Stroke in Patients With Peripheral Artery Disease
Background and Purpose- Predictors of stroke and transient ischemic attack (TIA) in patients with peripheral artery disease (PAD) are poorly understood. The primary aims of this analysis were to (1) determine the incidence of ischemic/hemorrhagic stroke and TIA in patients with symptomatic PAD, (2)...
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| Veröffentlicht in: | Stroke (1970) 2019-06, Vol.50 (6), p.1356 |
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| container_title | Stroke (1970) |
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| creator | Kolls, Brad J Sapp, Shelly Rockhold, Frank W Jordan, J Dedrick Dombrowski, Keith E Fowkes, F Gerry R Mahaffey, Kenneth W Berger, Jeffrey S Katona, Brian G Blomster, Juuso I Norgren, Lars Abramson, Beth L Leiva-Pons, Jose L Prieto, Juan Carlos Sokurenko, German Hiatt, William R Jones, W Schuyler Patel, Manesh R |
| description | Background and Purpose- Predictors of stroke and transient ischemic attack (TIA) in patients with peripheral artery disease (PAD) are poorly understood. The primary aims of this analysis were to (1) determine the incidence of ischemic/hemorrhagic stroke and TIA in patients with symptomatic PAD, (2) identify predictors of stroke in patients with PAD, and (3) compare the rate of stroke in ticagrelor- and clopidogrel-treated patients. Methods- EUCLID (Examining Use of Ticagrelor in Peripheral Artery Disease) randomized 13 885 patients with symptomatic PAD to receive monotherapy with ticagrelor or clopidogrel for the prevention of major adverse cardiovascular events (cardiovascular death, myocardial infarction, or ischemic stroke). Ischemic/hemorrhagic stroke and TIA were adjudicated and measured as incidence rates postrandomization and cumulative incidence (per patient-years). Post hoc multivariable competing risk hazards analyses were performed using baseline characteristics to determine factors associated with all-cause stroke in patients with PAD. Results- A total of 458 cerebrovascular events in 424 patients (317 ischemic strokes, 39 hemorrhagic strokes, and 102 TIAs) occurred over a median follow-up of 30 months, for a cumulative incidence of 0.87, 0.11, and 0.27 per 100 patient-years, respectively. Age, prior stroke, prior atrial fibrillation/flutter, diabetes mellitus, geographic region, ankle-brachial index |
| doi_str_mv | 10.1161/STROKEAHA.118.023534 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed</sourceid><recordid>TN_cdi_pubmed_primary_31092165</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>31092165</sourcerecordid><originalsourceid>FETCH-LOGICAL-c1534-1f54c4c6c5851b70b69ffded818f7dfbddf0a4d4a41f406868d814f67a45bddb3</originalsourceid><addsrcrecordid>eNo1jsFKAzEURYMgtlb_QCQ_MDVv8pJJl0OtrVhosRWXJZkkNNrWIYmL_r0BdXW5HDj3EnIHbAwg4WGzfV29zNpFW6oas5oLjhdkCKLGCmWtBuQ6pQ_GClHiigw4sEkNUgwJbHL8-nQ0nOha5-BOOdH3kPd07WLo9y7qA21jdvFMH0NyOrkbcun1IbnbvxyRt6fZdrqolqv587RdVh2U9Qq8wA472QklwDTMyIn31lkFyjfWG2s902hRI3hkUklVEHrZaBQFGj4i97_e_tscnd31MRx1PO_-v_Mfsd5FWg</addsrcrecordid><sourcetype>Index Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Stroke in Patients With Peripheral Artery Disease</title><source>MEDLINE</source><source>American Heart Association Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Journals@Ovid Complete</source><source>Alma/SFX Local Collection</source><creator>Kolls, Brad J ; Sapp, Shelly ; Rockhold, Frank W ; Jordan, J Dedrick ; Dombrowski, Keith E ; Fowkes, F Gerry R ; Mahaffey, Kenneth W ; Berger, Jeffrey S ; Katona, Brian G ; Blomster, Juuso I ; Norgren, Lars ; Abramson, Beth L ; Leiva-Pons, Jose L ; Prieto, Juan Carlos ; Sokurenko, German ; Hiatt, William R ; Jones, W Schuyler ; Patel, Manesh R</creator><creatorcontrib>Kolls, Brad J ; Sapp, Shelly ; Rockhold, Frank W ; Jordan, J Dedrick ; Dombrowski, Keith E ; Fowkes, F Gerry R ; Mahaffey, Kenneth W ; Berger, Jeffrey S ; Katona, Brian G ; Blomster, Juuso I ; Norgren, Lars ; Abramson, Beth L ; Leiva-Pons, Jose L ; Prieto, Juan Carlos ; Sokurenko, German ; Hiatt, William R ; Jones, W Schuyler ; Patel, Manesh R</creatorcontrib><description>Background and Purpose- Predictors of stroke and transient ischemic attack (TIA) in patients with peripheral artery disease (PAD) are poorly understood. The primary aims of this analysis were to (1) determine the incidence of ischemic/hemorrhagic stroke and TIA in patients with symptomatic PAD, (2) identify predictors of stroke in patients with PAD, and (3) compare the rate of stroke in ticagrelor- and clopidogrel-treated patients. Methods- EUCLID (Examining Use of Ticagrelor in Peripheral Artery Disease) randomized 13 885 patients with symptomatic PAD to receive monotherapy with ticagrelor or clopidogrel for the prevention of major adverse cardiovascular events (cardiovascular death, myocardial infarction, or ischemic stroke). Ischemic/hemorrhagic stroke and TIA were adjudicated and measured as incidence rates postrandomization and cumulative incidence (per patient-years). Post hoc multivariable competing risk hazards analyses were performed using baseline characteristics to determine factors associated with all-cause stroke in patients with PAD. Results- A total of 458 cerebrovascular events in 424 patients (317 ischemic strokes, 39 hemorrhagic strokes, and 102 TIAs) occurred over a median follow-up of 30 months, for a cumulative incidence of 0.87, 0.11, and 0.27 per 100 patient-years, respectively. Age, prior stroke, prior atrial fibrillation/flutter, diabetes mellitus, geographic region, ankle-brachial index <0.60, prior amputation, and systolic blood pressure were independent baseline factors associated with the occurrence of all-cause stroke. After adjustment for baseline factors, the rates of ischemic stroke and all-cause stroke remained lower in patients treated with ticagrelor as compared with those receiving clopidogrel. There was no significant difference in the incidence of hemorrhagic stroke or TIA between the 2 treatment groups. Conclusions- In patients with symptomatic PAD, ischemic stroke and TIA occur frequently over time. Comorbidities such as age, prior stroke, prior atrial fibrillation/flutter, diabetes mellitus, higher blood pressure, prior amputation, lower ankle-brachial index, and geographic region were each independently associated with the occurrence of all-cause stroke. Use of ticagrelor, as compared with clopidogrel, was associated with a lower adjusted rate of ischemic and all-cause stroke. Further study is needed to optimize medical management and risk reduction of all-cause stroke in patients with PAD. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT01732822.</description><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.118.023534</identifier><identifier>PMID: 31092165</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Clopidogrel - administration & dosage ; Clopidogrel - adverse effects ; Double-Blind Method ; Female ; Humans ; Intracranial Hemorrhages - epidemiology ; Intracranial Hemorrhages - etiology ; Intracranial Hemorrhages - prevention & control ; Ischemic Attack, Transient - epidemiology ; Ischemic Attack, Transient - etiology ; Ischemic Attack, Transient - prevention & control ; Male ; Middle Aged ; Peripheral Arterial Disease - complications ; Peripheral Arterial Disease - drug therapy ; Peripheral Arterial Disease - epidemiology ; Stroke - epidemiology ; Stroke - etiology ; Stroke - prevention & control ; Ticagrelor - administration & dosage ; Ticagrelor - adverse effects</subject><ispartof>Stroke (1970), 2019-06, Vol.50 (6), p.1356</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c1534-1f54c4c6c5851b70b69ffded818f7dfbddf0a4d4a41f406868d814f67a45bddb3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27929,27930</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31092165$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kolls, Brad J</creatorcontrib><creatorcontrib>Sapp, Shelly</creatorcontrib><creatorcontrib>Rockhold, Frank W</creatorcontrib><creatorcontrib>Jordan, J Dedrick</creatorcontrib><creatorcontrib>Dombrowski, Keith E</creatorcontrib><creatorcontrib>Fowkes, F Gerry R</creatorcontrib><creatorcontrib>Mahaffey, Kenneth W</creatorcontrib><creatorcontrib>Berger, Jeffrey S</creatorcontrib><creatorcontrib>Katona, Brian G</creatorcontrib><creatorcontrib>Blomster, Juuso I</creatorcontrib><creatorcontrib>Norgren, Lars</creatorcontrib><creatorcontrib>Abramson, Beth L</creatorcontrib><creatorcontrib>Leiva-Pons, Jose L</creatorcontrib><creatorcontrib>Prieto, Juan Carlos</creatorcontrib><creatorcontrib>Sokurenko, German</creatorcontrib><creatorcontrib>Hiatt, William R</creatorcontrib><creatorcontrib>Jones, W Schuyler</creatorcontrib><creatorcontrib>Patel, Manesh R</creatorcontrib><title>Stroke in Patients With Peripheral Artery Disease</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>Background and Purpose- Predictors of stroke and transient ischemic attack (TIA) in patients with peripheral artery disease (PAD) are poorly understood. The primary aims of this analysis were to (1) determine the incidence of ischemic/hemorrhagic stroke and TIA in patients with symptomatic PAD, (2) identify predictors of stroke in patients with PAD, and (3) compare the rate of stroke in ticagrelor- and clopidogrel-treated patients. Methods- EUCLID (Examining Use of Ticagrelor in Peripheral Artery Disease) randomized 13 885 patients with symptomatic PAD to receive monotherapy with ticagrelor or clopidogrel for the prevention of major adverse cardiovascular events (cardiovascular death, myocardial infarction, or ischemic stroke). Ischemic/hemorrhagic stroke and TIA were adjudicated and measured as incidence rates postrandomization and cumulative incidence (per patient-years). Post hoc multivariable competing risk hazards analyses were performed using baseline characteristics to determine factors associated with all-cause stroke in patients with PAD. Results- A total of 458 cerebrovascular events in 424 patients (317 ischemic strokes, 39 hemorrhagic strokes, and 102 TIAs) occurred over a median follow-up of 30 months, for a cumulative incidence of 0.87, 0.11, and 0.27 per 100 patient-years, respectively. Age, prior stroke, prior atrial fibrillation/flutter, diabetes mellitus, geographic region, ankle-brachial index <0.60, prior amputation, and systolic blood pressure were independent baseline factors associated with the occurrence of all-cause stroke. After adjustment for baseline factors, the rates of ischemic stroke and all-cause stroke remained lower in patients treated with ticagrelor as compared with those receiving clopidogrel. There was no significant difference in the incidence of hemorrhagic stroke or TIA between the 2 treatment groups. Conclusions- In patients with symptomatic PAD, ischemic stroke and TIA occur frequently over time. Comorbidities such as age, prior stroke, prior atrial fibrillation/flutter, diabetes mellitus, higher blood pressure, prior amputation, lower ankle-brachial index, and geographic region were each independently associated with the occurrence of all-cause stroke. Use of ticagrelor, as compared with clopidogrel, was associated with a lower adjusted rate of ischemic and all-cause stroke. Further study is needed to optimize medical management and risk reduction of all-cause stroke in patients with PAD. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT01732822.</description><subject>Aged</subject><subject>Clopidogrel - administration & dosage</subject><subject>Clopidogrel - adverse effects</subject><subject>Double-Blind Method</subject><subject>Female</subject><subject>Humans</subject><subject>Intracranial Hemorrhages - epidemiology</subject><subject>Intracranial Hemorrhages - etiology</subject><subject>Intracranial Hemorrhages - prevention & control</subject><subject>Ischemic Attack, Transient - epidemiology</subject><subject>Ischemic Attack, Transient - etiology</subject><subject>Ischemic Attack, Transient - prevention & control</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Peripheral Arterial Disease - complications</subject><subject>Peripheral Arterial Disease - drug therapy</subject><subject>Peripheral Arterial Disease - epidemiology</subject><subject>Stroke - epidemiology</subject><subject>Stroke - etiology</subject><subject>Stroke - prevention & control</subject><subject>Ticagrelor - administration & dosage</subject><subject>Ticagrelor - adverse effects</subject><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo1jsFKAzEURYMgtlb_QCQ_MDVv8pJJl0OtrVhosRWXJZkkNNrWIYmL_r0BdXW5HDj3EnIHbAwg4WGzfV29zNpFW6oas5oLjhdkCKLGCmWtBuQ6pQ_GClHiigw4sEkNUgwJbHL8-nQ0nOha5-BOOdH3kPd07WLo9y7qA21jdvFMH0NyOrkbcun1IbnbvxyRt6fZdrqolqv587RdVh2U9Qq8wA472QklwDTMyIn31lkFyjfWG2s902hRI3hkUklVEHrZaBQFGj4i97_e_tscnd31MRx1PO_-v_Mfsd5FWg</recordid><startdate>201906</startdate><enddate>201906</enddate><creator>Kolls, Brad J</creator><creator>Sapp, Shelly</creator><creator>Rockhold, Frank W</creator><creator>Jordan, J Dedrick</creator><creator>Dombrowski, Keith E</creator><creator>Fowkes, F Gerry R</creator><creator>Mahaffey, Kenneth W</creator><creator>Berger, Jeffrey S</creator><creator>Katona, Brian G</creator><creator>Blomster, Juuso I</creator><creator>Norgren, Lars</creator><creator>Abramson, Beth L</creator><creator>Leiva-Pons, Jose L</creator><creator>Prieto, Juan Carlos</creator><creator>Sokurenko, German</creator><creator>Hiatt, William R</creator><creator>Jones, W Schuyler</creator><creator>Patel, Manesh R</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope></search><sort><creationdate>201906</creationdate><title>Stroke in Patients With Peripheral Artery Disease</title><author>Kolls, Brad J ; Sapp, Shelly ; Rockhold, Frank W ; Jordan, J Dedrick ; Dombrowski, Keith E ; Fowkes, F Gerry R ; Mahaffey, Kenneth W ; Berger, Jeffrey S ; Katona, Brian G ; Blomster, Juuso I ; Norgren, Lars ; Abramson, Beth L ; Leiva-Pons, Jose L ; Prieto, Juan Carlos ; Sokurenko, German ; Hiatt, William R ; Jones, W Schuyler ; Patel, Manesh R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1534-1f54c4c6c5851b70b69ffded818f7dfbddf0a4d4a41f406868d814f67a45bddb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Clopidogrel - administration & dosage</topic><topic>Clopidogrel - adverse effects</topic><topic>Double-Blind Method</topic><topic>Female</topic><topic>Humans</topic><topic>Intracranial Hemorrhages - epidemiology</topic><topic>Intracranial Hemorrhages - etiology</topic><topic>Intracranial Hemorrhages - prevention & control</topic><topic>Ischemic Attack, Transient - epidemiology</topic><topic>Ischemic Attack, Transient - etiology</topic><topic>Ischemic Attack, Transient - prevention & control</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Peripheral Arterial Disease - complications</topic><topic>Peripheral Arterial Disease - drug therapy</topic><topic>Peripheral Arterial Disease - epidemiology</topic><topic>Stroke - epidemiology</topic><topic>Stroke - etiology</topic><topic>Stroke - prevention & control</topic><topic>Ticagrelor - administration & dosage</topic><topic>Ticagrelor - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kolls, Brad J</creatorcontrib><creatorcontrib>Sapp, Shelly</creatorcontrib><creatorcontrib>Rockhold, Frank W</creatorcontrib><creatorcontrib>Jordan, J Dedrick</creatorcontrib><creatorcontrib>Dombrowski, Keith E</creatorcontrib><creatorcontrib>Fowkes, F Gerry R</creatorcontrib><creatorcontrib>Mahaffey, Kenneth W</creatorcontrib><creatorcontrib>Berger, Jeffrey S</creatorcontrib><creatorcontrib>Katona, Brian G</creatorcontrib><creatorcontrib>Blomster, Juuso I</creatorcontrib><creatorcontrib>Norgren, Lars</creatorcontrib><creatorcontrib>Abramson, Beth L</creatorcontrib><creatorcontrib>Leiva-Pons, Jose L</creatorcontrib><creatorcontrib>Prieto, Juan Carlos</creatorcontrib><creatorcontrib>Sokurenko, German</creatorcontrib><creatorcontrib>Hiatt, William R</creatorcontrib><creatorcontrib>Jones, W Schuyler</creatorcontrib><creatorcontrib>Patel, Manesh R</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kolls, Brad J</au><au>Sapp, Shelly</au><au>Rockhold, Frank W</au><au>Jordan, J Dedrick</au><au>Dombrowski, Keith E</au><au>Fowkes, F Gerry R</au><au>Mahaffey, Kenneth W</au><au>Berger, Jeffrey S</au><au>Katona, Brian G</au><au>Blomster, Juuso I</au><au>Norgren, Lars</au><au>Abramson, Beth L</au><au>Leiva-Pons, Jose L</au><au>Prieto, Juan Carlos</au><au>Sokurenko, German</au><au>Hiatt, William R</au><au>Jones, W Schuyler</au><au>Patel, Manesh R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Stroke in Patients With Peripheral Artery Disease</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2019-06</date><risdate>2019</risdate><volume>50</volume><issue>6</issue><spage>1356</spage><pages>1356-</pages><eissn>1524-4628</eissn><abstract>Background and Purpose- Predictors of stroke and transient ischemic attack (TIA) in patients with peripheral artery disease (PAD) are poorly understood. The primary aims of this analysis were to (1) determine the incidence of ischemic/hemorrhagic stroke and TIA in patients with symptomatic PAD, (2) identify predictors of stroke in patients with PAD, and (3) compare the rate of stroke in ticagrelor- and clopidogrel-treated patients. Methods- EUCLID (Examining Use of Ticagrelor in Peripheral Artery Disease) randomized 13 885 patients with symptomatic PAD to receive monotherapy with ticagrelor or clopidogrel for the prevention of major adverse cardiovascular events (cardiovascular death, myocardial infarction, or ischemic stroke). Ischemic/hemorrhagic stroke and TIA were adjudicated and measured as incidence rates postrandomization and cumulative incidence (per patient-years). Post hoc multivariable competing risk hazards analyses were performed using baseline characteristics to determine factors associated with all-cause stroke in patients with PAD. Results- A total of 458 cerebrovascular events in 424 patients (317 ischemic strokes, 39 hemorrhagic strokes, and 102 TIAs) occurred over a median follow-up of 30 months, for a cumulative incidence of 0.87, 0.11, and 0.27 per 100 patient-years, respectively. Age, prior stroke, prior atrial fibrillation/flutter, diabetes mellitus, geographic region, ankle-brachial index <0.60, prior amputation, and systolic blood pressure were independent baseline factors associated with the occurrence of all-cause stroke. After adjustment for baseline factors, the rates of ischemic stroke and all-cause stroke remained lower in patients treated with ticagrelor as compared with those receiving clopidogrel. There was no significant difference in the incidence of hemorrhagic stroke or TIA between the 2 treatment groups. Conclusions- In patients with symptomatic PAD, ischemic stroke and TIA occur frequently over time. Comorbidities such as age, prior stroke, prior atrial fibrillation/flutter, diabetes mellitus, higher blood pressure, prior amputation, lower ankle-brachial index, and geographic region were each independently associated with the occurrence of all-cause stroke. Use of ticagrelor, as compared with clopidogrel, was associated with a lower adjusted rate of ischemic and all-cause stroke. Further study is needed to optimize medical management and risk reduction of all-cause stroke in patients with PAD. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT01732822.</abstract><cop>United States</cop><pmid>31092165</pmid><doi>10.1161/STROKEAHA.118.023534</doi><oa>free_for_read</oa></addata></record> |
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| identifier | EISSN: 1524-4628 |
| ispartof | Stroke (1970), 2019-06, Vol.50 (6), p.1356 |
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| language | eng |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete; Alma/SFX Local Collection |
| subjects | Aged Clopidogrel - administration & dosage Clopidogrel - adverse effects Double-Blind Method Female Humans Intracranial Hemorrhages - epidemiology Intracranial Hemorrhages - etiology Intracranial Hemorrhages - prevention & control Ischemic Attack, Transient - epidemiology Ischemic Attack, Transient - etiology Ischemic Attack, Transient - prevention & control Male Middle Aged Peripheral Arterial Disease - complications Peripheral Arterial Disease - drug therapy Peripheral Arterial Disease - epidemiology Stroke - epidemiology Stroke - etiology Stroke - prevention & control Ticagrelor - administration & dosage Ticagrelor - adverse effects |
| title | Stroke in Patients With Peripheral Artery Disease |
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