cardiovascular-agents and Brain-Damage--Chronic

Topics: Airway Management; Brain Damage, Chronic; Cardiopulmonary Resuscitation; Cardiovascular Agents; Electric Countershock; Emergency Medical Services; Heart Arrest; Heart Massage; Humans; Neuroimaging; Oxygen Inhalation Therapy; Respiration, Artificial; Tissue and Organ Harvesting

Approximately one in four ischemic strokes is of cardioembolic origin. Non-valvular atrial fibrillation accounts for 50% of these cases, followed by myocardial infarction, intraventricular thrombus, valvular heart disease and a miscellany of causes. The incidence of embolic heart disease in the population could be about 30 cases per 100,000 inhabitants per year, and its prevalence between 5 and 10 cases per 1,000 persons aged 65 years or older. Hospital mortality is high, and 5-year survival is only one out of every five patients. The recurrence rate of this type of stroke is about 12% at 3 months, higher than that of non-cardioembolic stroke. The severity of cardioembolic strokes and the resulting disability are greater than with non-cardioembolic stroke. Age, a history of stroke or transient ischemic attack, hypertension, diabetes and heart failure play a role in stroke with atrial fibrillation as additional risk factors for future embolisms. Stroke rates can reach over 20% per year and therefore the prevention and treatment of these events are of paramount importance.

Topics: Age Distribution; Atrial Fibrillation; Brain Damage, Chronic; Brain Ischemia; Cardiovascular Agents; Comorbidity; Diabetes Mellitus; Female; Heart Valve Diseases; Humans; Hypertension; Intracranial Embolism; Male; Myocardial Infarction; Prevalence; Recurrence; Risk Factors; Sex Distribution; Survival Rate; Thrombophilia

Atrial fibrillation (AF) is the most frequent heart arrhythmia and causes a substantial proportion of ischemic strokes. AF has a marked impact on stroke severity, as well as on morbidity and mortality in these patients. The importance of AF as an etiologic factor of stroke increases in the elderly and in the last few years its detection has increased. The presence of AF leads to more severe initial neurological involvement, longer hospitalization, greater disability and a lower probability of discharge to home. In addition, AF is an independent risk factor for mortality, especially in women and the elderly. All these factors lead to a higher social and economic impact among stroke patients with AF.

Topics: Atrial Fibrillation; Brain Damage, Chronic; Brain Ischemia; Cardiovascular Agents; Cost of Illness; Female; Health Care Costs; Health Expenditures; Hospitalization; Humans; Intracranial Embolism; Male; Prevalence; Quality of Life; Risk Factors; Social Adjustment; Social Change; Socioeconomic Factors; Stroke

A variety of primary end points have been used in acute stroke trials. We focus on the modified Rankin Scale, a reliable and valid ordinal outcome measure that assesses disability on a 7-point scale.. We provide an abbreviated discussion of analytical methods for ordinal scales, and related effect size measures; we illustrate these methods and their interpretation with outcome data from the SAINT I study of NXY-059 in acute ischemic stroke.. The nonparametric Mann-Whitney statistic provides a straightforward method for analysis of the modified Rankin Scale, and incorporates associated measures of effect size. These measures are directly related to the concepts of Number Needed to Treat and Number Needed to Harm.. Our re-examination of the outcome data from the SAINT I study provides little evidence for the purported efficacy of NXY-059. More broadly, analysis and interpretation of ordinal outcome scales based on ascribed numerical values to the steps of the scale should be done cautiously. Statistical treatment of multiple primary outcome measures in acute stroke clinical trials should be established before analysis. Lastly, conflating statistical and clinical significance should be avoided.

Topics: Acute Disease; Benzenesulfonates; Biomarkers; Brain Damage, Chronic; Brain Ischemia; Cardiovascular Agents; Clinical Trials as Topic; Clinical Trials, Phase III as Topic; Disability Evaluation; Double-Blind Method; Free Radical Scavengers; Humans; Neuroprotective Agents; Neuropsychological Tests; Nitrogen Oxides; Randomized Controlled Trials as Topic; Sample Size; Severity of Illness Index; Statistics, Nonparametric; Stroke; Treatment Failure; Treatment Outcome

One of every four persons in the Western industrialised nations has cardiovascular disease. The perioperative setting in those patients is associated with the risk of myocardial ischaemia (PMI) and myocardial infarction, and also with the risk of perioperative stroke and dysfunction of the central nervous system (CNS). Perioperative cardiovascular morbidity represents a major healthcare challenge. The relevance of PMI is well documented. It has been demonstrated in early trials that both myocardial ischaemia and infarction are preventable in high-risk patients undergoing surgery, and that therapeutic agents such as adenosine-related agents, alpha 2-agonists, and other stress modulators can be safely administered to these patients. Regarding perioperative stroke, approximately 3 to 7% of patients undergoing cardiac surgery suffer stroke, with an additional 30% or more suffering in-hospital CNS dysfunction, and 10% suffering moderately severe long-term CNS dysfunction. Few data are available for noncardiac surgery. The number of outcome studies addressing prophylactic or therapeutic options in these patients is quite limited. In fact, only one recent study has established that perioperative stroke is preventable with the use of an adenosine-regulating agent. Thus, it appears that it may be possible to prevent stroke, even though these results require confirmation. Because of the aging of our population, and the medical, financial and social impact of cardiovascular disease, the development of anti-ischaemic therapy, particularly in the surgical patient, will be a critical area of medical research for the next several decades.

Topics: Anesthesia, General; Brain Damage, Chronic; Cardiovascular Agents; Cardiovascular Diseases; Cerebrovascular Disorders; Humans; Intraoperative Complications; Myocardial Infarction; Myocardial Ischemia; Postoperative Complications; Premedication; Risk Factors

Successful resuscitation from cardiac arrest results in a post-cardiac arrest syndrome, which can evolve in the days to weeks after return of sustained circulation. The components of post-cardiac arrest syndrome are brain injury, myocardial dysfunction, systemic ischemia/reperfusion response, and persistent precipitating pathophysiology. Pediatric post-cardiac arrest care focuses on anticipating, identifying, and treating this complex physiology to improve survival and neurological outcomes. This scientific statement on post-cardiac arrest care is the result of a consensus process that included pediatric and adult emergency medicine, critical care, cardiac critical care, cardiology, neurology, and nursing specialists who analyzed the past 20 years of pediatric cardiac arrest, adult cardiac arrest, and pediatric critical illness peer-reviewed published literature. The statement summarizes the epidemiology, pathophysiology, management, and prognostication after return of sustained circulation after cardiac arrest, and it provides consensus on the current evidence supporting elements of pediatric post-cardiac arrest care.

Topics: Acute Kidney Injury; Adrenal Insufficiency; Anticonvulsants; Brain Damage, Chronic; Cardiomyopathies; Cardiopulmonary Resuscitation; Cardiovascular Agents; Child; Combined Modality Therapy; Fluid Therapy; Glucose Metabolism Disorders; Heart Arrest; Humans; Hypnotics and Sedatives; Hypothermia, Induced; Hypoxia-Ischemia, Brain; Infections; Inflammation; Monitoring, Physiologic; Multiple Organ Failure; Neuromuscular Blocking Agents; Oxygen Inhalation Therapy; Prognosis; Reperfusion Injury; Respiratory Therapy; Time Factors

The information on the existence of sex differences in management of stroke patients is scarce. We evaluated whether sex differences may influence clinical presentation, resource use, and outcome of stroke in a European multicenter study.. In a European Concerted Action involving 7 countries, 4499 patients hospitalized for first-in-a-lifetime stroke were evaluated for demographics, risk factors, clinical presentation, resource use, and 3-month survival, disability (Barthel Index), and handicap (Rankin Scale).. Overall, 2239 patients were males and 2260 females. Compared with males, female patients were significantly older (mean age 74.5+/-12.5 versus 69.2+/-12.1 years), more frequently institutionalized before stroke, and with a worse prestroke Rankin score (all values P<0.001). History of hypertension (P=0.007) and atrial fibrillation (P<0.001) were significantly more frequent in female stroke patients, as were coma (P<0.001), paralysis (P<0.001), aphasia (P=0.001), swallowing problems (P=0.005), and urinary incontinence (P<0.001) in the acute phase. Brain imaging, Doppler examination, echocardiogram, and angiography were significantly less frequently performed in female than male patients (all values P<0.001). The frequency of carotid surgery was also significantly lower in female patients (P<0.001). At the 3-month follow-up, after controlling for all baseline and clinical variables, female sex was a significant predictor of disability (odds ratio [OR], 1.41; 95% CI 1.10 to 1.81) and handicap (OR, 1.46; 95% CI 1.14 to 1.86). No significant gender effect was observed on 3-month survival.. Sex-specific differences existed in a large European study of hospital admissions for acute stroke. Both medical and sociodemographic factors may significantly influence stroke outcome. Knowledge of these determinants may positively impact quality of care.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alcohol Drinking; Atrial Fibrillation; Brain Damage, Chronic; Brain Ischemia; Cardiovascular Agents; Case Management; Comorbidity; Diabetes Mellitus; Diagnostic Imaging; Europe; Female; Follow-Up Studies; Glasgow Coma Scale; Humans; Hypertension; Hypoglycemic Agents; Institutionalization; Length of Stay; Male; Middle Aged; Myocardial Infarction; Patient Discharge; Prognosis; Registries; Risk Factors; Severity of Illness Index; Sex Factors; Smoking; Stroke; Stroke Rehabilitation; Subarachnoid Hemorrhage; Survival Analysis; Treatment Outcome