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

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dc.contributor.author Serena, Joaquín
dc.contributor.author Segura, Tomás
dc.contributor.author Roquer, Jaume
dc.contributor.author Garcia Gil, Maria
dc.contributor.author Castillo, José
dc.contributor.author ARTICO Study
dc.date.accessioned 2015-05-28T08:52:14Z
dc.date.available 2015-05-28T08:52:14Z
dc.date.issued 2015
dc.identifier.citation Serena J, Segura T, Roquer J, García-Gil M, Castillo J. The ARTICO study: identification of patients at high risk of vascular recurrence after a first non-cardioembolic stroke. BMC Neurol. 2015; Mar 11:15-28. doi: 10.1186/s12883-015-0278-4.
dc.identifier.issn 1471-2377
dc.identifier.uri http://hdl.handle.net/10230/23676
dc.description.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.
dc.description.sponsorship This research project was supported by an unrestricted grant from Bristol-Myers Squibb (Madrid, Spain) and by the Ministry of Health, Instituto de Salud Carlos III (RIC- RD12/0042/0020 FEDER and Red INVICTUS D12/0014)
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher BioMed Central
dc.relation.ispartof BMC Neurology. 2015;15(28).
dc.rights © 2015 Serena et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative/nCommons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and/nreproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain/nDedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article,/nunless otherwise stated.
dc.rights.uri http://creativecommons.org/licenses/by/4.0/
dc.subject.other Infart de miocardi
dc.subject.other Malalties -- Factors de risc
dc.subject.other Artèries caròtides -- Malalties
dc.title The ARTICO study: identification of patients at high risk of vascular recurrence after a first non-cardioembolic stroke.
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1186/s12883-015-0278-4
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion


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