Acute care and one-year outcome of Mexican patients with first-ever acute ischemic stroke: the PREMIER study
Cantú-Brito, C.; Ruiz-Sandoval, J.é L.; Murillo-Bonilla, L.M.; Chiquete, E.; León-Jiménez, C.; Arauz, A.; Villarreal-Careaga, J.; Rangel-Guerra, R.; Ramos-Moreno, A.; Barinagarrementería, F.; Cantú-Brito, C.; Ruiz-Sandoval, J.L.; Murillo-Bonilla, L.; Arauz-Góngora, J.A.; Villarreal-Careaga, J.; Barinagarrementería, F.; Rangel-Guerra, R.; Chiquete, E.
Revista de Neurologia 51(11): 641-649
2010
ISSN/ISBN: 1576-6578 PMID: 21108226 Document Number: 646440
Information on acute care and outcome of Mexican patients with ischaemic stroke is lacking. The aim of this report is to provide results of a first step stroke surveillance system and outcome at one year of follow-up. In the PREMIER study 1,376 patients from 59 Mexican hospitals were included from January 2005 to June 2006. Of these, 1,040 (52% women, mean age 67.5 years) with first-ever cerebral infarction are here analyzed. Five visits were completed during the one year follow-up. Main risk factors were hypertension (64%), obesity (51%) and diabetes (35%). Total anterior circulation stroke syndrome occurred in 19% of patients, partial anterior in 38%, lacunar in 26% and posterior stroke syndrome in 17% cases. In 8% the stroke mechanism was large-artery atherosclerosis, in 18% cardioembolism, in 20% lacunar, in 6% miscellaneous mechanisms and in 42% the mechanism was undetermined, mainly due to a low use of diagnostic resources. Although 17% of patients arrived in < 3 h from stroke onset, only 0.5% had IV thrombolysis. Only 1% received endarterectomy or stenting. The 30-day case fatality rate was 15%. At one-year of follow-up, 47% had a modified Rankin score 0-2 (independent), 23% had 2-5 (dependent) and 29% died. One-year acute ischaemic stroke recurrence rate was 8%. In Mexico a significant proportion of patients arrive on time for thrombolysis, but very few receive this therapy. There is a low use of diagnostic resources to assign aetiology. Thirty-day case fatality rate doubles at 1-year after acute ischaemic stroke.