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Prior intracerebral hemorrhage and white matter hyperintensity burden on recurrent stroke risk

Prior intracerebral hemorrhage (ICH) is associated with increased risk of ischemic stroke. Since white matter hyperintensity (WMH) is associated with ischemic stroke and ICH, this study aimed to evaluate the relationship between ICH and the risk of recurrent stroke by WMH severity. From a prospectiv...

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Autores principales: Park, Jong-Ho, Kwon, Sun U., Kwon, Hyuk Sung, Heo, Sung Hyuk
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8408204/
https://www.ncbi.nlm.nih.gov/pubmed/34465828
http://dx.doi.org/10.1038/s41598-021-96809-3
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author Park, Jong-Ho
Kwon, Sun U.
Kwon, Hyuk Sung
Heo, Sung Hyuk
author_facet Park, Jong-Ho
Kwon, Sun U.
Kwon, Hyuk Sung
Heo, Sung Hyuk
author_sort Park, Jong-Ho
collection PubMed
description Prior intracerebral hemorrhage (ICH) is associated with increased risk of ischemic stroke. Since white matter hyperintensity (WMH) is associated with ischemic stroke and ICH, this study aimed to evaluate the relationship between ICH and the risk of recurrent stroke by WMH severity. From a prospective multicenter database comprising 1454 noncardioembolic stroke patients with cerebral small-vessel disease, patients were categorized by presence or absence of prior ICH and WMH severity: mild-moderate WMH (reference); advanced WMH; ICH with mild-moderate WMH; and ICH with advanced WMH. Among patients with ICH, the association with stroke outcomes by WMH burden was further assessed. The primary endpoint was ischemic stroke and hemorrhagic stroke. The secondary endpoint was major adverse cardiovascular events (MACE): stroke/coronary heart disease/vascular death. During the mean 1.9-year follow-up period, the ischemic stroke incidence rate per 100 person-years was 2.7, 4.0, 2.5, and 8.1 in increasing severity, and the rate of hemorrhagic stroke was 0.7, 1.3, 0.6, and 2.1, respectively. The risk of ischemic stroke was higher in ICH with advanced WMH (adjusted HR 2.62; 95% CI 1.22−5.60) than the reference group, while the risk of hemorrhagic stroke trended higher (3.75, 0.85–16.53). The risk of MACE showed a similar pattern in ICH with advanced WMH. Among ICH patients, compared with mild WMH, the risk of ischemic stroke trended to be higher in advanced WMH (HR 3.37; 95% CI 0.90‒12.61). Advanced WMH was independently associated with an increased risk of hemorrhagic stroke (HR 33.96; 95% CI 1.52−760.95). Given the fewer rate of hemorrhagic stroke, the risk of hemorrhagic stroke might not outweigh the benefits of antiplatelet therapy for secondary prevention.
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spelling pubmed-84082042021-09-01 Prior intracerebral hemorrhage and white matter hyperintensity burden on recurrent stroke risk Park, Jong-Ho Kwon, Sun U. Kwon, Hyuk Sung Heo, Sung Hyuk Sci Rep Article Prior intracerebral hemorrhage (ICH) is associated with increased risk of ischemic stroke. Since white matter hyperintensity (WMH) is associated with ischemic stroke and ICH, this study aimed to evaluate the relationship between ICH and the risk of recurrent stroke by WMH severity. From a prospective multicenter database comprising 1454 noncardioembolic stroke patients with cerebral small-vessel disease, patients were categorized by presence or absence of prior ICH and WMH severity: mild-moderate WMH (reference); advanced WMH; ICH with mild-moderate WMH; and ICH with advanced WMH. Among patients with ICH, the association with stroke outcomes by WMH burden was further assessed. The primary endpoint was ischemic stroke and hemorrhagic stroke. The secondary endpoint was major adverse cardiovascular events (MACE): stroke/coronary heart disease/vascular death. During the mean 1.9-year follow-up period, the ischemic stroke incidence rate per 100 person-years was 2.7, 4.0, 2.5, and 8.1 in increasing severity, and the rate of hemorrhagic stroke was 0.7, 1.3, 0.6, and 2.1, respectively. The risk of ischemic stroke was higher in ICH with advanced WMH (adjusted HR 2.62; 95% CI 1.22−5.60) than the reference group, while the risk of hemorrhagic stroke trended higher (3.75, 0.85–16.53). The risk of MACE showed a similar pattern in ICH with advanced WMH. Among ICH patients, compared with mild WMH, the risk of ischemic stroke trended to be higher in advanced WMH (HR 3.37; 95% CI 0.90‒12.61). Advanced WMH was independently associated with an increased risk of hemorrhagic stroke (HR 33.96; 95% CI 1.52−760.95). Given the fewer rate of hemorrhagic stroke, the risk of hemorrhagic stroke might not outweigh the benefits of antiplatelet therapy for secondary prevention. Nature Publishing Group UK 2021-08-31 /pmc/articles/PMC8408204/ /pubmed/34465828 http://dx.doi.org/10.1038/s41598-021-96809-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Park, Jong-Ho
Kwon, Sun U.
Kwon, Hyuk Sung
Heo, Sung Hyuk
Prior intracerebral hemorrhage and white matter hyperintensity burden on recurrent stroke risk
title Prior intracerebral hemorrhage and white matter hyperintensity burden on recurrent stroke risk
title_full Prior intracerebral hemorrhage and white matter hyperintensity burden on recurrent stroke risk
title_fullStr Prior intracerebral hemorrhage and white matter hyperintensity burden on recurrent stroke risk
title_full_unstemmed Prior intracerebral hemorrhage and white matter hyperintensity burden on recurrent stroke risk
title_short Prior intracerebral hemorrhage and white matter hyperintensity burden on recurrent stroke risk
title_sort prior intracerebral hemorrhage and white matter hyperintensity burden on recurrent stroke risk
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8408204/
https://www.ncbi.nlm.nih.gov/pubmed/34465828
http://dx.doi.org/10.1038/s41598-021-96809-3
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