109 Stroke prognosis The Outcome of Ischemic Stroke of Undetermined Etiology with large Artery Atherosclerosis and Cardioembolism C. Lei1, B. Wu2, Y. Chen3, M. Liu4 Department of Neurology, West China Hospital, Sichuan University, Chengdu, CHINA1, De-partment of Neurology, West China Hospital, Sichuan University, Chengdu, CHINA2, Department of Neurology, West China Hospital, Sichuan University, Chengdu, CHINA3, Department of Neurol-ogy, West China Hospital, Sichuan University, Chengdu, CHINA4 Background and Purpose- Whether antiplatelet or anticoagulant agent for ischemic stroke of unde-termined etiology with large artery atherosclerosis and cardioembolism is still unclear. We aimed to investigate proportions, characteristics disability, mortality, and recurrence of acute ischemic or hemorrhagic stroke on these patients. Methods—We prospectively enrolled consecutive patients with acute ischemic stroke who were admitted within 1 month of stroke onset from 1 January, 2010 to 31 October, 2012. These patients could be divided into two groups according to the clinical characteristics and imaging data; group 1 patients whose maximal possible etiology is cardioembolism attributing to this stroke; group 2 pa-tients whose maximal possible etiology is large artery atherosclerosis attributing to this stroke; basic characteristics, functional outcomes, and recurrence were compared in different groups. Results—Of the 2032 cases included, ischemic stroke of undetermined etiology with large artery atherosclerosis and cardioembolism was present in 145 patients (16.2%). Eighty-nine patients were included in the group 1; fifty-six patients were included in the group 2. Antiplatelet therapy was giv-en to 69 cases in the group 1; anticoagulant therapy was given to 20 cases in the group 1; patients with antiplatelet therapy had higher recurrence of acute ischemic stroke than the patients with an-ticoagulant therapy. Anticoagulant therapy was given to 1 case in the group 2; antiplatelet therapy was given to 55 cases in the group 2; owing to the patients with anticoagulant therapy were rare, recurrence could not be compared in the group 2. Moreover, these patients whose maximal possible etiology is cardioembolism, compared with those patients whose maximal possible etiology is large artery atherosclerosis, were higher discharge and follow-up disability, mortality. Conclusions—Ischemic stroke of undetermined etiology with large artery atherosclerosis and cardi-oembolism should be treated according to the maximal possible etiology attributing to this stroke. 338 © 2013 S. Karger AG, Basel Scientific Programme 110 Stroke prognosis Early blood biomarkers to predict outcome after an ischemic stroke N. Turck1, L. Lagerstedt2, N. Tiberti3, X. Robin4, R. Sztajzel5, G. Wagner6, D.F. Hochstrasser7, P.R. Burkhard8, J-C Sanchez9 Biomedical Proteomics Research Group, Department of Human Protein Sciences, Faculty of Medicine, Geneva, SWITZERLAND1, Biomedical Proteomics Research Group, Department of Human Protein Sciences, Faculty of Medicine, Geneva, SWITZERLAND2, Biomedical Proteomics Research Group, Department of Human Protein Sciences, Faculty of Medicine, Geneva, SWITZER-LAND3, Biomedical Proteomics Research Group, Department of Human Protein Sciences, Faculty of Medicine, Geneva, SWITZERLAND4, Department of Neurology, Department of Clinical Neuro-sciences, Geneva University Hospitals, Geneva, SWITZERLAND5, Department of Neurology, De-partment of Clinical Neurosciences, Geneva University Hospitals, Geneva, SWITZERLAND6, Bio-medical Proteomics Research Group, Department of Human Protein Sciences, Faculty of Medicine, Geneva, SWITZERLAND7, Neuroproteomics Group, Department of Human Protein Sciences, Fac-ulty of Medicine, Geneva, SWITZERLAND8, Biomedical Proteomics Research Group, Department of Human Protein Sciences, Faculty of Medicine, Geneva, SWITZERLAND9 Background. Despite the existence of clinical models, early prediction of stroke outcome remains particularly challenging for physicians. Here, we investigated whether blood molecules traditionally described as stroke biomarker brought additional information for an early and accurate determina-tion of poor outcome. Methods. The blood level of 29 proteins was measured by immunoassays on ischemic stroke pa-tients (established ischemic stroke and transient ischemic attack) prospectively recruited within the first 24h after symptom onset. Patients were then separated according to their time of blood sam-pling (≤ 6h and 24h after onset). Clinical severity (NIHSS) and outcome (modified Rankin Scale) were assessed at admission and 3 months after stroke onset, respectively. Outcome was then dichotomized into good outcome (mRS 0-2) and poor outcome (mRS 3-6) for statistical analyses. The predictive performance of these biomarkers was established using Mann-Whitney U tests and ROC curves. Combination of biomarkers into panels was obtained by a threshold-based approach (PanelomiX). Results. Sixty-six ischemic stroke patients were included in our study and 27% displayed a poor outcome at 3 months. Stroke severity significantly varied between patients with good and poor out-come. Interestingly, only few biomarkers out of the 29 molecules were significantly increased at 6h (ICAM and S100b) or 24h after stroke onset (S100b, CRP, NT-proBNP HFABP and IL-6) in patients presenting unfavorable outcome (p<0.05). Nevertheless, taken individually, none of these molecules displayed better predictive values than NIHSS (Cutoff value: 8, 83% sensitivity and 93% specifici-ty). However, the combination of S100b, NT-proBNP and IL6 measured 24h after stroke onset into a panel allowed predicting outcome with 93% sensitivity and 93% specificity. Conclusions. Individually, the classical stroke biomarkers displayed low performances for functional outcome prediction. A panel including S100b, NT-proBNP and IL-6 permitted to reach performanc-es similar to NIHSS.
Karger_ESC London_2013
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