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BMC Neurol. 2015 Mar 11;15:28. doi: 10.1186/s12883-015-0278-4.

The ARTICO study: identification of patients at high risk of vascular recurrence after a first non-cardioembolic stroke.

Author information

1
Department of Neurology, Hospital Universitario Dr. Josep Trueta, IdIBGi (Institut d'Investigació Biomèdica de Girona), 17007, Girona, Spain. jserena.girona.ics@gencat.cat.
2
Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain. tsmtsm08@yahoo.es.
3
Department of Neurology, Hospital Universitari del Mar, Barcelona, Spain. JRoquer@parcdesalutmar.cat.
4
Institut d'Investigació en Atenció Primària (IDIAP Jordi Gol), Girona, Spain. mgarcia@idiapjgol.info.
5
Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain. jose.castillo@usc.es.

Abstract

BACKGROUND:

About 20% of patients with a first ischaemic stroke will experience a new vascular event within the first year. The atherosclerotic burden, an indicator of the extension of atherosclerosis in a patient, has been associated with the risk of new cardiovascular events in the general population. However, no predictive models reliably identify groups at a high risk of recurrence. The ARTICO study prospectively analysed the predictive value for the risk of recurrence of specific atherosclerotic markers.

METHODS:

The multicentre ARTICO study included 620 consecutive independent patients older than 60 years suffering from a first non-cardioembolic stroke. We analysed classical stroke risk factors; duplex study of supraaortic trunk including intima-media thickness (IMT) measurement; quantification of internal carotid (ICA) stenosis; number, morphology and surface characteristics of carotid plaques; ankle brachial index (ABI); and the presence of microalbuminuria. Patients were followed up at 6 and 12 months after inclusion. The primary end-point was death or major cardiovascular events.

RESULTS:

Any vascular event or death at 12 months occurred in 78 (13.8%) patients. In 40 (7.1%) of these the vascular event was a stroke recurrence. Weight, history of diabetes mellitus, history of symptomatic PAD, ABI <0.9 and significant ICA stenosis (>50%) were associated with a higher risk of vascular events on follow-up in the bivariate analysis. In the final Cox regression analysis, body mass index (BMI), systolic blood pressure, history of diabetes mellitus, symptomatic PAD (HR, 2.76; 95% CI, 1.10-6.95; p=0.03), and particularly patients with both ICA stenosis >50% and PAD (HR 4.52; 95% CI, 2.14-9.53; p<0.001) were independently associated with an increased risk of vascular events. Neither isolated ICA stenosis >50% nor isolated abnormal ABI remained associated with an increased risk of recurrence in comparison with the whole population.

CONCLUSIONS:

Symptomatic PAD identifies a high risk group of vascular recurrence after a first non-cardioembolic stroke. The associated increased risk was particularly high in patients with both ICA stenosis and either symptomatic or asymptomatic PAD. Neither asymptomatic PAD alone nor isolated ICA stenosis >50% were associated with an increased risk of recurrence in this particularly high-risk group of non-cardioembolic stroke.

PMID:
25884666
PMCID:
PMC4369369
DOI:
10.1186/s12883-015-0278-4
[Indexed for MEDLINE]
Free PMC Article

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