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Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies

DC FieldValueLanguage
dc.contributor.author허지회-
dc.date.accessioned2019-07-29T05:21:23Z-
dc.date.available2019-07-29T05:21:23Z-
dc.date.issued2019-
dc.identifier.issn1474-4422-
dc.identifier.urihttps://ir.ymlib.yonsei.ac.kr/handle/22282913/170461-
dc.description.abstractBACKGROUND: Cerebral microbleeds are a neuroimaging biomarker of stroke risk. A crucial clinical question is whether cerebral microbleeds indicate patients with recent ischaemic stroke or transient ischaemic attack in whom the rate of future intracranial haemorrhage is likely to exceed that of recurrent ischaemic stroke when treated with antithrombotic drugs. We therefore aimed to establish whether a large burden of cerebral microbleeds or particular anatomical patterns of cerebral microbleeds can identify ischaemic stroke or transient ischaemic attack patients at higher absolute risk of intracranial haemorrhage than ischaemic stroke. METHODS: We did a pooled analysis of individual patient data from cohort studies in adults with recent ischaemic stroke or transient ischaemic attack. Cohorts were eligible for inclusion if they prospectively recruited adult participants with ischaemic stroke or transient ischaemic attack; included at least 50 participants; collected data on stroke events over at least 3 months follow-up; used an appropriate MRI sequence that is sensitive to magnetic susceptibility; and documented the number and anatomical distribution of cerebral microbleeds reliably using consensus criteria and validated scales. Our prespecified primary outcomes were a composite of any symptomatic intracranial haemorrhage or ischaemic stroke, symptomatic intracranial haemorrhage, and symptomatic ischaemic stroke. We registered this study with the PROSPERO international prospective register of systematic reviews, number CRD42016036602. FINDINGS: Between Jan 1, 1996, and Dec 1, 2018, we identified 344 studies. After exclusions for ineligibility or declined requests for inclusion, 20 322 patients from 38 cohorts (over 35 225 patient-years of follow-up; median 1·34 years [IQR 0·19-2·44]) were included in our analyses. The adjusted hazard ratio [aHR] comparing patients with cerebral microbleeds to those without was 1·35 (95% CI 1·20-1·50) for the composite outcome of intracranial haemorrhage and ischaemic stroke; 2·45 (1·82-3·29) for intracranial haemorrhage and 1·23 (1·08-1·40) for ischaemic stroke. The aHR increased with increasing cerebral microbleed burden for intracranial haemorrhage but this effect was less marked for ischaemic stroke (for five or more cerebral microbleeds, aHR 4·55 [95% CI 3·08-6·72] for intracranial haemorrhage vs 1·47 [1·19-1·80] for ischaemic stroke; for ten or more cerebral microbleeds, aHR 5·52 [3·36-9·05] vs 1·43 [1·07-1·91]; and for ≥20 cerebral microbleeds, aHR 8·61 [4·69-15·81] vs 1·86 [1·23-1·82]). However, irrespective of cerebral microbleed anatomical distribution or burden, the rate of ischaemic stroke exceeded that of intracranial haemorrhage (for ten or more cerebral microbleeds, 64 ischaemic strokes [95% CI 48-84] per 1000 patient-years vs 27 intracranial haemorrhages [17-41] per 1000 patient-years; and for ≥20 cerebral microbleeds, 73 ischaemic strokes [46-108] per 1000 patient-years vs 39 intracranial haemorrhages [21-67] per 1000 patient-years). INTERPRETATION: In patients with recent ischaemic stroke or transient ischaemic attack, cerebral microbleeds are associated with a greater relative hazard (aHR) for subsequent intracranial haemorrhage than for ischaemic stroke, but the absolute risk of ischaemic stroke is higher than that of intracranial haemorrhage, regardless of cerebral microbleed presence, antomical distribution, or burden. FUNDING: British Heart Foundation and UK Stroke Association.-
dc.description.statementOfResponsibilityrestriction-
dc.languageEnglish-
dc.publisherLancet Pub. Group-
dc.relation.isPartOfLANCET NEUROLOGY-
dc.rightsCC BY-NC-ND 2.0 KR-
dc.rightsnull-
dc.titleCerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies-
dc.typeArticle-
dc.contributor.collegeCollege of Medicine (의과대학)-
dc.contributor.departmentDept. of Neurology (신경과학교실)-
dc.contributor.googleauthorDuncan Wilson-
dc.contributor.googleauthorGareth Ambler-
dc.contributor.googleauthorKeon-Joo Lee-
dc.contributor.googleauthorJae-Sung Lim-
dc.contributor.googleauthorMasayuki Shiozawa-
dc.contributor.googleauthorMasatoshi Koga-
dc.contributor.googleauthorLinxin Li-
dc.contributor.googleauthorCaroline Lovelock-
dc.contributor.googleauthorHugues Chabriat-
dc.contributor.googleauthorMichael Hennerici-
dc.contributor.googleauthorYuen Kwun Wong-
dc.contributor.googleauthorHenry Ka Fung Mak-
dc.contributor.googleauthorLuis Prats-Sánchez-
dc.contributor.googleauthorAlejandro Martínez-Domeño-
dc.contributor.googleauthorShigeru Inamura-
dc.contributor.googleauthorKazuhisa Yoshifuji-
dc.contributor.googleauthorEthem Murat Arsava-
dc.contributor.googleauthorSolveig Horstmann-
dc.contributor.googleauthorJan Purrucker-
dc.contributor.googleauthorBonnie Yin Ka Lam-
dc.contributor.googleauthorAdrian Wong-
dc.contributor.googleauthorYoung Dae Kim-
dc.contributor.googleauthorTae-Jin Song-
dc.contributor.googleauthorMaarten Schrooten-
dc.contributor.googleauthorRobin Lemmens-
dc.contributor.googleauthorSebastian Eppinger-
dc.contributor.googleauthorThomas Gattringer-
dc.contributor.googleauthorEnder Uysal-
dc.contributor.googleauthorZeynep Tanriverdi-
dc.contributor.googleauthorNatan M Bornstein-
dc.contributor.googleauthorEinor Ben Assayag-
dc.contributor.googleauthorHen Hallevi-
dc.contributor.googleauthorJun Tanaka-
dc.contributor.googleauthorHideo Hara-
dc.contributor.googleauthorShelagh B Coutts-
dc.contributor.googleauthorLisa Hert-
dc.contributor.googleauthorAlexandros Polymeris-
dc.contributor.googleauthorDavid J Seiffge-
dc.contributor.googleauthorPhilippe Lyrer-
dc.contributor.googleauthorAle Algra-
dc.contributor.googleauthorJaap Kappelle-
dc.contributor.googleauthorRustam Al-Shahi Salman-
dc.contributor.googleauthorHans R Jäger-
dc.contributor.googleauthorGregory Y H Lip-
dc.contributor.googleauthorHeinrich P Mattle-
dc.contributor.googleauthorLeonidas D Panos-
dc.contributor.googleauthorJean-Louis Mas-
dc.contributor.googleauthorLaurence Legrand-
dc.contributor.googleauthorChristopher Karayiannis-
dc.contributor.googleauthorThanh Phan-
dc.contributor.googleauthorSarah Gunkel-
dc.contributor.googleauthorNicolas Christ-
dc.contributor.googleauthorJill Abrigo-
dc.contributor.googleauthorThomas Leung-
dc.contributor.googleauthorWinnie Chu-
dc.contributor.googleauthorFrancesca Chappell-
dc.contributor.googleauthorStephen Makin-
dc.contributor.googleauthorDerek Hayden-
dc.contributor.googleauthorDavid J Williams-
dc.contributor.googleauthorM Eline Kooi-
dc.contributor.googleauthorDianne H K van Dam-Nolen-
dc.contributor.googleauthorCarmen Barbato-
dc.contributor.googleauthorSimone Browning-
dc.contributor.googleauthorKim Wiegertjes-
dc.contributor.googleauthorAnil M Tuladhar-
dc.contributor.googleauthorNoortje Maaijwee-
dc.contributor.googleauthorChristine Guevarra-
dc.contributor.googleauthorChathuri Yatawara-
dc.contributor.googleauthorAnne-Marie Mendyk-
dc.contributor.googleauthorChristine Delmaire-
dc.contributor.googleauthorSebastian Köhler-
dc.contributor.googleauthorRobert van Oostenbrugge-
dc.contributor.googleauthorYing Zhou-
dc.contributor.googleauthorChao Xu-
dc.contributor.googleauthorSaima Hilal-
dc.contributor.googleauthorBibek Gyanwali-
dc.contributor.googleauthorChristopher Chen-
dc.contributor.googleauthorMin Lou-
dc.contributor.googleauthorJulie Staals-
dc.contributor.googleauthorRégis Bordet-
dc.contributor.googleauthorNagaendran Kandiah-
dc.contributor.googleauthorFrank-Erik de Leeuw-
dc.contributor.googleauthorRobert Simister-
dc.contributor.googleauthorAad van der Lugt-
dc.contributor.googleauthorPeter J Kelly-
dc.contributor.googleauthorJoanna M Wardlaw-
dc.contributor.googleauthorYannie Soo-
dc.contributor.googleauthorFelix Fluri-
dc.contributor.googleauthorVelandai Srikanth-
dc.contributor.googleauthorDavid Calvet-
dc.contributor.googleauthorSimon Jung-
dc.contributor.googleauthorVincent I H Kwa-
dc.contributor.googleauthorStefan T Engelter-
dc.contributor.googleauthorNils Peters-
dc.contributor.googleauthorEric E Smith-
dc.contributor.googleauthorYusuke Yakushiji-
dc.contributor.googleauthorDilek Necioglu Orken-
dc.contributor.googleauthorFranz Fazekas-
dc.contributor.googleauthorVincent Thijs-
dc.contributor.googleauthorJi Hoe Heo-
dc.contributor.googleauthorVincent Mok-
dc.contributor.googleauthorRoland Veltkamp-
dc.contributor.googleauthorHakan Ay-
dc.contributor.googleauthorToshio Imaizumi-
dc.contributor.googleauthorBeatriz Gomez-Anson-
dc.contributor.googleauthorKui Kai Lau-
dc.contributor.googleauthorEric Jouvent-
dc.contributor.googleauthorPeter M Rothwell-
dc.contributor.googleauthorKazunori Toyoda-
dc.contributor.googleauthorHee-Joon Bae-
dc.contributor.googleauthorJoan Marti-Fabregas-
dc.contributor.googleauthorDavid J Werring-
dc.identifier.doi10.1016/S1474-4422(19)30197-8-
dc.contributor.localIdA04369-
dc.relation.journalcodeJ02153-
dc.identifier.eissn1474-4465-
dc.identifier.pmid31130428-
dc.subject.keywordCC28-
dc.subject.keywordEnterococcus faecalis-
dc.subject.keywordampicillin-
dc.subject.keywordclinical outcome-
dc.subject.keywordpenicillin-
dc.contributor.alternativeNameHeo, Ji Hoe-
dc.contributor.affiliatedAuthor허지회-
dc.citation.volume18-
dc.citation.number7-
dc.citation.startPage653-
dc.citation.endPage665-
dc.identifier.bibliographicCitationLANCET NEUROLOGY, Vol.18(7) : 653-665, 2019-
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers

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