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The first Mexican multicenter register on ischaemic stroke (The PREMIER Study): demographics, risk factors and outcome
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The first Mexican multicenter register on ischaemic stroke (The PREMIER Study): demographics, risk factors and outcome

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The readers of the International Journal ...

The readers of the International Journal
of Stroke may be interested to know that
in Mexico, information on acute care
and long-term outcome of patients
with ischaemic stroke (IS) and transient
ischaemic attack (TIA) is still unknown.
TheMexicanPREMIERregistry, amulticentre
first-step stroke surveillance system,
was designed to investigate on risk
factors, acute care, secondary prevention
strategies and long-term outcome of
patients with IS and TIA. Here, we
present information on acute care and
one-year outcome of the IS cohort.

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    The first Mexican multicenter register on ischaemic stroke (The PREMIER Study): demographics, risk factors and outcome The first Mexican multicenter register on ischaemic stroke (The PREMIER Study): demographics, risk factors and outcome Document Transcript

    • Letters to the editor ´ C. Cantu-Brito et al. with atrial fibrillation: full text: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the European Society of Cardiology Committee for Practice Guidelines. Europace 2006; 8:651–745. 2 Page RL, Wilkinson WE, Clair WK, McCarthy EA, Pritchett EL. Asymptomatic arrhythmias in patients with symptomatic paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia. Circulation 1994; 89:224–7. 3 Hindricks G, Pokushalov E, Urban L et al. Performance of a new leadless implantable cardiac monitor in detecting and quantifying atrial fibrillation. Results of the XPECT trial. Circ Arrhythm Electrophysiol 2010; 3:141–7. patients with IS and TIA. Here, we present information on acute care and one-year outcome of the IS cohort. A total of 1376 patients (52% women, mean age 68Á5-years) were registered from January 2005 to June 2006. Of these cases, 1246 (91%) corresponded to IS (mean NIHSS at admission: 12Á8 points) and 130 (9%) to TIA. Risk factors, acute care practices, IS subtypes and long-term management were recorded. Five visits were completed during one-year of follow-up. Main risk factors were hypertension (65%), obesity (51%) and diabetes (35%). IS mechanisms were registered as follows (see Table 1): 8% large-artery atherosclerosis, 20% cardioembolism, 20% lacunes, 5% miscellaneous mechanisms and 41% undetermined aetiology. Only 0Á6% patients received IV thrombolysis (23% arriving in o3 h after stroke onset) and 1% endarterectomies or stentings. The 30-day case fatality rate in IS patients was 15%. One year after the brain infarction, one-third of the patients had mRS 0–1 (functionally independent), one-third had mRS 2–5 (dependent) and another third died. The one-year recurrence rate (1183 acute survivors) was 11%. As shown here, largely modifiable risk factors are responsible for IS in Mexico (1). A quarter of IS patients The first Mexican multicenter register on ischaemic stroke (The PREMIER Study): demographics, risk factors and outcome The readers of the International Journal of Stroke may be interested to know that in Mexico, information on acute care and long-term outcome of patients with ischaemic stroke (IS) and transient ischaemic attack (TIA) is still unknown. The Mexican PREMIER registry, a multicentre first-step stroke surveillance system, was designed to investigate on risk factors, acute care, secondary prevention strategies and long-term outcome of arrive on time for thrombolysis, but o1% of patients receive this management, a characteristic of developing countries (2). We observed that most IS cases are of undetermined aetiology, which denounces a low use of diagnostic resources. Knowledge is needed for action; thus, multitask efforts are imperative to change this scenario in lowincome countries (3). ´ Carlos Cantu-Brito1Ã, ´ Jose L. Ruiz-Sandoval2, Luis M. Murillo-Bonilla3, Erwin Chiquete4, Carolina ´ ´ Leon-Jimenez5, Antonio Arauz6, Jorge Villarreal-Careaga7, Fernando Barinagarrementeria8, Alma Ramos-Moreno9, and the PREMIER Investigators 1 Department of Neurology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador ´ Zubiran, Mexico City, Mexico 2 Department of Neurology, Hospital Civil de Guadalajara ‘Fray Antonio Alcalde’, ´ Guadalajara, Mexico 3 Department of Neurology, Facultad de ´ Medicina, Universidad Autonoma de ´ Guadalajara, Guadalajara, Mexico 4 Department of Internal Medicine, Hospital Civil de Guadalajara ‘Fray Antonio Alcalde’, ´ Guadalajara, Mexico 5 ´ Department of Neurology, Hospital Valentın ´ ´ Gomez Farıas, Zapopan, Mexico 6 ´ Stroke Clinic, Instituto Nacional de Neurologıa ´ ´ y Neurocirugıa, Mexico City, Mexico Table 1 Gender, stroke severity on admission and short-term clinical outcome by aetiological subtypes of ischaemic stroke patients (n 5 1246) Total (n 5 1246) Gender (%) Female Male Age, median (interquartile range), years NIHSS score (%)Ã r8 9–18 418 30-day outcome (%) mRS: 0–1 mRS: 2–3 mRS: 4–5 Death LAA (n 5 105, 8Á4%) Lacunar (n 5 250, 20Á1%) CE (n 5 246, 19Á7%) Mixed (n 5 69, 5Á5%) Other (n 5 63, 5Á1%) Undetermined (n 5 513, 41Á2%) P value 51Á6 48Á4 71 (58–80) 43Á8 56Á2 75 (66–78) 43Á6 56Á4 69 (59–76) 61Á0 39Á0 75 (62–83) 53Á6 46Á4 76 (67–85) 63Á5 36Á5 48 (34–65) 50Á9 49Á1 70 (58–80) 0Á001 o0Á001 n 5 1223 39Á5 36Á5 24Á0 n 5 105 47Á6 34Á3 18Á1 n 5 240 69Á2 27Á5 3Á3 n 5 242 30Á6 35Á5 33Á9 n 5 68 41Á2 33Á8 25Á0 n 5 59 40Á7 40Á7 18Á6 n 5 509 27Á7 41Á7 30Á6 22Á8 31Á1 31Á0 15Á2 22Á9 35Á2 33Á3 8Á6 35Á6 52Á8 7Á6 4Á0 17Á1 26Á0 35Á8 21Á1 21Á7 37Á7 31Á9 8Á7 38Á1 25Á4 25Á4 11Á1 17Á5 21Á8 40Á2 20Á5 o0Á001 o0Á001 o0Á001 ÃData were missing for 23 patients.CE, cardioembolism; LAA, large-artery atherosclerosis; NIHSS, National Institutes of Health stroke scale. & 2011 The Authors. International Journal of Stroke & 2011 World Stroke Organization Vol 6, February 2011, 90–94 93
    • Letters to the editor 7 Department of Neurology, Hospital General de ´ ´ Culiacan, Culiacan, Mexico 8 Department of Neurology, Hospital Angeles de ´ ´ ´ Queretaro, Queretaro, Mexico 9 ´ Strategic Clinical Research, Mexico City, Mexico ´ Correspondence: Carlos Cantu-BritoÃ, Department of Neurology, Instituto Nacional ´ ´ de Ciencias Medicas y Nutricion Salvador ´ ´ Zubiran, Vasco de Quiroga #15, Col. Seccion XVI, Tlalpan, Mexico City 14439, Mexico. E-mail: carloscantu_brito@hotmail.com 94 DOI: 10.1111/j.1747-4949.2010.00549.x References ´ 1 Cantu-Brito C, Majersik JJ, Sanchez BN et al. Hospitalized stroke surveillance in the community of Durango, Mexico: the brain attack surveillance in Durango study. Stroke 2010; 41:878–84. ´ C. Cantu-Brito et al. 2 Durai Pandian J, Padma V, Vijaya P, Sylaja PN, Murthy JM. Stroke and thrombolysis in developing countries. Int J Stroke 2007; 2: 17–26. 3 Mendis S. Prevention and care of stroke in low- and middle-income countries; the need for a public health perspective. Int J Stroke 2010; 5:86–91. & 2011 The Authors. International Journal of Stroke & 2011 World Stroke Organization Vol 6, February 2011, 90–94