22. European Stroke Conference 6 Acute cerebrovascular events (ACE): TIA and minor strokes 9:20 - 9:30 Do blood biomarkers predict early recurrent stroke? H.C. Segal1, A.I. Burgess2, D.L. Poole3, L.E. Silver4, Z. Mehta5, P.M. Rothwell6 Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, Univer-sity of Oxford, Oxford, UNITED KINGDOM1,Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UNITED KINGDOM2, Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UNITED KINGDOM3, Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UNITED KINGDOM4, Stroke Pre-vention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UNITED KINGDOM5, Stroke Prevention Research Unit, Nuffield Department of Clin-ical Neurosciences, University of Oxford, Oxford, UNITED KINGDOM6 BACKGROUND: The risk of recurrent stroke is high in the first few days and weeks after TIA or minor stroke. Risk scores based on clinical and imaging data are moderately predictive, but more accurate identification of high risk individuals would be useful for research and in clinical practice. We aimed to determine the value of blood biomarkers in the prediction of early recur-rent stroke after TIA or stroke. METHODS: We studied a panel of 14 haemostatic, inflammato-ry and cell damage biomarkers (table 1) in consecutive patients with TIA and ischaemic stroke in a population-based study (Oxford Vascular Study). These were measured in plasma using an automated coagulation analyser (Sta, Stago, Asiners, France) and commercial enzyme immuno-assay systems including the Randox biochip analyser (Randox Laboratories Ltd, Co. Antrium, UK). The levels of biomarkers in the whole cohort and separately in TIA, minor stroke (NIHSS score ≤3) or major stroke were related to the 90 day risk (Hazard Ratio per decile increase in biomarker level) of recurrent stroke after adjustment for age and sex. RESULTS: Among 1206 patients with biomarkers measured in samples taken after presentation, there were 51 90-day recurrent strokes. Table 1 shows that for all patients the only biomarkers predictive of recur-rent stroke were fibrinogen (HR=1.16, 95%CI 1.03-1.32, p=0.017) and CRP (1.13, 1.00-1.28, p=0.04). P-selectin predicted recurrent stroke after TIA (1.91, 1.12-3.25, p = 0.017), but not af-ter minor or major stroke. In patients with minor or major stroke, no biomarker was significant-ly predictive. CONCLUSION: In the first large population-based study, we found that a panel of blood biomarkers was poorly predictive of early recurrent stroke after adjustment for age and sex and is unlikely to add to clinical risk scores. The possible value of P-selectin in predicting early recurrent stroke after TIA requires validation. 5 Acute cerebrovascular events (ACE): TIA and minor strokes 9:10 - 9:20 Cardiovascular Risk factors for microemboli in patients with symptomatic carotid artery stenosis M. Saedon1, D.R. Singer2, C.E. Hutchinson3, C.H. Imray4 Warwick Medical School, University of Warwick, Coventry, UNITED KINGDOM1,Uni-versity of Warwick, Coventry, UNITED KINGDOM2, University of Warwick, Coventry, UNIT-ED KINGDOM3, University of Warwick, Coventry, UNITED KINGDOM4 Background Transient cerebral microembolic signals detected by transcranial Doppler are biomarkers of high risk of stroke syndromes in patients with carotid artery disease. We aimed to identify asso-ciation of cardiovascular risk factors with development of microemboli in patients with symp-tomatic carotid artery stenosis. Methods We studied 171 patients with critical stenosis of the carotid artery who presented within 2 weeks symptoms of acute ischaemic stroke or transient ischaemic attack (TIA). Seventy-two patients (age 70 ± 1 (SEM) years, male 49, Caucasian 70) had evidence of microemboli and 60 of them underwent carotid endarterectomy (CEA). Ninety-nine patients (age 71 ± 1, male 75, Caucasian 92) did not have microembolisation and, 82 of them underwent CEA (controls). Data were analysed using X2 and Mann-Whitney U tests. Results In patients who had microemboli associated with stroke/TIA, both peripheral arterial disease (PAD: 6 (8%)) and family history (FH: 17(24%)) of vascular disease were less common than in patients with stroke/TIA in the absence of microemboli (PAD stroke (21 (21%); p = 0.02, X2 test; FH: (38 (38%) p= 0.04, X2). The microembolic stroke/TIA cohort had a modestly raised level of cholesterol (5.0 ± 1.2 mmol/L; stroke/TIA without microemboli 4.4 ± 0.1mmol/L; p=0.01, MW) Conclusions Why stroke syndromes patients develop microemboli is unclear and not explained by a major excess in classical cardiovascular risk factor burden over non-embolic stroke syndrome pa-tients. Investigating for microemboli should be part of protocols to identify potentially treatable risk factors in these patients at high risk of recurrent stroke syndromes. 102 © 2013 S. Karger AG, Basel Scientific Programme
Karger_ESC London_2013
To see the actual publication please follow the link above