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Jaume Roquer, MD, PhD; Angel Ois, MD; Ana Rodríguez-Campello, MD; Meritxell Gomis, MD; Elvira Munteis, MD; Jordi Jiménez-Conde, MD; Elisa Cuadrado-Godia, MD; José E. Martínez-Rodríguez, MD

Arch Neurol. 2007;64(5):699-704.

Background  The influence that previous clinical expressions of systemic atherosclerosis may have on evolution and early mortality in patients with acute ischemic stroke is not known.

Objective  To evaluate the influence that atherosclerotic burden (ATB), assessed by a simple clinical scale, has on the 30-day mortality in patients with first-ever ischemic stroke.

Design  Retrospective review of case series from a prospective stroke record. An ATB score ranging from 0 to 2 was created using the history of ischemic heart disease and peripheral arterial disease. The impact of this score on the 30-day mortality was analyzed by multivariate regression analysis.

Setting  Tertiary university hospital.

Patients  A total of 1527 patients with first-ever ischemic stroke.

Main Outcome Measure  Thirty-day mortality.

Results  The 30-day mortality rate was 13.8%. Multivariate regression analysis showed an association between the ATB score and the 30-day mortality (P<.001). Comparing patients having no previous ATB with those with an ATB score of 1 or 2, the odds ratio (OR) for 30-day mortality increased from 1.71 (95% confidence interval [CI], 1.06-2.75) for patients with an ATB score of 1 to 5.90 (95% CI, 2.48-14.04) for those with an ATB score of 2. Age (OR, 1.05; 95% CI, 1.03-1.08), National Institutes of Health Stroke Scale score at admission (OR, 1.22; 95% CI, 1.18-1.25), atrial fibrillation (OR, 1.61; 95% CI, 1.10-2.35), hyperlipidemia as protector (OR, 0.39; 95% CI, 0.25-0.60), and glycemia at admission (OR, 1.07; 95% CI, 1.02-1.12) were also predictors of 30-day mortality.

Conclusion  Previous symptomatic atherosclerotic disease evaluated by a simple clinical score is an independent predictor of early mortality in patients with first-ever ischemic stroke.

Author Affiliations: Unitat d’Ictus, Servei de Neurologia, Hospital Universitari del Mar, IMIM–Hospital del Mar, Barcelona, Spain.