title: Atherothrombotic burden and medium-term prognosis in patients with acute ischemic stroke: findings of the SIRIO study.
abstract: BACKGROUND
  Short- and medium-term mortality after acute stroke is related to the severity of the index event and the patient's age. However, recent studies have reassessed the prognostic value of the systemic atherothrombotic burden in these patients, not only in the long term. This post hoc analysis of the findings of the SIRIO trial (Stroke in Italy and Related Impact on Outcome) examined the prognostic impact of systemic atherothrombosis.
  
  
  METHODS
  SIRIO was a multicenter observational study enrolling patients during the acute phase of stroke of both ischemic and hemorrhagic origin. The present analysis, however, only covered patients with ischemic stroke. At baseline, the main personal and clinical details were recorded and patients were classified as having either polyvascular disease or single arterial disease on the basis of whether they had symptomatic atherothrombotic disease in other sites besides the cerebrovascular location. For all patients we calculated the Essen Stroke Risk Score (ESRS), dividing them into groups with scores of less than 3 or 3 and more. We recorded total mortality and nonfatal vascular events 12 months after enrolment. Multivariate logistic regression analysis was used to select predictors of medium-term mortality and nonfatal cardiovascular events. There were 2,561 patients with ischemic stroke, 823 of them classified as having polyvascular disease; 940 (out of 2,485) had an ESRS of less than 3 and 1,545 had a score of 3 or more.
  
  
  RESULTS
  The combined endpoint 'death (all causes) and nonfatal cardiovascular events within 12 months of hospital discharge' was significantly dependent on the following factors: ESRS, Rankin scale and National Institutes of Health Stroke Scale scores, and polyvascular disease. Polyvascular disease status significantly affected mortality and nonfatal cardio- and cerebrovascular events after discharge (OR = 1.44, 95% CI = 1.10-1.88). Age was also confirmed as a significant predictor of the combined endpoint.
  
  
  CONCLUSIONS
  Besides age and the clinical severity of the index event, symptomatic involvement of several vascular districts was also an important predictor of mortality and nonfatal cardiovascular events in the medium term in patients with ischemic stroke.
authors.affiliation: Department of Medicine, Vimercate Hospital, Azienda Ospedaliera di Desio e Vimercate, Vimercate, Italy. claudio.cimminiello@aovimercate.org
authors.forename: Claudio
authors.initials: C
authors.lastname: Cimminiello
authors.forename: Augusto
authors.initials: A
authors.lastname: Zaninelli
authors.forename: Antonio
authors.initials: A
authors.lastname: Carolei
authors.forename: Simona
authors.initials: S
authors.lastname: Sacco
authors.forename: Danilo
authors.initials: D
authors.lastname: Toni
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Gensini
mesh_terms: D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D002545:Brain Ischemia / Q000150:complications / Q000401:mortality / Q000473:pathology*; D002423:Cause of Death; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000401:mortality / Q000473:pathology*; D020767:Intracranial Thrombosis / Q000401:mortality / Q000473:pathology*; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants