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London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 333 100 Stroke prognosis Embolic sources of ischemic stroke and stroke recurrences S. Mezuki1, S. Fujimoto2, T. Matsuki3, J. Jinnouchi4, T. Ishitsuka5 Stroke Center, Steel Memorial Yawata Hospital, Kitakyusyu, JAPAN1, Stroke Center, Steel Memorial Yawata Hospital, Kitakyusyu, JAPAN2, Stroke Center, Steel Memorial Yawata Hospital, Kitakyusyu, JAPAN3, Stroke Center, Steel Memorial Yawata Hospital, Kitakyusyu, JAPAN4, Stroke Center, Steel Memorial Yawata Hospital, Kitakyusyu, JAPAN5 Background & Purpose: Some previous reports revealed that the prognosis of brain embolism pa-tients differed according to their embolic sources, and more than one embolic source coexisted fre-quently. We investigated the relationship between embolic sources of ischemic stroke and long-term stroke recurrences. Methods: For the present study, 542 patients with ischemic stroke or transient ischemic attack who underwent transesophageal echocardiography (TEE) to search for embolic sources were included. According to the categories of embolic sources, patients were classified into 4 groups: patients with severe aortic arch atheroma of 4mm or more in diameter (group A; n=167), patients with cardiogenic embolic sources such as atrial fibrillation, spontaneous echo contrast in left atrium or intracardiac thrombus (group C; n=93), patients with both factors as described above (group B; n=88), and other patients (group O; n=194). We followed them up for mean period of 3.2 years, and investigated the frequency of stroke recurrences and death from any cause according to embolic sources. Results: Stroke recurrences were observed in 12.0% patients in group A, 11.8% pa-tients in group C, 18.2% patients in group B, and 6.7% patients in group O respectively (p=0.0371). Stroke recurrences and death from any cause occurred in 14.4%, 15.1%, 21.6% and 6.7% patients respectively (p=0.0041). Kaplan-Meier curve analysis revealed a significant difference in the recur-rence- free survival among the four groups (p=0.0076, log-rank test). On COX proportional-hazards model analysis, diabetes mellitus (HR 1.73, p=0.0264), aortic arch atheroma of 4mm or more (HR 1.86, p=0.0146), and cardiogenic embolic sources such as atrial fibrillation, spontaneous echo con-trast in left atrium or intracardiac thrombus (HR 1.61, p=0.0519) were independently-significant predictors for stroke recurrences and death from any cause. Conclusions: Severe aortic arch ather-oma or cardiogenic embolic sources can independently be associated with stroke recurrences and death, furthermore, a combination of them showed more frequent events than each of them alone. 101 Stroke prognosis Higher cholesterol levels at admission but also statin treatment are associated with improved survival after ischemic stroke. U. Nilsson1, I. Markaki2, K. Kostulas3, C. Sjöstrand4 Department of Neurology, Karolinska University Hospital, Stockholm, SWEDEN1, Department of Neurology, Karolinska University Hospital, Stockholm, SWEDEN2, Department of Neurology, Karolinska University Hospital, Stockholm, SWEDEN3, Department of Neurology, Karolinska Uni-versity Hospital, Stockholm, SWEDEN4 Background: Hyperlipidemia is a major risk factor for atherosclerotic coronary disease, but its role in ischemic stroke (IS) risk is not equally established; possibly because not all etiological subtypes of IS relate to atherosclerosis. Lipid lowering with statins, but not with other medical or dietary treatment, reduces the IS risk. That may indicate a protective effect of statins mediated by mecha-nisms other than cholesterol lowering. The aim of this study was to evaluate the effect of cholesterol levels and statin treatment on survival after IS. Methods: Consecutive IS patients were retrospectively screened. Plasma cholesterol levels were measured within 72 hours from symptom onset, and statin treatment at admission and at discharge was recorded. Information on the date of death was obtained in all deceased patients. Cholesterol status was examined as binary variable, after dichotomization at 50th percentile (4.6 mmol/L). Time to death was examined with Kaplan-Meier analysis and Cox proportional hazards regression analy-sis was performed to calculate hazard ratios (HR). Results: Of 136 IS patients, 43 patients died during a median observation period of 15 months. Three-month survival rates were 90% and 98% in patients with low and high cholesterol levels re-spectively. One- and five-year survival rates were 82% and 58% respectively in low cholesterol group, and 95% and 82% in high cholesterol group (p=0.007 with the log rank test). After adjust-ment for age and severity of stroke, the HR in patients with cholesterol levels < 4.7 mmol/L was 2.5 (95% CI 1-6.4). Initiation of statins in patients with no previous treatment was associated with im-proved survival (HR 0.4; 95% CI 0.1-0.9). Conclusion: High cholesterol levels at admission, but also initiation of statin treatment at IS onset, are associated to improved short- and long-term survival; a paradox that may reflect a pleiotropic ef-fect of statins.


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