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Comparison of Risk Factors, Treatment, and Outcome in Patients with Symptomatic Intracranial Atherosclerotic Disease in India and the United States.
Annals of Indian Academy of Neurology ( IF 1.9 ) Pub Date : 2020-05-01 , DOI: 10.4103/aian.aian_549_19 Udit Saraf 1 , Shyam Prabhakaran 2 , K Arun 1 , Ahmed Babiker 2 , Adithyan Rajendran 3 , Chandrasekharan Kesavadas 3 , P N Sylaja 1
Background and Aims: Intracranial atherosclerotic disease (ICAD) is common in the Asian population, but less studied in South Asians compared to East Asians. We compared risk factors, treatments, and outcomes among consecutive patients with symptomatic ICAD from India with a mixed-ethnic cohort from Chicago, Illinois. Methods: Consecutive patients with symptomatic ICAD were enrolled at 2 academic medical centers in Kerala, India and Chicago, United States. Data on demographics, risk factors, initial stroke severity (National Institute of Health Stroke Scale score [NIHSS]), recurrent stroke, and 3-month functional outcome (modified Rankin Scale [mRS]) were prospectively collected. Recurrent stroke was defined as symptomatic recurrence of focal neurologic deficits associated with radiographic evidence of new cerebral infarction within 3 months of index admission. Results: 329 patients (117 from Kerala, 212 from Chicago) were included. Indian patients were younger (61 vs. 68, P < 0.001), less frequently had prior stroke history (15.4 vs. 32.5%, P = 0.001) and coronary artery disease (11.1 vs. 22.2%, P = 0.013) but had higher initial NIHSS score (median 6 vs. 3, P < 0.001). Both groups received reperfusion therapy in similar proportions (8.5 vs. 7.1%, P = 0.630) but at discharge, 90.6% of Indian patients compared to 59.0% of Chicago patients were treated with dual antiplatelet therapy. More recurrent strokes occurred in Chicago patients (21.7 vs. 1.9%, P < 0.001) but functional outcome did not differ significantly. Conclusion: Compared to patients in US with symptomatic ICAD, Indian patients were younger and had more severe strokes. However, Indian patients had lower rates of recurrent stroke, perhaps due to greater use of dual antiplatelet therapy.
中文翻译：
印度和美国有症状的颅内动脉粥样硬化疾病患者的危险因素、治疗和结果的比较。
背景和目的：颅内动脉粥样硬化疾病 (ICAD) 在亚洲人群中很常见，但与东亚人相比，南亚人的研究较少。我们比较了来自印度的连续症状性 ICAD 患者与来自伊利诺伊州芝加哥的混合种族队列的风险因素、治疗和结果。方法：在印度喀拉拉邦和美国芝加哥的 2 个学术医疗中心招募了有症状的 ICAD 患者。前瞻性收集了有关人口统计学、危险因素、初始卒中严重程度（美国国立卫生研究院卒中量表评分 [NIHSS]）、复发性卒中和 3 个月功能结果（改良 Rankin 量表 [mRS]）的数据。复发性卒中被定义为在入院后 3 个月内出现与新发脑梗死的放射学证据相关的局灶性神经功能缺损的症状性复发。结果：纳入了 329 名患者（117 名来自喀拉拉邦，212 名来自芝加哥）。印度患者更年轻（61 比 68，P < 0.001），既往卒中史较少（15.4 比 32.5%，P= 0.001）和冠状动脉疾病（11.1 对 22.2%，P = 0.013），但初始 NIHSS 评分较高（中位数 6 对 3，P < 0.001）。两组接受再灌注治疗的比例相似（8.5% vs. 7.1%，P = 0.630），但在出院时，90.6% 的印度患者与 59.0% 的芝加哥患者接受双重抗血小板治疗。芝加哥患者中风复发率更高（21.7% vs. 1.9%，P < 0.001），但功能结果无显着差异。结论：与美国有症状的 ICAD 患者相比，印度患者更年轻，中风更严重。然而，印度患者的卒中复发率较低，这可能是由于更多地使用双重抗血小板治疗。
更新日期：2020-05-01
Annals of Indian Academy of Neurology ( IF 1.9 ) Pub Date : 2020-05-01 , DOI: 10.4103/aian.aian_549_19 Udit Saraf 1 , Shyam Prabhakaran 2 , K Arun 1 , Ahmed Babiker 2 , Adithyan Rajendran 3 , Chandrasekharan Kesavadas 3 , P N Sylaja 1
Affiliation
Background and Aims: Intracranial atherosclerotic disease (ICAD) is common in the Asian population, but less studied in South Asians compared to East Asians. We compared risk factors, treatments, and outcomes among consecutive patients with symptomatic ICAD from India with a mixed-ethnic cohort from Chicago, Illinois. Methods: Consecutive patients with symptomatic ICAD were enrolled at 2 academic medical centers in Kerala, India and Chicago, United States. Data on demographics, risk factors, initial stroke severity (National Institute of Health Stroke Scale score [NIHSS]), recurrent stroke, and 3-month functional outcome (modified Rankin Scale [mRS]) were prospectively collected. Recurrent stroke was defined as symptomatic recurrence of focal neurologic deficits associated with radiographic evidence of new cerebral infarction within 3 months of index admission. Results: 329 patients (117 from Kerala, 212 from Chicago) were included. Indian patients were younger (61 vs. 68, P < 0.001), less frequently had prior stroke history (15.4 vs. 32.5%, P = 0.001) and coronary artery disease (11.1 vs. 22.2%, P = 0.013) but had higher initial NIHSS score (median 6 vs. 3, P < 0.001). Both groups received reperfusion therapy in similar proportions (8.5 vs. 7.1%, P = 0.630) but at discharge, 90.6% of Indian patients compared to 59.0% of Chicago patients were treated with dual antiplatelet therapy. More recurrent strokes occurred in Chicago patients (21.7 vs. 1.9%, P < 0.001) but functional outcome did not differ significantly. Conclusion: Compared to patients in US with symptomatic ICAD, Indian patients were younger and had more severe strokes. However, Indian patients had lower rates of recurrent stroke, perhaps due to greater use of dual antiplatelet therapy.
中文翻译：
印度和美国有症状的颅内动脉粥样硬化疾病患者的危险因素、治疗和结果的比较。
背景和目的：颅内动脉粥样硬化疾病 (ICAD) 在亚洲人群中很常见，但与东亚人相比，南亚人的研究较少。我们比较了来自印度的连续症状性 ICAD 患者与来自伊利诺伊州芝加哥的混合种族队列的风险因素、治疗和结果。方法：在印度喀拉拉邦和美国芝加哥的 2 个学术医疗中心招募了有症状的 ICAD 患者。前瞻性收集了有关人口统计学、危险因素、初始卒中严重程度（美国国立卫生研究院卒中量表评分 [NIHSS]）、复发性卒中和 3 个月功能结果（改良 Rankin 量表 [mRS]）的数据。复发性卒中被定义为在入院后 3 个月内出现与新发脑梗死的放射学证据相关的局灶性神经功能缺损的症状性复发。结果：纳入了 329 名患者（117 名来自喀拉拉邦，212 名来自芝加哥）。印度患者更年轻（61 比 68，P < 0.001），既往卒中史较少（15.4 比 32.5%，P= 0.001）和冠状动脉疾病（11.1 对 22.2%，P = 0.013），但初始 NIHSS 评分较高（中位数 6 对 3，P < 0.001）。两组接受再灌注治疗的比例相似（8.5% vs. 7.1%，P = 0.630），但在出院时，90.6% 的印度患者与 59.0% 的芝加哥患者接受双重抗血小板治疗。芝加哥患者中风复发率更高（21.7% vs. 1.9%，P < 0.001），但功能结果无显着差异。结论：与美国有症状的 ICAD 患者相比，印度患者更年轻，中风更严重。然而，印度患者的卒中复发率较低，这可能是由于更多地使用双重抗血小板治疗。
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