Maximal Admission Core Lesion Compatible With Favorable Outcome in Acute Stroke Patients Undergoing Endovascular Procedures.

BACKGROUND AND PURPOSE: Multiparametric imaging is meant to identify nonreversible lesions and predict on admission the minimum final infarct volume, a strong predictor of outcome. We aimed to confirm this hypothesis and define the maximal admission lesion volume compatible with favorable outcome (MALCOM). METHODS: We studied patients with internal carotid artery/middle cerebral artery occlusion selected with multiparametric computed tomography/magnetic resonance imaging, who underwent endovascular procedures. Admission infarct core was measured on initial cerebral blood volume-computed tomography perfusion or diffusion weighted imaging-magnetic resonance imaging. We defined percentage of lesion growth (final lesion admission core/admission core) and MALCOM: cutoff admission core volume above which probability of modified Rankin Scale 0 to 2 is <10%. RESULTS: Fifty-seven patients were studied (29 magnetic resonance imaging and 28 computed tomography perfusion). Mean core volume was 28±22 mL, and recanalization thrombolysis in cerebral ischemia 2b-3 was 77%. At 24 hours, mean infarct volume was 64±97 mL, and at 3 months modified Rankin Scale 0 to 2 was 45%. Median lesion growth was smaller in recanalizers (16.7% versus 198.3%; P<0.01). MALCOM was 39 mL. When recanalization was achieved, 64% of patients within MALCOM (<39 mL) achieved favorable outcome, whereas despite recanalization only 12% of patients beyond MALCOM (>39 mL) achieved modified Rankin Scale 0 to 2 (P=0.01). A regression model adjusted for age and recanalization showed that the only predictor of favorable outcome was having admission core lesion below MALCOM (OR: 9.3, 95% CI: 1.9-46.4; P<0.01). Analysis according to imaging modality showed that computed tomography-cerebral blood volume allowed larger MALCOM (42 mL) than magnetic resonance-diffusion weighted imaging (29 mL). In octogenarians, MALCOM (15 mL) was lower in younger patients (40 mL). CONCLUSIONS: Admission lesion core is associated with final infarct volume and is a strong predictor of favorable outcome. MALCOM according to imaging modality and patient age could be set and used on admission to select candidates for endovascular procedures.

Riesgo vascular en las consultas de Medicina Interna. Estudio MICARE / Vascular risk in outpatient from Internal Medicine departments. MICARE Study

Fundamento y objetivo: La población atendida por los servicios de Medicina Interna en España tiene una edad creciente, pero desconocemos la prevalencia de los factores de riesgo vascular y su grado de control, así como sus diferencias según el tipo de hospital o de consulta. Pacientes y método: Estudio epidemiológico, transversal y multicéntrico en pacientes 18 años. Participaron 290 investigadores de las 17 comunidades autónomas. Se determinó el tipo de hospital y de consulta. La presión arterial se consideró controlada si era < 140/90 mmHg (< 130/80 mmHg en diabéticos o pacientes con enfermedades clínicas asociadas), el colesterol, si el colesterol unido a lipoproteínas de baja densidad (colesterol LDL) < 130 mg/dl (< 100 mg/dl en diabéticos o pacientes con enfermedades clínicas asociadas) y la diabetes, si la hemoglobina glucosilada < 7%. Resultados: Se analizaron 2.704 pacientes (54% varones), con una edad media (DE) de 64,1 (14,5) años. El 93% tenía algún factor de riesgo: hipertensión 73,9%, dislipidemia 59,5%, obesidad abdominal 43,4%, diabetes 39,5%. El 50,0% tenía alguna lesión de órgano diana, el 46,7% alguna enfermedad clínica asociada y el 71,2% un riesgo vascular alto o muy alto. El control de los factores de riesgo fue: hipertensión 33,8%, colesterol LDL 40,8% y diabetes 50,7%. No existieron diferencias relevantes según el tipo de hospital o de consultas. Conclusiones: Más del 90% de los enfermos atendidos en las consultas hospitalarias de Medicina Interna presenta algún factor de riesgo vascular, independientemente del tipo de consulta u hospital. El control de los factores de riesgo es reducido (AU)

Background and objectives: The population attended in the Spanish Internal Medicine departments is of increasing age, but the prevalence of vascular risk factors and its degree of control are unknown, as well as the differences by type of hospital or consulting room. Patients and methods: Epidemiologic, transversal and metacentric study in patients 18 years treated in outpatient Internal Medicine hospital. Two-hundred and ninety physicians from 17 Autonomic Communities participated in the study. The type of hospital or consulting room was also recorded. Blood pressure control was defined as < 140/90 mmHg (< 130/80 mmHg in diabetics or patients with vascular disease), LDL-cholesterol control when < 130 mg/dl (< 100 mg/dl in diabetic or vascular disease) and diabetes control if glycated hemoglobin was < 7%. Results: Data from 2,704 patients was collected (54% men) mean age (SD) 64,1 (14,5) years. Ninety-three percent of them had at least one cardiovascular risk factor: hypertension 73.9%, dyslipidemia 59.5%, abdominal obesity 43.4%, diabetes 39.5%. Fifty percent had some target organ damaged, 46.7% showed vascular disease and 71.2% a high or very high vascular risk. Control over risk factors was: hypertension 33.8%, cholesterol-LDL 40.8% and diabetes 50.7%. There were no differences between type of hospital or type of outpatient consultancy. Conclusions: Over 90% of patients treated in outpatient consultancies of Internal Medicine departments present vascular risk factors, regardless of the type of hospital or type of consulting room. Risk factors control was poor (AU)

[Vascular risk in outpatient from Internal Medicine departments. MICARE Study]. / Riesgo vascular en las consultas de Medicina Interna. Estudio MICARE.

BACKGROUND AND OBJECTIVES: The population attended in the Spanish Internal Medicine departments is of increasing age, but the prevalence of vascular risk factors and its degree of control are unknown, as well as the differences by type of hospital or consulting room. PATIENTS AND METHODS: Epidemiologic, transversal and metacentric study in patients ≥ 18 years treated in outpatient Internal Medicine hospital. Two-hundred and ninety physicians from 17 Autonomic Communities participated in the study. The type of hospital or consulting room was also recorded. Blood pressure control was defined as <140/90 mm Hg (<130/80 mm Hg in diabetics or patients with vascular disease), LDL-cholesterol control when<130 mg/dl (<100mg/dl in diabetic or vascular disease) and diabetes control if glycated hemoglobin was<7%. RESULTS: Data from 2,704 patients was collected (54% men) mean age (SD) 64,1 (14,5) years. Ninety-three percent of them had at least one cardiovascular risk factor: hypertension 73.9%, dyslipidemia 59.5%, abdominal obesity 43.4%, diabetes 39.5%. Fifty percent had some target organ damaged, 46.7% showed vascular disease and 71.2% a high or very high vascular risk. Control over risk factors was: hypertension 33.8%, cholesterol-LDL 40.8% and diabetes 50.7%. There were no differences between type of hospital or type of outpatient consultancy. CONCLUSIONS: Over 90% of patients treated in outpatient consultancies of Internal Medicine departments present vascular risk factors, regardless of the type of hospital or type of consulting room. Risk factors control was poor.

Multifactorial control and treatment intensity of type-2 diabetes in primary care settings in Catalonia.

BACKGROUND: Many studies on diabetes have demonstrated that an intensive control of glycaemia and the main associated risk factors (hypertension, dislipidaemia, obesity and smoking) reduce cardiovascular morbi-mortality. Different scientific societies have proposed a multifactorial approach to type 2 diabetes.The objective of this study was to identify the degree of control of glycosylated haemoglobin (HbA1c) and of cardiovascular risk factors in type 2 diabetic patients, using the GedapS 2004 guidelines, and to analyse the type and intensity of drug treatment. METHODS: This cross-sectional, multicentre, epidemiological study was conducted in a primary care setting in Vallès Occidental South, Catalonia. Data were collected of 393 patients aged 18 and above who were diagnosed with diabetes mellitus type 2. Biodemographic and clinical data, cardiovascular risk factors, associated cardiovascular disease, and treatment were assessed. Descriptive and multivariable analysis with logistic regression was realized. RESULTS: A total of 392 patients with a mean age of 66.8 years (SD = 10.6) (45.4% male patients) were analyzed. The duration of diabetes was 8.4 years (SD = 7.6). The degree of multifactorial control of risk factors was only 2.6%, although in more than 50% individual cardiovascular risk factor was controlled, except for LDL cholesterol (40.6%) and systolic blood pressure (29.6%). Furthermore, only 13.0% of subjects had an optimal BMI, 27.5% an optimal waist circumference. Treatment for diabetes was prescribed in 82.7% of patients, for hypertension 70.7%, for dyslipidaemia 47.2% and 40.1% were taking antiplatelets. CONCLUSION: Over 50% of type 2 diabetic patients presented optimal control of the majority of individual cardiovascular risk factors, although the degree of multifactorial control of diabetes was insufficient (2.6%) and should be improved. Drug treatment can be intensified using a larger number of combinations, particularly in patients with target organ damage and associated clinical cardiovascular disease.