Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies
Background 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 recurr...
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| Tipo de documento: | Artículo |
| Estado: | Published version |
| Fecha de publicación: | 2019 |
| País: | España |
| Institución: | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| Repositorio: | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| OAI Identifier: | oai:iibsantpau.fundanetsuite.com:p8070 |
| Acceso en línea: | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=8070 http://ddd.uab.cat/record/226468 |
| Nivel de acceso: | Acceso abierto |
| _version_ | 1878731946421387264 |
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| author | Wilson, D |
| author2 | Ambler, G Lee, KJ Lim, JS Shiozawa, M Koga, M Li, LX Lovelock, C Chabriat, H Hennerici, M Wong, YK Mak, HKF Prats-Sanchez, L Martinez-Domeno, A Inamura, S Yoshifuji, K Arsava, EM Horstmann, S Purrucker, J Lam, BYK Wong, A Kim, YD Song, TJ Schrooten, M Lemmens, R Eppinger, S Gattringer, T Uysal, E Tanriverdi, Z Bornstein, NM Ben Assayag, E Hallevi, H Tanaka, J Hara, H Coutts, SB Hert, L Polymeris, A Seiffge, DJ Lyrer, P Algra, A Kappelle, J Salman, RAS Jager, HR Lip, GYH Mattle, HP Panos, LD Mas, JL Legrand, L Karayiannis, C Phan, T Gunkel, S Christ, N Abrigo, J Leung, T Chu, W Chappell, F Makin, S Hayden, D Williams, DJ Kooi, ME van Dam-Nolen, DHK Barbato, C Browning, S Wiegertjes, K Tuladhar, AM Maaijwee, N Guevarra, C Yatawara, C Mendyk, AM Delmaire, C Kohler, S van Oostenbrugge, R Zhou, Y Xu, C Hilal, S Gyanwali, B Chen, C Lou, M Staals, J Bordet, R Kandiah, N de Leeuw, FE Simister, R van der Lugt, A Kelly, PJ Wardlaw, JM Soo, Y Fluri, F Srikanth, V Calvet, D Jung, S Kwa, VIH Engelter, ST Peters, N Smith, EE Yakushiji, Y Orken, DN Fazekas, F Thijs, V Heo, JH Mok, V Veltkamp, R Ay, H Imaizumi, T Gomez-Anson, B Lau, KK Jouvent, E Rothwell, PM Toyoda, K Bae, HJ Marti-Fabregas, J Werring, DJ Microbleeds Int Collaborative Net |
| author2_role | author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| author_browse | Abrigo, J Algra, A Ambler, G Arsava, EM Ay, H Bae, HJ Barbato, C Ben Assayag, E Bordet, R Bornstein, NM Browning, S Calvet, D Chabriat, H Chappell, F Chen, C Christ, N Chu, W Coutts, SB Delmaire, C Engelter, ST Eppinger, S Fazekas, F Fluri, F Gattringer, T Gomez-Anson, B Guevarra, C Gunkel, S Gyanwali, B Hallevi, H Hara, H Hayden, D Hennerici, M Heo, JH Hert, L Hilal, S Horstmann, S Imaizumi, T Inamura, S Jager, HR Jouvent, E Jung, S Kandiah, N Kappelle, J Karayiannis, C Kelly, PJ Kim, YD Koga, M Kohler, S Kooi, ME Kwa, VIH Lam, BYK Lau, KK Lee, KJ Legrand, L Lemmens, R Leung, T Li, LX Lim, JS Lip, GYH Lou, M Lovelock, C Lyrer, P Maaijwee, N Mak, HKF Makin, S Marti-Fabregas, J Martinez-Domeno, A Mas, JL Mattle, HP Mendyk, AM Microbleeds Int Collaborative Net Mok, V Orken, DN Panos, LD Peters, N Phan, T Polymeris, A Prats-Sanchez, L Purrucker, J Rothwell, PM Salman, RAS Schrooten, M Seiffge, DJ Shiozawa, M Simister, R Smith, EE Song, TJ Soo, Y Srikanth, V Staals, J Tanaka, J Tanriverdi, Z Thijs, V Toyoda, K Tuladhar, AM Uysal, E Veltkamp, R Wardlaw, JM Werring, DJ Wiegertjes, K Williams, DJ Wilson, D Wong, A Wong, YK Xu, C Yakushiji, Y Yatawara, C Yoshifuji, K Zhou, Y de Leeuw, FE van Dam-Nolen, DHK van Oostenbrugge, R van der Lugt, A |
| author_facet | Wilson, D Ambler, G Lee, KJ Lim, JS Shiozawa, M Koga, M Li, LX Lovelock, C Chabriat, H Hennerici, M Wong, YK Mak, HKF Prats-Sanchez, L Martinez-Domeno, A Inamura, S Yoshifuji, K Arsava, EM Horstmann, S Purrucker, J Lam, BYK Wong, A Kim, YD Song, TJ Schrooten, M Lemmens, R Eppinger, S Gattringer, T Uysal, E Tanriverdi, Z Bornstein, NM Ben Assayag, E Hallevi, H Tanaka, J Hara, H Coutts, SB Hert, L Polymeris, A Seiffge, DJ Lyrer, P Algra, A Kappelle, J Salman, RAS Jager, HR Lip, GYH Mattle, HP Panos, LD Mas, JL Legrand, L Karayiannis, C Phan, T Gunkel, S Christ, N Abrigo, J Leung, T Chu, W Chappell, F Makin, S Hayden, D Williams, DJ Kooi, ME van Dam-Nolen, DHK Barbato, C Browning, S Wiegertjes, K Tuladhar, AM Maaijwee, N Guevarra, C Yatawara, C Mendyk, AM Delmaire, C Kohler, S van Oostenbrugge, R Zhou, Y Xu, C Hilal, S Gyanwali, B Chen, C Lou, M Staals, J Bordet, R Kandiah, N de Leeuw, FE Simister, R van der Lugt, A Kelly, PJ Wardlaw, JM Soo, Y Fluri, F Srikanth, V Calvet, D Jung, S Kwa, VIH Engelter, ST Peters, N Smith, EE Yakushiji, Y Orken, DN Fazekas, F Thijs, V Heo, JH Mok, V Veltkamp, R Ay, H Imaizumi, T Gomez-Anson, B Lau, KK Jouvent, E Rothwell, PM Toyoda, K Bae, HJ Marti-Fabregas, J Werring, DJ Microbleeds Int Collaborative Net |
| author_role | author |
| collection | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| description | Background 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 [149-1.80] 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. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | ES_39cbe6bca61995bd5d2126a49fabe91f |
| institution | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| instname_str | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| network_acronym_str | ES |
| network_name_str | España |
| oai_identifier_str | oai:iibsantpau.fundanetsuite.com:p8070 |
| publishDate | 2019 |
| publishDateSort | 2019 |
| publisher | ELSEVIER SCIENCE INC |
| publisherStr | ELSEVIER SCIENCE INC |
| reponame_str | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| spelling | Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies Wilson, D Ambler, G Lee, KJ Lim, JS Shiozawa, M Koga, M Li, LX Lovelock, C Chabriat, H Hennerici, M Wong, YK Mak, HKF Prats-Sanchez, L Martinez-Domeno, A Inamura, S Yoshifuji, K Arsava, EM Horstmann, S Purrucker, J Lam, BYK Wong, A Kim, YD Song, TJ Schrooten, M Lemmens, R Eppinger, S Gattringer, T Uysal, E Tanriverdi, Z Bornstein, NM Ben Assayag, E Hallevi, H Tanaka, J Hara, H Coutts, SB Hert, L Polymeris, A Seiffge, DJ Lyrer, P Algra, A Kappelle, J Salman, RAS Jager, HR Lip, GYH Mattle, HP Panos, LD Mas, JL Legrand, L Karayiannis, C Phan, T Gunkel, S Christ, N Abrigo, J Leung, T Chu, W Chappell, F Makin, S Hayden, D Williams, DJ Kooi, ME van Dam-Nolen, DHK Barbato, C Browning, S Wiegertjes, K Tuladhar, AM Maaijwee, N Guevarra, C Yatawara, C Mendyk, AM Delmaire, C Kohler, S van Oostenbrugge, R Zhou, Y Xu, C Hilal, S Gyanwali, B Chen, C Lou, M Staals, J Bordet, R Kandiah, N de Leeuw, FE Simister, R van der Lugt, A Kelly, PJ Wardlaw, JM Soo, Y Fluri, F Srikanth, V Calvet, D Jung, S Kwa, VIH Engelter, ST Peters, N Smith, EE Yakushiji, Y Orken, DN Fazekas, F Thijs, V Heo, JH Mok, V Veltkamp, R Ay, H Imaizumi, T Gomez-Anson, B Lau, KK Jouvent, E Rothwell, PM Toyoda, K Bae, HJ Marti-Fabregas, J Werring, DJ Microbleeds Int Collaborative Net Background 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 [149-1.80] 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. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd. ELSEVIER SCIENCE INC https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=8070 http://ddd.uab.cat/record/226468 |
| spellingShingle | Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies Wilson, D |
| status_str | publishedVersion |
| title | Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies |
| title_full | Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies |
| title_fullStr | Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies |
| title_full_unstemmed | Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies |
| title_short | Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies |
| title_sort | Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies |
| url | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=8070 http://ddd.uab.cat/record/226468 |