Publications by authors named "Anxin Wang"

239 Publications

Associations Between Polyvascular Disease and Stroke Recurrence in Patients With Lacunar Stroke.

Front Neurol 2021 8;12:706991. Epub 2021 Sep 8.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

This study aimed to examine the association of polyvascular disease and clinical outcomes in patients with lacunar stroke. Data of patients with recent lacunar stroke were collected from The Third China National Stroke Registry. Polyvascular disease is defined as the existence of atherosclerosis across two or more vascular beds. For the present study, polyvascular disease patients were grouped as follows: coronary heart disease (CHD) and lacunar stroke, peripheral arterial disease (PAD) and lacunar stroke, and CHD/PAD and lacunar stroke. The major clinical outcome was recurrence, and the secondary clinical outcome was major adverse cardiovascular events (MACEs). A Cox proportional multivariable hazards regression model was applied to estimate the association between polyvascular disease and outcomes. Among 3,165 patients with recent lacunar stroke, CHD was present in 375 (11.8%) and peripheral arterial disease in 168 (5.3%). The hazard ratio (HR) for stroke recurrence was 0.98 (95% confidence interval [CI], 0.65-1.46; = 0.91) for patients with CHD and lacunar stroke, 1.07 (95% CI, 0.61-1.87; = 0.82) for patients with PAD and lacunar stroke, and 0.95 (95% CI, 0.66-1.35; = 0.75) for patients with CHD/PAD and lacunar stroke compared with patients with isolated lacunar stroke. The HR for MACEs was 1.01 (95% CI, 0.69-1.49; = 0.94) for patients with CHD and lacunar stroke, 1.11 (95% CI, 0.65-1.90; = 0.71) for patients with PAD and lacunar stroke, and 0.99 (95% CI, 0.70-1.40; = 0.95) for patients with CHD/PAD and lacunar stroke. Polyvascular disease is not associated with recurrence of stroke and MACEs in patients with recent lacunar stroke at 1 year.
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http://dx.doi.org/10.3389/fneur.2021.706991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8455816PMC
September 2021

Effects of Sevoflurane-Propofol-Balanced Anesthesia on Flash Visual Evoked Potential Monitoring in Spine Surgery: A Randomized Noninferiority Trial.

Anesth Analg 2021 Sep 20. Epub 2021 Sep 20.

From the Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.

Background: Intraoperative flash visual evoked potential (FVEP) can be used to monitor visual function during spine surgery. However, it is limited due to the previous perception of its sensitivity to inhalation anesthesia. We conducted this trial to test the noninferiority of sevoflurane-propofol-balanced anesthesia (BA) versus popular propofol-based total intravenous anesthesia (TIVA) on the amplitude of FVEP during spine surgery.

Methods: A total of 60 patients undergoing spine surgery were randomized to receive either sevoflurane-propofol-balanced anesthesia (BA group) or propofol-based total intravenous anesthesia (TIVA group) for anesthesia maintenance. We titrated the propofol plasma concentration to keep the bispectral index (BIS) values between 40 and 50. The primary outcome was the P100-N145 amplitudes of FVEP at 120 minutes after induction of anesthesia. The noninferiority margin (δ) was defined as 10% of the P100-N145 amplitude at 120 minutes after induction in the TIVA group. If the confidence interval (CI) for mean differences of P100-N145 amplitude at 120 minutes after induction between BA and TIVA groups lied above the lower limit of -δ with P < .025, we defined BA group was noninferior to TIVA group.

Results: Fifty-nine patients were included in the final analysis. The amplitude of P100-N145 at 120 minutes after anesthesia induction in group BA was noninferior to group TIVA (3.8 [1.3] µV vs 3.2 [1.6] µV, -δ = -0.32, mean difference, 0.57, 95% CI, -0.18 to 1.33, P for noninferiority = .015).

Conclusions: The effect of 0.5 minimum alveolar concentration (MAC) of sevoflurane-propofol-balanced anesthesia on the P100-N145 amplitude of FVEP was noninferior to that of propofol-based TIVA under comparable BIS range.
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http://dx.doi.org/10.1213/ANE.0000000000005742DOI Listing
September 2021

Effect of Adjusted Antiplatelet Therapy on Preventing Ischemic Events After Stenting for Intracranial Aneurysms.

Stroke 2021 Sep 20:STROKEAHA120032989. Epub 2021 Sep 20.

Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, China. (W.L., W.Z., Yisen Zhang, K.W., Ying Zhang, C.W., J.L., X.Y.).

Background And Purpose: This study tests whether patients with unruptured intracranial aneurysm who underwent stent placement benefitted from platelet function monitoring-guided adjustment of antiplatelet therapy.

Methods: We conducted a randomized, open-label, parallel group, assessor-blinded trial. Patients with unruptured intracranial aneurysm who underwent stent placement were assigned in a 1:1 ratio to receive either drug adjustment (patients who had high on-treatment platelet reactivity to antiplatelet therapy on the basis of platelet function monitoring [monitoring group]) or conventional therapy (without monitoring and drug adjustment [conventional group]). The second monitoring was performed 14 days after randomization in patients with drug adjustment. The primary outcome was the composite frequency of ischemic stroke, transient ischemic attack, stent thrombosis, urgent revascularization, and cerebrovascular death within 7 days after stent implantation. The safety outcome was the composite frequency of major, minor, or minimal bleeding within 1 month after stent implantation.

Results: In total, 314 patients were included (n=157 per group). The primary combined outcome occurred in 19 patients (12.1%) in the conventional group and 8 patients (5.1%) in the monitoring group (hazard ratio, 0.39 [95% CI, 0.17-0.92]; =0.03). Ischemic stroke occurred at a lower frequency in the monitoring group compared with that in the conventional group (4.5% versus 12.1%; hazard ratio, 0.34 [95% CI, 0.14-0.83]; =0.01), which drove the overall primary combined outcome. The safety outcome occurred in the monitoring group (7.0%) and in the conventional group (1.9%; hazard ratio, 3.87 [95% CI, 1.06-14.14]; =0.03). A significant difference was observed in the frequency of minor or minimal bleeding events between the two groups (monitoring group versus conventional group, 6.4% versus 1.3%; =0.02) but not in the frequency of major bleeding events between the two groups.

Conclusions: Platelet function monitoring-guided antiplatelet therapy reduces thromboembolic events in patients with unruptured intracranial aneurysm after stent placement, significantly enhancing minor or minimal bleeding events but not major bleeding events. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03989557.
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http://dx.doi.org/10.1161/STROKEAHA.120.032989DOI Listing
September 2021

Non-traditional Lipid Parameters as Potential Predictors of Asymptomatic Intracranial Arterial Stenosis.

Front Neurol 2021 31;12:679415. Epub 2021 Aug 31.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Intracranial arterial stenosis (ICAS) is a common cause of stroke. Identifying effective predictors of ICAS that could be easily obtained in clinical practice is important. The predictive values of serum individual lipid parameters have been well-established. In recent years, several non-traditional lipid parameters demonstrated greater predictive values for cardiovascular disease and ischemic stroke than traditional individual lipid parameters. However, their effects on asymptomatic ICAS (aICAS) are less clear. Therefore, we sought to observe the effects of non-traditional lipid parameters on aICAS. We enrolled 5,314 participants from the Asymptomatic Polyvascular Abnormalities in Community study. Asymptomatic ICAS was detected by transcranial Doppler ultrasonography (TCD). Non-traditional lipid parameters, including non-high-density lipoprotein cholesterol (non-HDL-C), the triglycerides/high-density lipoprotein cholesterol ratio (TG/HDL-C), atherogenic coefficient (AC), atherogenic index of plasma, and Castelli's risk index (CRI) were measured. We used multivariable logistic analysis to assess the association of different lipid parameters with aICAS; a trend test and subgroup analyses were also performed. In total, 695 of 5,314 participants had aICAS in this study. For the comparison of the highest to the lowest tertile, the multivariable-adjusted odds ratios (ORs) (95% CIs) were 1.78 (1.39-2.27) ( trend < 0.001) for non-HDL-C, 1.48 (1.18-1.85) ( trend = 0.004) for the AC, 1.48 (1.18-1.85) ( trend = 0.004) for CRI-I, and 1.34 (1.09-1.66) ( trend = 0.032) for CRI-II. Subgroup analyses showed significant interactions between the AC, CRI-I, and diabetes. This large community-based study showed that non-HDL-C, AC, CRI-I, and CRI-II were significantly associated with increased prevalence of aICAS.
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http://dx.doi.org/10.3389/fneur.2021.679415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8438411PMC
August 2021

Association Between Alkaline Phosphatase and Clinical Outcomes in Patients With Spontaneous Intracerebral Hemorrhage.

Front Neurol 2021 30;12:677696. Epub 2021 Aug 30.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Spontaneous intracerebral hemorrhage (ICH) is associated with high rates of mortality and morbidity. Alkaline phosphatase (ALP) is related to increased risk of cardiovascular events and is also closely associated with adverse outcomes after ischemic or hemorrhagic stroke. However, there are limited data about the effect of ALP on clinical outcomes after ICH. Therefore, we aimed to investigate the relationship between serum ALP level and prognosis in ICH patients. From January 2014 to September 2016, 939 patients with spontaneous ICH were enrolled in our study from 13 hospitals in Beijing. Patients were categorized into four groups based on the ALP quartiles (Q1, Q2, Q3, Q4). The main outcomes were 30-day, 90-day, and 1-year poor functional outcomes (modified Rankin Scale score of 3-6). Multivariable logistic regression and interaction analyses were performed to evaluate the relationships between ALP and clinical outcomes after ICH. In the logistic regression analysis, compared with the third quartile of ALP, the adjusted odds ratios of the Q1, Q2, and Q4 for 30-day poor functional outcome were 1.31 (0.80-2.15), 1.16 (0.71-1.89), and 2.16 (1.32-3.55). In terms of 90-day and 1-year poor functional outcomes, the risks were significantly higher in the highest quartile of ALP compared with the third quartile after adjusting the confounding factors [90-day: highest quartile OR = 1.86 (1.12-3.10); 1-year: highest quartile OR = 2.26 (1.34-3.80)]. Moreover, there was no significant interaction between ALP and variables like age or sex. High ALP level (>94.8 U/L) was independently associated with 30-day, 90-day, and 1-year poor functional outcomes in ICH patients. Serum ALP might serve as a predictor for poor functional outcomes after ICH onset.
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http://dx.doi.org/10.3389/fneur.2021.677696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8435581PMC
August 2021

High lactate dehydrogenase was associated with adverse outcomes in patients with acute ischemic stroke or transient ischemic attack.

Ann Palliat Med 2021 Aug 30. Epub 2021 Aug 30.

China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Background: Previous studies found that lactate dehydrogenase (LDH) levels predicted poor outcomes in hemorrhagic stroke, but the prognostic role of LDH in ischemic stroke (IS) remains unclear. The aim of this study is to investigate the association between LDH and adverse clinical outcomes in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA).

Methods: All patients were enrolled from the Third China National Stroke Registry (CNSR-III). Adverse outcomes included all-cause death and poor functional outcomes [defined as modified Rankin Scale (mRS) score 3-6 and 2-6] at 3 months and 1 year. Multivariable Cox proportional hazards models and logistic regressions were used to evaluate the association of LDH with risk of all-cause death and poor functional outcomes, respectively.

Results: Among 9,796 included patients, the median [interquartile range (IQR)] of LDH was 175.00 (151.00-205.40) U/L. After adjustment for confounding factors, patients in the highest LDH quartile had a higher risk of all-cause death [hazard ratio (HR), 2.23; 95% confidence interval (CI), 1.27-3.90], and a higher proportion of mRS score 3-6 (odds ratio (OR), 1.54; 95% CI, 1.26-1.90) and mRS score 2-6 (OR, 1.56; 95% CI, 1.32-1.84) at 3 months. We also observed a J-shaped association between LDH and risk of each outcome. Consistent results were found at 1 year.

Conclusions: Higher LDH levels are independently associated with adverse outcomes in patients with AIS or TIA.
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http://dx.doi.org/10.21037/apm-21-2195DOI Listing
August 2021

A novel score for evaluating cerebral aneurysms treated with flow diversion: 4F-flow diversion predictive score.

Ther Adv Neurol Disord 2021 19;14:17562864211039336. Epub 2021 Aug 19.

Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing 100050, China.

Background And Purpose: Although grading scales for angiography outcomes following cerebral aneurysm treatment with flow diversion have been published, physicians have not widely adopted these scales in practice. The aim of this study is to propose and validate a novel Flow diversion Predictive Score (4F-FPS) grading scale based on previously established scales that is simple and reliable.

Methods: We retrospectively analyzed consecutive patients who underwent endovascular treatment for cerebral aneurysms with flow diversion between January 2014 and September 2019. The included patients were randomly divided into the derivation and validation group in a 70/30 ratio, respectively. Aneurysms were classified as incomplete or complete occlusion based on final angiography outcomes. 4F-FPS was derived to predict aneurysm occlusion from multivariate logistic regression analyses in the derivation group and validated with previously published grading scales in the validation group.

Results: Overall, 662 patients [mean age, 53.8 years; 72.5% (480/662) female] with 662 aneurysms treated with the Pipeline flow diverter were included [69.9% (463/662) derivation group, 30.1% (199/662) validation group]. The incidence of aneurysm occlusion was 82.7%. 4F-FPS demonstrated significant discrimination in 10-fold cross validation [mean receiver operating characteristic (ROC) area, 0.862 ± 0.055] and calibration (Cox & Snell , 0.251; Nagelkerke , 0.413) in the derivation group. The ROC area of 4F-FPS score in both the derivation and validation groups is the largest compared with previously published grading scales/scores ( < 0.05), which shows better sensitivity and specificity. The 4F-FPS score showed excellent prediction, discrimination, and calibration properties.

Conclusion: The 4F-FPS score is a simple and reliable tool to predict angiography outcome after flow diversion treatment. If widely adopted, it may provide a common language to be used in future reporting of flow diversion results for clinical trials and daily practice.

Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT03831672.
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http://dx.doi.org/10.1177/17562864211039336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381420PMC
August 2021

Electrolytes and clinical outcomes in patients with acute ischemic stroke or transient ischemic attack.

Ann Transl Med 2021 Jul;9(13):1069

China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Background: Abnormal electrolytes were closely related to the prognosis of various diseases, the prognostic role of electrolytes in stroke has not been investigated well. We aimed to investigate the association between electrolytes and clinical outcomes in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA).

Methods: Data were recruited from the China National Stroke Registry III study. Patients were classified into three groups according to tertiles and the normal range of each electrolyte. Multivariable logistic and Cox proportional hazards regressions were adopted to explore the associations of electrolytes with poor functional outcomes [modified Rankin Scale (mRS) 3-6/2-6] and all-cause death at 3 months and 1 year.

Results: A total of 10,299 eligible patients were enrolled. After adjusted for confounding factors, the first tertile electrolytes were associated with increased risk of poor functional outcome (mRS score 3-6) at 1 year, the adjusted odds ratios (95% confidence intervals) were 1.33 (1.14-1.55) for potassium, 1.41 (1.20-1.60) for sodium, 1.27 (1.08-1.48) for chloride, compared with the second tertile. Similar results were found when poor functional outcome was defined as mRS score 2-6 and all-cause death. However, almost no significant association was present of calcium with these outcomes. All results were consistent when each electrolyte was classified into three groups according to the normal range and the outcomes timepoint was set at 3 months.

Conclusions: Lower levels of potassium, sodium, chloride but not calcium were associated with higher risk of poor functional outcomes and death in patients with AIS or TIA.
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http://dx.doi.org/10.21037/atm-21-741DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339832PMC
July 2021

Neutrophil to lymphocyte ratio and adverse clinical outcomes in patients with ischemic stroke.

Ann Transl Med 2021 Jul;9(13):1047

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Background: Neutrophils and lymphocytes mediate differential inflammatory responses after ischemic stroke and have different effects on patients' clinical outcomes. Several studies have used the neutrophil to lymphocyte ratio (NLR) as a prognostic indicator for ischemic stroke; however, some limitations remain.

Methods: We derived data from the Third China National Stroke Registry. The NLR is defined as neutrophil count/lymphocyte count. Patients included in the study were classified into four groups by NLR quartiles. Odds ratios (ORs) of adverse clinical outcomes were calculated with the lowest quartile group as the reference category. We plotted receiver operating characteristic (ROC) curves of NLR for adverse clinical outcomes and calculated area under the curve (AUC) values and cutoff values. Under different TOAST classifications, medians of NLR and ORs of adverse clinical outcomes were also calculated. Furthermore, interaction tests between NLR and etiology were performed.

Results: A total of 13,018 patients were enrolled. At both 3- and 12-month follow-ups, higher quartile groups were associated with increased risks of death and poor functional outcomes, even after adjustments. For death, the cutoff values of NLR were 3.872 at 3-month follow-up and 3.180 at 12-month follow-up. For poor functional outcomes, the cutoff value of NLR was 2.846 at both 3- and 12-month follow-ups. The association between NLR and stroke recurrence was significant only at 3-month follow-up before adjustments. There was no correlation between NLR and hemorrhagic transformation during hospitalization. Under different TOAST classifications, the medians of NLR were different; conversely, the correlations of NLR with adverse clinical outcomes had no differences.

Conclusions: High level of NLR within the first 24 h after admission was associated with increased risks of both short- and long-term adverse clinical outcomes in patients with ischemic stroke, regardless of etiology.
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http://dx.doi.org/10.21037/atm-21-710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339844PMC
July 2021

Association between the triglyceride-glucose index and carotid plaque stability in nondiabetic adults.

Nutr Metab Cardiovasc Dis 2021 09 3;31(10):2921-2928. Epub 2021 Jul 3.

China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Electronic address:

Background And Aims: The rupture of an unstable atherosclerotic plaque is one of the major causes of thrombosis. However, there was limited evidence on the relationship of triglyceride-glucose (TyG) index, a simple surrogate marker of insulin resistance, with the carotid plaque stability. This study aimed to investigate the association between the TyG index and carotid plaque stability in nondiabetic adults.

Methods And Results: The study included 4748 nondiabetic participants from the Asymptomatic Polyvascular Abnormalities Community study. Carotid plaque stability was assessed using ultrasonography. The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Logistic regression was used to evaluate the association of the TyG index with carotid plaque stability by calculating odds ratio (OR) and 95% confidence interval (CI). Of the 4748 participants, 1192 (25.11%) participants had stable carotid plaque, and 1247 (26.26%) had unstable carotid plaque. The prevalence of unstable carotid plaque substantially increased with increasing TyG index tertile (P for trend <0.0001). In the fully adjusted model, the OR comparing participants in the highest versus the lowest tertile of the TyG index was 1.31 (95% CI, 1.09-1.57). The optimal cutoff point for the TyG index in case of unstable carotid plaque was 8.56. However, we did not observe a statistically significant association between the TyG index and stable carotid plaque.

Conclusions: Elevated the TyG index was significantly associated with the prevalence of unstable carotid plaque in nondiabetic adults.
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http://dx.doi.org/10.1016/j.numecd.2021.06.019DOI Listing
September 2021

Association of triglyceride-glucose index with intra- and extra-cranial arterial stenosis: a combined cross-sectional and longitudinal analysis.

Endocrine 2021 Aug 4. Epub 2021 Aug 4.

China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Purpose: This study aimed to assess the cross-sectional and longitudinal associations of the triglyceride glucose (TyG) index, a simple surrogate marker of insulin resistance, with intra-cranial and extra-cranial artery stenosis (ICAS and ECAS) in Chinese adults.

Methods: Participants were recruited from the Asymptomatic Polyvascular Abnormalities Community study, 5381 participants were enrolled in the cross-sectional analysis, then 3447 and 1853 participants in the longitudinal analysis for incident ICAS and ECAS, respectively. The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Multivariable logistic analysis was used to calculate odds ratio (OR) and 95% confidence interval (CI).

Results: The results of the cross-sectional and longitudinal analysis were basically the same, as the fully adjusted OR comparing participants in the highest tertile versus lowest tertile of the TyG index was 1.34 (95% CI, 1.13-1.59) for the prevalence of ECAS and 1.85 (95% CI, 1.26-2.71) for incident ECAS, respectively. The addition of TyG index to a conventional model had an incremental effect on the predictive value for ECAS. However, we did not observe any significant association between the TyG index and ICAS.

Conclusions: Elevated TyG index was significantly associated with a higher risk of ECAS, but not with ICAS in Chinese adults. This conclusion lends support to the clinical significance of the TyG index for the assessment of artery stenosis, especially for ECAS.
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http://dx.doi.org/10.1007/s12020-021-02794-yDOI Listing
August 2021

Joint association of modifiable lifestyle and metabolic health status with incidence of cardiovascular disease and all-cause mortality: a prospective cohort study.

Endocrine 2021 Aug 3. Epub 2021 Aug 3.

China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Purpose: We aimed to identify the joint associations of modifiable lifestyle and metabolic factors with the incidences of cardiovascular disease and all-cause mortality.

Methods: We recruited 94,831 participants (men, 79.76%; median age, 51.60 [43.47-58.87]) without a history of cardiovascular disease from the Kailuan study during 2006 and 2007 and followed them until a cardiovascular disease event, or death occurred, or until December 31, 2017. Baseline metabolic health status was assessed using Adult Treatment Panel III criteria, and details of the lifestyles of the participants were recorded using a self-reported questionnaire. We used Cox proportional hazards models to evaluate the joint associations.

Results: During a median follow-up of 11.03 years, we recorded 6590 cardiovascular disease events and 9218 all-cause mortality. Participants with the most metabolic risk components and the least healthy lifestyle had higher risk of cardiovascular disease (hazard ratio 2.06 [95% confidence interval (CI) 1.77-2.39]) and mortality (HR 1.53 [95% CI 1.31-1.78]), than participants with fewer metabolic risk components and the healthiest lifestyle. Compared with those in participants with the healthiest lifestyle, the HRs for cardiovascular disease in participants with the least healthy lifestyle were 1.26 (95% CI 1.17-1.37), 1.16 (95% CI 1.03-1.31), and 1.07 (95% CI 0.90-1.27) for those with low, medium, and high metabolic risk, respectively.

Conclusion: Healthy lifestyle is associated with a lower risk of cardiovascular disease and there is no significant interaction between metabolic risk and a healthy lifestyle. Therefore, a healthy lifestyle should be promoted, even for people with high metabolic risk.
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http://dx.doi.org/10.1007/s12020-021-02832-9DOI Listing
August 2021

Leukocyte subtypes and adverse clinical outcomes in patients with acute ischemic cerebrovascular events.

Ann Transl Med 2021 May;9(9):748

China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Background: Our study aimed to evaluate whether the effects on adverse clinical outcomes, defined as death, recurrent stroke, and poor functional outcomes, differed by leukocyte subtype in patients with acute ischemic cerebrovascular events, including both ischemic stroke and transient ischemic attack (TIA).

Methods: We derived data from the Third China National Stroke Registry (CNSR-III). The counts and percentages of each leukocyte subtype were collected within the first 24 hours after admission. Enrolled patients were classified into four groups by the quartiles of each leukocyte subtype count or percentage. Hazard ratios (HRs) or odds ratios (ORs) and their 95% confidence intervals (CIs) of adverse clinical outcomes were calculated, with the lowest quartile group as the reference category. We used C statistics, integrated discrimination improvement (IDI), and the net reclassification index (NRI) to evaluate each leukocyte subtype's incremental predictive value beyond conventional risk factors.

Results: A total of 14,174 patients were enrolled. Higher counts of leukocytes, neutrophils, and monocytes were associated with elevated risks of adverse clinical outcomes. In contrast, higher counts of lymphocytes and eosinophils were related to reduced risks of adverse clinical outcomes. Meanwhile, basophil counts seemed to not correlate with adverse clinical outcomes. Furthermore, there were also significant associations between the percentages of leukocyte subtypes and adverse clinical outcomes.

Conclusions: Leukocyte subtypes had different relationships with adverse clinical outcomes at 3-month and 1-year follow-up in patients with acute ischemic cerebrovascular events and could slightly increase the predictive value compared with the conventional model.
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http://dx.doi.org/10.21037/atm-20-7931DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8246222PMC
May 2021

Safety and Efficacy of Low-Dose Tirofiban Combined With Intravenous Thrombolysis and Mechanical Thrombectomy in Acute Ischemic Stroke: A Matched-Control Analysis From a Nationwide Registry.

Front Neurol 2021 10;12:666919. Epub 2021 Jun 10.

Interventional Neuroradiology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Tirofiban administration to acute ischemic stroke patients undergoing mechanical thrombectomy with preceding intravenous thrombolysis remains controversial. The aim of the current study was to evaluate the safety and efficacy of low-dose tirofiban during mechanical thrombectomy in patients with preceding intravenous thrombolysis. Patients with acute ischemic stroke undergoing mechanical thrombectomy and preceding intravenous thrombolysis were derived from "ANGEL-ACT," a multicenter, prospective registry study. The patients were dichotomized into tirofiban and non-tirofiban groups based on whether tirofiban was administered. Propensity score matching was used to minimize case bias. The primary safety endpoint was symptomatic intracerebral hemorrhage (sICH), defined as an intracerebral hemorrhage (ICH) associated with clinical deterioration as determined by the Heidelberg Bleeding Classification. All ICHs and hemorrhage types were recorded. Clinical outcomes included successful recanalization, dramatic clinical improvement, functional independence, and mortality at the 3-month follow-up timepoint. Successful recanalization was defined as a modified Thrombolysis in Cerebral Ischemia score of 2b or 3. Dramatic clinical improvement at 24 h was defined as a reduction in NIH stroke score of ≥10 points compared with admission, or a score ≤1. Functional independence was defined as a Modified Rankin Scale (mRS) score of 0-2 at 3-months. The study included 201 patients, 81 in the tirofiban group and 120 in the non-tirofiban group, and each group included 68 patients after propensity score matching. Of the 201 patients, 52 (25.9%) suffered ICH, 15 (7.5%) suffered sICH, and 18 (9.0%) died within 3-months. The median mRS was 3 (0-4), 99 (49.3%) achieved functional independence. There were no statistically significant differences in safety outcomes, efficacy outcomes on successful recanalization, dramatic clinical improvement, or 3-month mRS between the tirofiban and non-tirofiban groups (all > 0.05). Similar results were obtained after propensity score matching. In acute ischemic stroke patients who underwent mechanical thrombectomy and preceding intravenous thrombolysis, low-dose tirofiban was not associated with increased risk of sICH or ICH. Further randomized clinical trials are needed to confirm the effects of tirofiban in patients undergoing bridging therapy.
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http://dx.doi.org/10.3389/fneur.2021.666919DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225265PMC
June 2021

Mediation effect of arterial stiffness on ideal cardiovascular health and stroke.

Nutr Metab Cardiovasc Dis 2021 07 18;31(8):2382-2390. Epub 2021 May 18.

China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Electronic address:

Background And Aims: Ideal cardiovascular health (CVH) metrics was associated with stroke, but the causal pathway was poorly investigated. Arterial stiffness was a major factor associated with both ideal CVH metrics and stroke. This study aimed to investigate whether the effect of ideal CVH metrics on stroke was mediated and enhanced by arterial stiffness.

Methods And Results: A total of 15,297 participants were included in current study. Arterial stiffness was measured by brachial-ankle pulse wave velocity (baPWV). Causal mediation analyses were used to separate the overall effects of ideal CVH metrics on stroke into indirect effects (mediated by arterial stiffness) and direct effects (mediated through pathways other than arterial stiffness). After a median follow-up of 5.88 years, 324 total stroke events (292 ischemic stroke and 31 hemorrhagic stroke) occurred. Mediation analysis showed 23.94% of the relation between ideal CVH and total stroke was mediated by baPWV (95% confidence interval [CI] of the indirect effect: 0.93-0.95). Further analysis showed the ideal CVH < median combined with baPWV ≥1400 cm/s was associated with the highest risk of total stroke (hazard ratio: 5.62; 95% CI, 3.53-8.96), compared with CVH ≥ median combined with baPWV < 1400 cm/s. Similar results were observed for ischemic stroke, but not for hemorrhagic stroke.

Conclusions: Arterial stiffness played a mediating role in the associations between ideal CVH metrics and risk of total and ischemic stroke. Combined ideal CVH metrics and baPWV is a reasonable and useful tool for the assessment and prevention of stroke.
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http://dx.doi.org/10.1016/j.numecd.2021.05.006DOI Listing
July 2021

Cumulative Serum Uric Acid and Its Time Course Are Associated With Risk of Myocardial Infarction and All-Cause Mortality.

J Am Heart Assoc 2021 Jul 14;10(13):e020180. Epub 2021 Jun 14.

Department of Epidemiology and Health Statistics School of Public Health Capital Medical University Beijing China.

Background Serum uric acid (SUA) has been demonstrated as a risk factor for myocardial infarction (MI) and all-cause mortality; however, the impact of cumulative SUA (cumSUA) remains unclear. We aimed to investigate the association of cumSUA with MI risk and all-cause mortality, and to further explore the effects of SUA accumulation time course. Methods and Results The study enrolled 53 463 participants without a history of MI, and these participants underwent 3 examinations during 2006 to 2010. cumSUA from baseline to the third examination was calculated, multiplying mean values between consecutive examinations by time intervals between visits. Cox models estimated hazard ratios (HRs) and 95% CIs of MI and all-cause mortality for cumSUA quartiles, hyperuricemia exposure duration, and SUA accumulation time course. During a median follow-up of 7.04 years, 476 incident MIs and 2692 deaths occurred. In the fully adjusted model, a higher MI risk was observed in the highest cumSUA quartile (HR, 1.48; 95% CI, 1.10-1.99), in participants with longer hyperuricemia exposure duration (HR, 1.71; 95% CI, 1.06-2.73), and in participants with cumSUA≥median and a negative slope (HR, 1.58; 95% CI, 1.18-2.11). Similar associations persisted for all-cause mortality. Conclusions The risk of MI and all-cause mortality increased with higher cumSUA and was affected by the SUA accumulation time course. Early SUA accumulation contributed more to MI risk and all-cause mortality than later SUA accumulation with the same overall cumulative exposure, emphasizing the importance of optimal SUA control early in life.
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http://dx.doi.org/10.1161/JAHA.120.020180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8403320PMC
July 2021

Risk of arterial stiffness according to metabolically healthy obese phenotype: a combined cross-sectional and longitudinal study in kailuan cohort.

Aging (Albany NY) 2021 06 3;13(11):15114-15125. Epub 2021 Jun 3.

China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

We aim to investigate the risk of incident arterial stiffness according to metabolically healthy obese (MHO) phenotype in Chinese population. 37,180 participants with at least one-time measurement of branchial-ankle pulse wave velocity (baPWV) were included in the cross-sectional analysis, and 16,236 participants with repeated measurement of baPWV during the follow-ups were included in the longitudinal study. Cross-classification of body mass index (BMI) categories and metabolic health status created six groups. Linear and logistic regression analyses were used. The results of cross-sectional and longitudinal investigation were essentially the same, as the abnormality of baPWV increased with BMI categories in metabolically healthy participants, while the increasing tendency disappeared in metabolically unhealthy participants. A 1.4-fold, 2.2-fold increased risk for the new occurrence of arterial stiffness were documented in MHO and metabolically unhealthy obese participants compared to metabolically healthy normal-weight controls in the fully adjusted model. Further stratified analysis showed that metabolic health status was an interaction factor between BMI and arterial stiffness in all study populations (=0.0001 for cross-sectional study and =0.0238 for longitudinal study). In conclusion, metabolic health status and BMI categories contribute to the progression of arterial stiffness, while BMI is positively associated with arterial stiffness only in metabolically healthy participants.
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http://dx.doi.org/10.18632/aging.203075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8221340PMC
June 2021

Safety and efficacy of oral antiplatelet for patients who had acute ischaemic stroke undergoing endovascular therapy.

Stroke Vasc Neurol 2020 Nov 11. Epub 2020 Nov 11.

Neurointervention center, Beijing Tiantan Hospital, Beijing, China

Background And Purpose: To investigate the safety and efficacy of oral antiplatelet therapy (APT) for patients who had acute ischaemic stroke (AIS), receiving endovascular therapy (EVT).

Methods: Patients were divided into non-APT group and APT (single APT or dual APT (DAPT)) group. The safety and efficacy endpoints at 3-month follow-up were symptomatic intracranial haemorrhage (sICH), recanalisation rate, clinical outcome and mortality.

Results: Among 915 patients who had AIS, those in APT group (n=199) showed shorter puncture-to-recanalisation time, lower frequency of intravenous thrombolysis and more use of tirofiban compared with those in non-antiplatelet group (n=716) (p<0.05 for all). Oral APT was found to be associated with superior clinical outcome compared with non-APT (APT (44.2%) versus non-APT (41.1%)), adjusted OR=2.605, 95% CI 1.244 to 5.455, p=0.011). DAPT showed superior clinical outcome compared with non-APT (DAPT (56.5%) versus non-APT (41.1%), adjusted OR=5.405, 95% CI 1.614 to 18.102, p=0.006) and lower risk of mortality at 3-month follow-up (DAPT (4.8%) versus non-DAPT (17.7%), adjusted OR=0.008, 95% CI 0.000 to 0.441, p=0.019). There was no significant difference in sICH between the two groups.

Conclusions: Oral APT prior to undergoing EVT is safe and may accompany with superior clinical outcomes. DAPT may associate with superior clinical outcomes and lower risk of mortality.
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http://dx.doi.org/10.1136/svn-2020-000466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258061PMC
November 2020

Change in triglyceride-glucose index predicts the risk of cardiovascular disease in the general population: a prospective cohort study.

Cardiovasc Diabetol 2021 05 26;20(1):113. Epub 2021 May 26.

China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.

Background: Previous studies has shown a significant relationship between baseline triglyceride-glucose (TyG) index and subsequent cardiovascular disease (CVD). However, the effect of longitudinal changes in TyG index on the risk of CVD remains uncertain. This study aimed to investigate the association between change in TyG index and the risk of CVD in the general population.

Methods: The current study included 62,443 Chinese population who were free of CVD. The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2], and change in TyG index was defined as the difference between the TyG index in 2010 and that in 2006. Multivariable-adjusted Cox proportional hazard models and restricted cubic spline analysis were used to examine the association between change in TyG index and the risk of CVD.

Results: During a median follow-up of 7.01 years, 2530 (4.05%) incident CVD occurred, including 2018 (3.23%) incident stroke and 545 (0.87%) incident myocardial infarction (MI). The risk of developing CVD increased with the quartile of change in TyG index, after adjustment for multiple potential confounders, the hazard ratios for the Q4 group versus the Q1 group were 1.37 (95% confidence interval [CI], 1.21-1.54) for the overall CVD, 1.38 (95% CI, 1.19-1.60) for stroke, and 1.36 (95% CI, 1.05-1.76) for MI. Restricted cubic spline analysis also showed a cumulative increase in the risk of CVD with increases in the magnitude of change in TyG index. The addition of change in TyG index to a baseline risk model for CVD improved the C-statistics (P = 0.0097), integrated discrimination improvement value (P < 0.0001), and category-free net reclassification improvement value (P < 0.0001). Similar results were observed for stroke and MI.

Conclusions: Substantial changes in TyG index independently predict the risk of CVD in the general population. Monitoring long-term changes in TyG may assist with in the early identification of individuals at high risk of CVD.
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http://dx.doi.org/10.1186/s12933-021-01305-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157734PMC
May 2021

Efficacy and safety of butylphthalide for patients who had acute ischaemic stroke receiving intravenous thrombolysis or endovascular treatment (BAST trial): study protocol for a randomised placebo-controlled trial.

BMJ Open 2021 05 25;11(5):e045559. Epub 2021 May 25.

Department of Neurological Intervention, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Introduction: As a neuroprotective medication, butylphthalide (NBP) may help protect against cerebral ischaemic injury. However, evidence on whether NBP influences the outcomes of patients who had acute ischaemic stroke who are receiving revascularisation treatment is limited. This study aims to evaluate whether additional NBP therapy can improve the functional outcome of patients who receive intravenous recombinant tissue plasminogen activator and/or endovascular treatment (EVT).

Methods And Analysis: The study will be a randomised, double-blind, placebo-controlled, multiple-centre, parallel group trial. The sample size is estimated at 1200 patients. Eligible patients will be randomised at a 1:1 ratio to receive either NBP or placebo daily for 90 days, which will include 14 days of injections and 76 days of capsules. The first use of NBP/placebo will be started within 6 hours of onset of ischaemic stroke. The primary outcome is the functional outcome as assessed by the 90-day modified Rankin Scale, adjusted for baseline scores on the National Institutes of Health Stroke Scale. The primary safety outcome is the percentage of serious adverse events during the 90 days of treatment. This trial will determine whether NBP medication benefits patients who had acute ischaemic stroke who receive intravenous thrombolysis or EVT.

Ethics And Dissemination: The protocol was written according to the general ethical guidelines of the Declaration of Helsinki and approved by the Institutional Review Board/Ethics Committee of Beijing Tiantan Hospital, Capital Medical University with approval number KY 2018-003-02. Ethics committees of all participating sites have approved the study . Results of the study will be published in peer-reviewed scientific journals and shared in scientific presentations.

Trial Registration Number: NCT03539445.
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http://dx.doi.org/10.1136/bmjopen-2020-045559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154958PMC
May 2021

Non-High-Density Lipoprotein Cholesterol Predicts Adverse Outcomes in Acute Ischemic Stroke.

Stroke 2021 Jun 18;52(6):2035-2042. Epub 2021 May 18.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (G.W., J.J., A.W., X. Zhang, X. Zhao, Z.L., C.W., H.L., L.L., Yongjun Wang, Yilong Wang).

[Figure: see text].
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http://dx.doi.org/10.1161/STROKEAHA.120.030783DOI Listing
June 2021

Vascular Risk Factors, Imaging, and Outcomes in Transient Ischemic Attack/Ischemic Stroke Patients with Neuroimaging Evidence of Probable/Possible Cerebral Amyloid Angiopathy.

Oxid Med Cell Longev 2021 26;2021:9958851. Epub 2021 Apr 26.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Background: In TIA/ischemic stroke patients, the clinical significance of lobar microbleeds potentially indicating cerebral amyloid angiopathy (CAA) is unknown. We assessed vascular risk factors and outcomes, including cognition, in TIA/ischemic stroke patients with neuroimaging evidence of probable/possible CAA.

Methods: This prospective cohort was conducted from August 2015 and January 2018 at 40 centers. 2625 participants were collected. Eligible participants were aged at least 55 years. Montreal Cognitive Assessment (MoCA) score is less than or equal to 26. A total of 1620 patients were included. 1604 (99.0%) and 1582 (97.7%) participants are followed up at 3 and 12 months. The primary outcomes were death or disability (mRS score, 3-6) and Montreal Cognitive Assessment (MoCA) at 3 months and 12 months. Demographic and vascular risk factors were measured at baseline (smoking, alcohol, diabetes, atrial fibrillation, hypertension, hypercholesterolemia, coronary artery disease, ischemic stroke, and transient ischemic attack). Blood samples were collected within 24 hours of admission. MRI was recommended for all patients. MoCA score was evaluated at baseline and follow-up.

Results: In total, 291/1620 patients with ischemic stroke/TIA (32.7% female and mean age, 67.8 years) had neuroimaging evidence of probable/possible CAA. Higher age, history of hypertension, atrial fibrillation, ischemic stroke, alcohol, and high glucose at the admission were more common in the patients. Mean MoCA changed from 21.4 at 3 months (SD 5.2) to 22.3 at 12 months (SD 4.7), difference 0.3 (SD 3.8). At the 3-month and 12-month follow-up, there were significant differences in age, education level, and sex among different cognitive groups. Higher age, lower education (less than high school), and female sex were the predictors of changing in MoCA score from 3 months to 12 months. Moreover, age (more than 66 years) and education (less than high school) are strongly associated with MoCA at 3- and 12-month follow-up. 30 of 286 (10.5%) and 37 of 281 (13.2%) patients had poor outcome of death or disability (modified Rankin Scale score, 3-6) at follow-up 3 and 12 months. Cortical superficial siderosis (cSS) was associated with higher mRS at follow-up. cSS status, cSS count 1-2, cSS strictly lobar, and strictly deep might be the risks of outcomes in adjusted analyses.

Conclusion: This study suggested that an increasing number of vascular risk factors and imaging markers were significantly associated with outcomes of TIA/ischemic stroke patients with CAA pattern. Male, young patients with high education should get better cognitive recovery.
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http://dx.doi.org/10.1155/2021/9958851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096555PMC
April 2021

Clopidogrel with aspirin in High-risk patients with Acute Non-disabling Cerebrovascular Events II (CHANCE-2): rationale and design of a multicentre randomised trial.

Stroke Vasc Neurol 2021 Jun 5;6(2):280-285. Epub 2021 May 5.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Background: In patients with a minor ischaemic stroke or transient ischaemic attack (TIA), separate trials have shown that dual antiplatelet therapy with clopidogrel plus aspirin (clopidogrel-aspirin) or ticagrelor plus aspirin (ticagrelor-aspirin) are more effective than aspirin alone in stroke secondary prevention. However, these two sets of combination have not been directly compared. Since clopidogrel was less effective in stroke patients who were loss-of-function (LOF) allele carriers, whether ticagrelor-aspirin is clinically superior to clopidogrel-aspirin in this subgroup of patients with stroke is unclear.

Aim: To describe the rationale and design considerations of the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE-2) trial.

Design: CHANCE-2 is a randomised, double-blind, double-dummy, placebo-controlled, multicentre trial that compares two dual antiplatelet strategies for minor stroke or TIA patients who are allele carriers: ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily on days 2-90) or clopidogrel (300 mg loading dose on day 1 followed by 75 mg daily on days 2-90), plus open-label aspirin with a dose of 75-300 mg on day 1 followed by 75 mg daily on day 2-21. All will be followed for 1 year.

Study Outcomes: The primary efficacy outcome is any stroke (ischaemic or haemorrhagic) within 3 months and the primary safety outcome is any severe or moderate bleeding event within 3 months.

Discussion: The CHANCE-2 trial will evaluate whether ticagrelor-aspirin is superior to clopidogrel-aspirin for minor stroke or TIA patients who are LOF allele carriers.

Trial Registration Number: NCT04078737.
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http://dx.doi.org/10.1136/svn-2020-000791DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258075PMC
June 2021

Analytical validation of GMEX rapid point-of-care genotyping system for the CHANCE-2 trial.

Stroke Vasc Neurol 2021 Jun 5;6(2):274-279. Epub 2021 May 5.

China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Background And Purpose: Rapid genotyping is useful for guiding early antiplatelet therapy in patients with high-risk nondisabling ischaemic cerebrovascular events (HR-NICE). Conventional genetic testing methods used in genotype-guided antiplatelet therapy for patients with HR-NICE did not satisfy the needs of the Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events (CHANCE)-2 trial. Therefore, we developed the rapid-genotyping GMEX (point-of-care) system to meet the needs of the CHANCE-2 trial.

Methods: Healthy individuals and patients with history of cardiovascular diseases (n=408) were enrolled from six centres of the CHANCE-2 trial. We compared the laboratory-based genomic test results with Sanger sequencing test results for accuracy verification. Next, we demonstrated the accuracy, timeliness and clinical operability of the GMEX system compared with laboratory-based technology (YZY Kit) to verify whether the GMEX system satisfies the needs of the CHANCE-2 trial.

Results: Genotypes reported by the GMEX system showed 100% agreement with those determined by using the YZY Kit and Sanger sequencing for all three alleles (*2, *3 and *17) tested. The average result's turnaround times for the GMEX and YZY Kit methods were 85.0 (IQR: 85.0-86.0) and 1630.0 (IQR: 354.0-7594.0) min (p<0.001), respectively.

Conclusions: Our data suggest that the GMEX system is a reliable and feasible point-of-care system for rapid genotyping for the CHANCE-2 trial or related clinical and research applications.
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http://dx.doi.org/10.1136/svn-2021-000874DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258065PMC
June 2021

Imaging Parameters Predict Recurrence After Transient Ischemic Attack or Minor Stroke Stratified by ABCD Score.

Stroke 2021 Jun 5;52(6):2007-2015. Epub 2021 May 5.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (J.J., Y.S., A.W., Y.Z., Y.J., L.L., X.Z., Yilong Wang, Z.L., H.L., X.M., Yongjun Wang).

Background And Purpose: Whether imaging parameters would independently predict stroke recurrence in low-risk minor ischemic stroke (MIS) or transient ischemic attack (TIA) according to traditional score system (such as ABCD score, which was termed on the basis of the initials of the five factors: age, blood pressure, clinical features, duration, diabetes) remains unclear. We sought to evaluate the association between imaging parameters and 1-year stroke recurrence in patients with TIA or MIS in different risk stratum stratified by ABCD score.

Methods: We included patients with TIA and MIS (National Institutes of Health Stroke Scale score ≤3) with complete baseline vessel and brain imaging data from the Third China National Stroke Registry III. Patients were categorized into different risk groups based on ABCD score (low risk, 0-3; moderate risk, 4-5; and high risk, 6-7). The primary outcome was stroke recurrence within 1 year. Multivariable Cox proportional-hazards regression models were used to assess whether imaging parameters (large artery stenosis, infarction number) were independently associated with stroke recurrence.

Results: Of the 7140 patients included, 584 patients experienced stroke recurrence within 1 year. According to the ABCD score, large artery stenosis was associated with higher stroke recurrence in both low-risk (adjusted hazard ratio, 1.746 [95% CI, 1.200-2.540]) and moderate-risk group (adjusted hazard ratio, 1.326 [95% CI, 1.042-1.687]) but not in the high-risk group (>0.05). Patients with multiple acute infarctions or single acute infarction had a higher risk of recurrent stroke than those with no infarction in both low- and moderate-risk groups, but not in the high-risk group.

Conclusions: Large artery stenosis and infarction number were independent predictors of 1-year stroke recurrence in low-moderate risk but not in high-risk patients with TIA or MIS stratified by ABCD score. This finding emphasizes the importance of early brain and vascular imaging evaluation for risk stratification in patients with TIA or MIS.
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http://dx.doi.org/10.1161/STROKEAHA.120.032424DOI Listing
June 2021

Association of Polyvascular Disease and Elevated Interleukin-6 With Outcomes in Acute Ischemic Stroke or Transient Ischemic Attack.

Front Neurol 2021 13;12:661779. Epub 2021 Apr 13.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Polyvascular disease (PolyVD) and interleukin (IL)-6 are associated with poor outcomes in patients with stroke respectively. However, whether combined PolyVD and elevated IL-6 levels would increase the risk of poor outcomes of stroke patients is yet unclear. Data were obtained from the Third China National Stroke Registry (CNSR-III). PolyVD was defined as acute ischemic stroke (AIS) or transient ischemic attack (TIA) with coronary artery disease (CAD) and/or peripheral artery disease (PAD). Patients were divided into four groups according to the combination of vascular beds number (non-PolyVD or PolyVD) and IL-6 levels (IL-6 < 2.64 pg/mL or IL-6 ≥ 2.64 pg/mL). The primary outcome was a recurrent stroke at 1-year follow-up. Cox proportional hazard models were employed to identify the association of the combined effect of PolyVD and IL-6 with the prognosis of patients. A total of 10,773 patients with IL-6 levels and 1-year follow-up were included. The cumulative incidence of recurrent stroke was 9.87% during the 1-year follow-up. Compared to non-PolyVD and IL-6<2.64 pg/mL patients, patients had non-PolyVD with IL-6 ≥ 2.64 pg/mL (HR 1.245 95%CI 1.072-1.446; < 0.001) and PolyVD with IL-6 <2.64 pg/mL (HR 1.251 95%CI 1.002-1.563; = 0.04) were associated with an increased risk of recurrent stroke during 1-year follow-up. Likewise, patients with PolyVD and IL-6 ≥ 2.64 pg/mL (HR 1.290; 95% CI 1.058-1.572; = 0.01) had the highest risk of recurrent stroke at 1-year follow-up among groups. PolyVD and elevated IL-6 levels are both associated with poor outcomes in patients with AIS or TIA. Moreover, the combination of them increases the efficiency of stroke risk stratification compared with when used alone. More attention and intensive treatment should be given to those patients with both PolyVD and elevated IL-6 levels.
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http://dx.doi.org/10.3389/fneur.2021.661779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076541PMC
April 2021

Current status of aspiration thrombectomy for acute stroke patients in China: data from ANGEL-ACT Registry.

Ther Adv Neurol Disord 2021 12;14:17562864211007715. Epub 2021 Apr 12.

Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.

Background And Aims: Although noninferior to stent retriever (SR) as first-line approach for endovascular treatment (EVT) of acute large vessel occlusion (LVO) stroke, little is known about the current status of direct aspiration (DA) as first-line thrombectomy in China. This analysis of a prospective, nationwide registry (ANGEL-ACT) aimed to investigate the prevalence and comparative effectiveness of DA-first thrombectomy in a real-world practice in China.

Methods: All patients receiving thrombectomy were screened from a prospective cohort of LVO patients undergoing EVT at 111 hospitals in China between November 2017 and March 2019, and divided into two groups based upon which type of thrombectomy was attempted first ("DA-first" and "SR-first"). The following outcome measures were compared using logistic regression models with adjustment: successful recanalization after first-device alone and all procedures, use of rescue treatment, intracranial hemorrhage (ICH) within 24 h, and modified Rankin Scale (mRS) score at 90 days.

Results: A total of 1225 patients, 102 (8.3%) in DA-first group and 1123 (91.7%) in SR-first group, were included. Patients receiving DA-first had less often successful recanalization after first-device alone [30.4 66.4%; odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.15-0.37], more frequent rescue treatment (62.8 27.0%; OR = 4.55, 95% CI = 2.92-7.08) and ICH (35.4 22.1%; OR = 1.78, 95% CI = 1.12-2.83) than those receiving SR-first; however, no significant difference was found in successful recanalization after all procedures (84.3 90.3%;  = 0.18) and 90-day mRS (median: 3 3 points;  = 0.90) between both groups.

Conclusion: This real-world registry suggested that DA-first thrombectomy for acute stroke patients lagged behind in China during the study period. Far fewer DA-first than SR-first thrombectomies were performed, and DA-first was associated with lower first-device recanalization, more frequently requiring rescue treatment, and increased ICH risk.

Clinical Trial Registration: ClinicalTrials.gov, NCT03370939.
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http://dx.doi.org/10.1177/17562864211007715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8047968PMC
April 2021

Clopidogrel Plus Aspirin in Patients With Different Types of Single Small Subcortical Infarction.

Front Neurol 2021 29;12:631220. Epub 2021 Mar 29.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

We aim to investigate the effects and safety of clopidogrel plus aspirin in patients with different types of single small subcortical infarction (SSSI) in the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. SSSI was defined as single DWI lesion of ≤2.0 cm. Patients with SSSI were divided into SSSI + PAD (parent artery disease) and SSSI - PAD, according to the stenosis of the parent artery. The efficacy outcome was stroke recurrence during 90-day follow-up. Cox proportional hazards models or logistic regression models were used to assess the interaction of the treatment effects of clopidogrel plus aspirin vs. aspirin alone among patients with and without PAD. Among 338 patients with SSSI included in the subanalysis, 105 were with PAD and 233 without. The efficacy of clopidogrel plus aspirin compared with aspirin alone on any stroke was consistent between patients with [adjusted hazard ratio (HR) 0.84; 95% confidence interval (CI), 0.25-2.75] and without PAD (adjusted HR 1.03; 95% CI, 0.40-2.68, interaction = 0.83). In patients with SSSI + PAD, the rate of stroke recurrence in those treated with dual antiplatelet therapy and mono antiplatelet therapy was not significantly different (10.9 vs. 13.6%, = 0.77). The number of bleeding events was similar between the clopidogrel-aspirin group and aspirin group regardless of SSSI + PAD or SSSI - PAD. There was no significant difference in the efficacy of clopidogrel plus aspirin compared with aspirin alone between patients with SSSI + PAD and SSSI - PAD in the CHANCE trial. Studies in other populations and with adequate power are needed to further verify such findings.
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http://dx.doi.org/10.3389/fneur.2021.631220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039512PMC
March 2021

Cumulative burden of lipid profiles predict future incidence of ischaemic stroke and residual risk.

Stroke Vasc Neurol 2021 Apr 7. Epub 2021 Apr 7.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Objectives: Incident ischaemic stroke (IS) risk may increase not only with lipids concentration but also with longer duration of exposure. This study aimed to investigate the impact of cumulative burden of lipid profiles on risk of incident IS.

Methods: A total of 43 836 participants were enrolled who participated in four surveys during 2006-2013. Individual cumulative lipid burden was calculated as number of years (2006-2013) multiplied by the levels of low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), non-HDL-C and triglyceride (TG), respectively. The primary outcome was defined as the incident IS during 2012-2017.

Results: During 4.67 years (±0.70 years) follow-up on average, we identified 1023 (2.33%) incident IS. Compared with respective reference groups, the HRs (95% CIs) of the upper tertile in cumulative TG burden, cumulative LDL-C burden, cumulative TC burden and cumulative non-HDL-C burden were 1.26 mmol/L (1.02-1.55 mmol/L), 1.47 mmol/L (1.25-1.73 mmol/L), 1.33 mmol/L (1.12-1.57 mmol/L) and 1.51 mmol/L (1.28-1.80 mmol/L) for incidence of IS, respectively. However, this association was not significant in cumulative HDL-C burden and IS (HR: 1.09; 95% CI: 0.79 to 1.52), after adjustment for confounding variables. Among 16 600 participants with low cumulative LDL-C burden, HRs (95% CI) for TC, TG, non-HDL-C and HDL-C with IS were 1.63 mmol/L (1.03-2.57 mmol/L), 1.65 mmol/L (1.19-2.31 mmol/L), 1.57 mmol/L (1.06-2.32 mmol/L) and 0.98 mmol/L (0.56-1.72 mmol/L), respectively.

Conclusions: We observed the correlation between cumulative burden of lipid profiles, except for cumulative burden of HDL-C, with the risk of incident IS. Cumulative burden of TC, TG and non-HDL-C may still predict IS in patients with low cumulative LDL-C burden.

Trial Registration Number: ChiCTR-TNRC-11001489.
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http://dx.doi.org/10.1136/svn-2020-000726DOI Listing
April 2021

Diabetes modifies the association of prehypertension with cardiovascular disease and all-cause mortality.

J Clin Hypertens (Greenwich) 2021 06 4;23(6):1221-1228. Epub 2021 Apr 4.

Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Prehypertension is a risk factor for cardiovascular disease (CVD) and all-cause mortality. However, it is unclear whether prehypertension combined with diabetes associate with a higher risk for cardiovascular disease and all-cause mortality. The purpose of this study was to explore the relationship between prehypertension and the risk of CVD and all-cause mortality was different among individuals with or without diabetes. In the prospective community-based Kailuan study, 67 344 participants without hypertension or a history of CVD at baseline (2006) were included. Prehypertension was defined as systolic blood pressure of 120-139 mmHg or diastolic blood pressure of 80-89 mmHg. The outcomes were CVD and all-cause mortality were followed up through December 31, 2017. We performed Cox proportional hazards models to evaluate the relationships between prehypertension and CVD and all-cause mortality by diabetes status. During a median follow-up of 11.03 years, 2981 CVD events and 4655 all-cause mortality occurred. After adjusting age, sex, and other factors, the associations of prehypertension with risk of CVD and all-cause mortality were significant in participants without diabetes (hazard ratio and 95% confidence interval: 1.54 [1.38-1.71] and 1.27 [1.17-1.38]), but not in participants with diabetes (1.20 [0.93-1.56] and 0.88 [0.73-1.07]). The interactions between prehypertension and diabetes for the risk of CVD and all-cause mortality were all significant (all p < .05). Prehypertension was only associated with an increased risk for CVD and all-cause mortality in non-diabetes participants. Diabetes modifies the relation of prehypertension with the risk of CVD and all-cause mortality.
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http://dx.doi.org/10.1111/jch.14246DOI Listing
June 2021
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