Acute care and one-year outcome of Mexican patients with first-ever acute ischemic stroke: the PREMIER study.
BACKGROUND
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.


METHODS
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.


RESULTS
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%.


CONCLUSIONS
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.
Department of Neurology, Instituto Nacional de Ciencias Medicas y de Nutricion Salvador Zubiran, Tlalpan, Mexico. carloscantu_brito@hotmail.com
Carlos
C
Cantú-Brito
José L
JL
Ruiz-Sandoval
Luis M
LM
Murillo-Bonilla
Erwin
E
Chiquete
Carolina
C
León-Jiménez
Antonio
A
Arauz
Jorge
J
Villarreal-Careaga
Ricardo
R
Rangel-Guerra
Alma
A
Ramos-Moreno
Fernando
F
Barinagarrementería
D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D005343:Fibrinolytic Agents