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• W4300574906 abstract "HomeStrokeVol. 48, No. 11Stroke: Highlights of Selected Articles Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBStroke: Highlights of Selected Articles Originally published1 Nov 2017https://doi.org/10.1161/STROKEAHA.117.019420Stroke. 2017;48:2924Validation of the Telephone Interview of Cognitive Status and Telephone Montreal Cognitive Assessment Against Detailed Cognitive Testing and Clinical Diagnosis of Mild Cognitive Impairment After StrokeIn this study, Zietemann et al assessed the accuracy of the Telephone Interview of Cognitive Status (TICS) and the Telephone Montreal Cognitive Assessment (T-MoCA) for the diagnosis of poststroke mild cognitive impairment (MCI). Comprehensive neuropsychological testing (CNT) and the Clinical Dementia Rating scale were used as gold standards for diagnosis of single-domain and multidomain MCI. Patients were included from the Determinants of Dementia After Stroke study, which studied stroke patients with an acute focal neurological deficit with corresponding abnormality on magnetic resonance brain imaging and no evidence of preceding dementia. Patients received 2 separate phone interviews (TICS and T-MoCA) and in-person visits with CNT, at months 6, 12, 36, and 60. Phone interviews occurred at least 1 week separate from personal assessments. MCI was defined as a score of 0.5 on the Clinical Dementia Rating and also determined by CNT and classified as single-domain or multidomain MCI. Of 105 patients who completed CNT and at least 1 telephone interview, 15% had MCI. Ninety-six patients completed all the assessments. Areas under the receiver operator curve were not significantly different for TICS compared with T-MoCA, independent of the definition of MCI (0.76–0.83 for TICS and 0.73–0.94 for T-MoCA). Optimal cutoffs for determination of multidomain MCI according to CNT were <36 for TICS and <18 for T-MoCA. Similarly, optimal cutoffs for MCI using Clinical Dementia Rating as definition were <36 for TICS and <19 for T-MoCA. Therefore, both TICS and T-MoCA proved to be good screening tools to exclude MCI after stroke, independently of patients’ educational level. However, given the very small numbers of patients in this study, lower severity of disease in this population, and the higher educational level of the subjects, these findings need to be replicated in other populations. See p 2952.Thrombolysis in Postoperative StrokeIn this study, Voelkel et al aimed to analyze the safety of intravenous thrombolysis (IVT) in patients with stroke undergoing surgery within 90 days before ischemic stroke. They retrospectively analyzed data from the telemedical project for integrative stroke care registry, which studies patients with stroke receiving acute stroke care via telemedicine in Bavaria, Germany. The surgery was classified as recent if performed ≤10 days and nonrecently if performed 11 to 90 before stroke. Major surgery was defined as surgery involving a major bodily cavity, skull, or heavily vascularized tissue or large arteries; the remainder of surgeries were considered minor. The primary outcome was surgical site hemorrhage (SSH). From 4848 patients who received IVT, 134 had surgery within 90 days prior: 63% nonrecently and 63% were major surgeries. Patients were older, with mean age of 75 years, and median admission National Institutes of Health Stroke scale was 11. SSH occurred in 7% of cases and was life-threatening/disabling in 3%, all of which occurred in patients who had undergone major surgery. SSH was significantly more likely to occur in patients with recent as compared with nonrecent surgery, and rates of SSH were nonsignificantly higher in patients with major than in patients with minor procedures. As expected, patients receiving IVT who had undergone recent major surgery had the highest risk of SSH: odds ratioadj 8.36 (95% confidence interval, 1.82–38.48). Overall, this study showed a relatively low risk of SSH after IVT, and an even lower risk of life-threatening/disabling bleeding. However, these data must be analyzed taking into account important study limitations, including its retrospective nature, lack of control group, and importantly selection bias as patients were only offered IVT after rigorous assessment by a consulting stroke neurologist. See p 3034.Incidence and Outcomes of Myocardial Infarction in Patients Admitted With Acute Ischemic StrokeIn this study, Alqahtani et al addressed the important question of clinical outcomes, predictors, and current trends in management of patients with acute ischemic stroke (AIS) complicated by acute myocardial infarction (AMI). To that end, they studied 864 043 patients with AIS from the National Inpatient Sample over an 11-year period. Patients (1.6%) had an AMI, of whom 79.5% were non–ST-segment–elevation AMI. In a multivariate model, older age was the strongest predictor of AMI after AIS; other predictors included known coronary artery disease, chronic kidney disease, conduction abnormalities, atrial fibrillation, and having received mechanical thrombectomy for AIS. Patients with AMI had significantly higher in-hospital mortality, hospital morbidities, hospital stay, and in-hospital costs. A small percentage (7.5%) of patients with AMI received coronary angiography, and only 2% underwent percutaneous coronary intervention. Coronary angiography and percutaneous coronary intervention were significantly associated with decreased in-hospital mortality in patients with AMI after AIS. Age >85 years and having received mechanical thrombectomy were predictive of a deferral of cardiac catheterization procedures in patients with AMI. These data highlight current deficiencies in the management of AMI after AIS and pave the way for further studies aiming to improve clinical outcomes in such patients. See p 2931. Previous Back to top Next FiguresReferencesRelatedDetails November 2017Vol 48, Issue 11 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.117.019420PMID: 30560729 Originally publishedNovember 1, 2017 PDF download Advertisement SubjectsAngiographyCognitive ImpairmentIschemic StrokeMyocardial Infarction" @default.
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