Infartos cerebrales intrahospitalarios: datos del registro multicéntrico de pacientes con infarto cerebral ingresados en Cardiología y Cirugía Cardiaca / In-hospital ischemic strokes in patients admitted to Cardiology and Cardiac Surgery departments. Multi-centre registry

Fundamento y objetivo: Los pacientes ingresados en Cardiología y Cirugía Cardiaca tienen un riesgo importante de sufrir un infarto cerebral (IC). Analizamos las características clínicas, calidad de la atención neurológica y la evolución de los ictus intrahospitalarios (IIH) en estos servicios. Pacientes y método:Registro prospectivo de IC en pacientes ingresados en Cardiología y Cirugía Cardiaca en 13 hospitales españoles durante 2008. Recogemos datos demográficos, clínicos, terapéuticos, evolutivos y de mortalidad. Resultados: Registramos 73 casos. La edad media (DE) fue de 72 (11,6) años. El 75,4% de los IC fueron cardioembólicos. Como factores de riesgo para ictus destacaron: presencia de cardiopatías embolígenas (86,3%), suspensión del tratamiento antitrombótico previo (22%) y procedimientos invasivos (65,7%). La evaluación neurológica se hizo en menos de 3 horas en el 49,5% y pasadas 24 horas del IC en el 20,5%. Diez pacientes fueron tratados con trombólisis intravenosa, 8 no pudieron ser tratados por el retraso en avisar a Neurología. Entre las contraindicaciones para trombólisis destacaron la anticoagulación en rango (38%) y la cirugía reciente (33,3%). A los 3 meses, la mortalidad fue del 15% y solamente el 53,7% eran independientes. Los pacientes tratados con trombólisis tuvieron mejor evolución (87,5% de pacientes independientes, p=0,04).Conclusiones: Los IC intrahospitalarios en Cardiología y Cirugía Cardiaca son fundamentalmente cardioembólicos y producen una gran proporción de pacientes dependientes. Los pacientes tratados con trombólisis tuvieron mejor evolución clínica. El retraso en la llamada a Neurología impidió que una proporción relevante de pacientes fueran tratados con trombólisis intravenosa (AU)

Background and objective: Patients admitted to Cardiology and Cardiac Surgery Departments have an increased risk of ischemic stroke (IS). We analyzed clinical characteristics, quality of neurological care and mortality of in-hospital strokes (IHS) in these departments. Patients and method:Prospective registry of in-hospital ISs in Cardiology and Cardiac Surgery in 13 Spanish hospitals during 2008. Demographic, clinical and therapeutic data as well as mortality and functional evolution were recorded. Results: 73 patients were included. Mean age was 72±11.6 years. 75.4% of IS were cardioembolic. Special risk factors were presence of cardiac sources of embolism (86.3%), prior withdrawal of antithrombotic treatment (22%) and invasive procedures (65.7%). First neurological assessment was done in the first 3hours in 49.5% and beyond 24hours from IS onset in 20.5%. Ten patients were treated with intravenous thrombolysis, which was not possible in 8 patients because of the delay in calling the neurologist. Most frequent reasons for exclusion from thrombolytic therapy were recent major surgical procedures (33.3%) and anticoagulant therapy (38%). Three-month mortality was 15% and only 53.7% were functionally independent. Patients treated with thrombolysis had a better evolution (87.5% of independent patients, p=0.04). Conclusions: IS in Cardiology and Cardiac Surgery are mostly cardioembolic strokes and produce a high proportion of dependent patients. Patients treated with thrombolysis had a better evolution. Delays in contacting the neurologist led to exclusion from treatment an important proportion of patients who met thrombolysis criteria (AU)

[In-hospital ischemic strokes in patients admitted to Cardiology and Cardiac Surgery departments. Multi-centre registry]. / Infartos cerebrales intrahospitalarios: datos del registro multicéntrico de pacientes con infarto cerebral ingresados en Cardiología y Cirugía Cardiaca.

BACKGROUND AND OBJECTIVE: Patients admitted to Cardiology and Cardiac Surgery Departments have an increased risk of ischemic stroke (IS). We analyzed clinical characteristics, quality of neurological care and mortality of in-hospital strokes (IHS) in these departments. PATIENTS AND METHOD: Prospective registry of in-hospital ISs in Cardiology and Cardiac Surgery in 13 Spanish hospitals during 2008. Demographic, clinical and therapeutic data as well as mortality and functional evolution were recorded. RESULTS: 73 patients were included. Mean age was 72±11.6 years. 75.4% of IS were cardioembolic. Special risk factors were presence of cardiac sources of embolism (86.3%), prior withdrawal of antithrombotic treatment (22%) and invasive procedures (65.7%). First neurological assessment was done in the first 3hours in 49.5% and beyond 24hours from IS onset in 20.5%. Ten patients were treated with intravenous thrombolysis, which was not possible in 8 patients because of the delay in calling the neurologist. Most frequent reasons for exclusion from thrombolytic therapy were recent major surgical procedures (33.3%) and anticoagulant therapy (38%). Three-month mortality was 15% and only 53.7% were functionally independent. Patients treated with thrombolysis had a better evolution (87.5% of independent patients, p=0.04). CONCLUSIONS: IS in Cardiology and Cardiac Surgery are mostly cardioembolic strokes and produce a high proportion of dependent patients. Patients treated with thrombolysis had a better evolution. Delays in contacting the neurologist led to exclusion from treatment an important proportion of patients who met thrombolysis criteria.

Serum cholesterol LDL and 90-day mortality in patients with intracerebral hemorrhage.

BACKGROUND AND PURPOSE: Prognostic significance of low-density lipoprotein cholesterol (LDL-C) in intracranial hemorrhage (ICH) is unclear. The objective of this study was to determine the association between LDL-C and mortality in ICH. METHODS: Consecutive patients (n=88) presenting with ICH were included in the study. Lipid profile was obtained during the first hours after admission. We analyzed the impact of LDL-C on 90-day mortality using the Hazard Rate (HR) crude, analysis crude for trend by Mantel-Haenszel Test, Multiple Cox Proportional Hazards model, and analysis of survival curves. Association between LDL-C and severity markers of ICH were explored using Spearman correlation coefficient. RESULTS: Low LDL-C levels were independently associated with death after intracranial hemorrhage (HR=3.07 (95% CI:1.04 to 9.02; P=0.042) in multivariable analysis after controlling for confounding factors. Analysis for trend showed a significant association (Xt=-2.144; P=0.032) by Mantel-Haenszel Test. Spearman analysis showed no correlation between LDL-C and variables that are markers of ICH severity: NIH score (r=-0.091; P=0.400), GCS score (r=0.136; P=0.207), ICH volume (r=0.140; P=0.192), and length of stay (r=-0.111; P=0.308). CONCLUSIONS: Low levels of LDL-C are independently associated with an increased risk of death in patients with brain hemorrhage. We have not found evidences that the levels of LDL-C can act as a biological marker of severity.