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Objective:To investigate the clinical characteristics and outcomes in patients with wake-up stroke.Methods:From January 2019 to December 2019, consecutive patients with acute ischemic stroke admitted to the Department of Neurology, Huizhou Municipal Central Hospital were enrolled retrospectively. The modified Rankin Scale was used to evaluate the outcome of patients at 90 d after the onset. 0 to 2 was defined as a good outcome, and >2 was defined as a poor outcome. Multivariate logistic regression analysis was used to determine the factors affecting the poor outcome of patients with wake-up stroke. Results:A total of 356 patients with acute ischemic stroke were enrolled, including 97 (27.2%) wake-up stroke, and 259 (72.8%) non-wake-up stroke. The National Institutes of Health Stroke Scale (NIHSS) score at admission and the proportion of patients with atrial fibrillation, moderate to severe stroke and cardiogenic embolism in the wake-up stroke group were significantly higher than those of the non-wake-up stroke group, and the proportion of patients with small artery occlusion was significantly lower than that in the non-wake-up stroke group (all P<0.05). Moreover, the proportion of patients with poor outcome in the wake-up stroke group was significantly higher than that in the non-wake-up stroke group (36.1% vs. 24.7%; χ2=4.546, P=0.033). In the wake-up stroke group, 62 patients (63.9%) had a good outcome, and 35 (36.1%) had a poor outcome. The NIHSS score at admission and the proportion of patients with atrial fibrillation and moderate to severe stroke in the subgroup with poor outcome were significantly higher than those in the subgroup with good outcome, and the proportion of patients receiving intravenous thrombolysis and mechanical thrombectomy was significantly lower than those in the good outcome subgroup (all P<0.05). Multivariate logistic regression analysis showed that moderate to severe stroke (odds ratio [ OR] 6.674, 95% confidence interval [ CI] 2.223-20.034; P=0.001) was independently associated with the poor outcome in patients with wake-up stroke, while intravenous thrombolysis ( OR 0.102, 95% CI 0.017-0.630; P=0.014) and endovascular mechanical thrombectomy ( OR 0.108, 95% CI 0.023-0.506; P=0.005) were independently associated with the good outcome of patients with wake-up stroke. Conclusions:In patients with wake-up stroke, the proportion of cardioembolism is higher, the clinical symptoms are more serious and the incidence of poor outcome is higher. The severity of stroke at admission is associated with poor short-term outcome, and intravenous thrombolysis and endovascular mechanical thrombectomy can improve the outcome in patients with wake-up stroke.
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Objective:To investigate the predictive value of STAF (score for the targeting of atrial fibrillation) score for paroxysmal atrial fibrillation (PAF) in patients with recurrent acute ischemic stroke.Methods:Consecutive patients with recurrent acute ischemic stroke hospitalized in the Department of Neurology, Huizhou Municipal Central Hospital from January 2014 to January 2020 were enrolled retrospectively. All patients were divided into a sinus rhythm (SR) group and a PAF group. PAF was defined as no PAF during the last stroke hospitalization or after discharge, and PAF was found by routine ECG, ambulatory ECG or long-term ECG monitoring after this recurrent acute ischemic stroke. Multivariate logistic regression analysis was used to evaluate the independent related factors of PAF in patients with recurrent acute ischemic stroke. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of STAF for PAF in patients with recurrent acute ischemic stroke. Results:A total of 234 patients with recurrent acute ischemic stroke were enrolled, including 174 males (74.4%), aged 67.15±10.63 years, and 199 (85.0%) in the SR group and 35 (15.0%) in the PAF group. Univariate analysis showed that the proportion of patients in age >62 years old (94.3% vs. 63.8%; χ2=12.777, P<0.001) and left atrial enlargement (54.3% vs. 11.1%; χ2=40.379, P<0.001) of the PAF group was significantly higher than those of the SR group. Multivariate logistic regression analysis showed that age (odd ratio [ OR] 1.071, 95% confidence interval [ CI] 1.028-1.114; P=0.001) or age >62 years ( OR 17.512, 95% CI 2.881-106.453; P=0.002), left atrial enlargement ( OR 17.511, 95% CI 6.298-48.687; P<0.001), absence of vascular etiology ( OR 8.562, 95% CI 2.534-28.923; P=0.001), STAF score ( OR 2.715, 95% CI 1.969-3.744; P<0.001) and STAF score ≥5 ( OR 12.714, 95% CI 5.636-28.681; P<0.001) were independently associated with PAF. ROC curve analysis showed that the area under the curve of STAF for predicting PAF in patients with recurrent acute ischemic stroke was 0.848 (95% CI 0.779-0.917), and the sensitivity and specificity of STAF ≥5 for predicting PAF were 58.1% and 89.4%, respectively; the area under the curve for predicting PAF in patients with recurrent ischemic stroke of undetermined cause was 0.809 (95% CI 0.663-0.956), and the sensitivity and specificity of STAF ≥5 for predicting PAF were 53.8% and 91.3%, respectively. Conclusions:PAF is likely to exist in patients with recurrent acute ischemic stroke and aged >62 years, left atrial enlargement and absence of vascular etiology. STAF has medium predictive value for PAF in patients with recurrent acute ischemic stroke, but the sensitivity is not high.
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Objective To investigate the risk factors of intracranial hemorrhagic (ICH) transformation within 14-days in acute cerebral infarction with non-valvular atrial fibrillation (NVAF) patients. Methods CT and/or MRI scans of the head were conducted within 14 days on patients with NVAF acute cerebral infarction who admitted to the Department of Neurology, Huizhou Municipal Central Hospital between January 2015 to March 2018. The baseline scan data were reviewed to determine whether ICH conversion occurred. Comparable risk assessment were based on stratification scores using HAS-BLED, ASPECTS, and pc-ASPECTS. Results There were 150 cases of acute cerebral infarction with NVAF, 126 patients were eligible for the analysis, with an ICH conversion rate of 27.0% (34/126). The following four risk factors were statistically significant among the ICH and non-ICH transformation groups: ①systolic blood pressure (SBP) >160 mmHg or diastolic blood pressure (DBP) >100 mmHg post-cerebral infarction, ②Severe cerebral infarction, progressing stroke, ③ASPECTS (pc-ASPECTS) score ≤7 points, and ④ HAS-BLED score ≥3 points (P<0.05). Conclusion Approximately 1/3 of NVAF acute cerebral infarction patients experience an ICH transformation within 14 days of their episode. The following indicators are independent risk factors of ICH transformation: SBP >160mmHg or DBP >100mmHg after cerebral infarction, severe cerebral infarction, progressing stroke, ASPECTS (pc-ASPECTS)≤7 points, and HAS-BLED score≥3 points.
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Early anticoagulation with conventional anticoagulants (such as heparin, low-molecular- weight heparin or warfarin) has no benefit in preventing recurrence of stroke in ischemic stroke patients with atrial fibrillation. Non-vitamin K oral anticoagulants (NOACs) has the same or better anticoagulant effect and much lower incidence of intracranial hemorrhage than warfarin, and it works on the same day. Although it has been available for less than 10 years, it has a tendency to replace warfarin. This article reviews the research progress in the prevention of early recurrence with NOACs in ischemic stroke patients with atrial fibrillation.