Ischemic strokes in Pakistan: observations from the national acute ischemic stroke database.
BACKGROUND
The objective of this study was to establish a multicenter ischemic stroke registry, first of its kind in Pakistan, to provide insight into the epidemiology, subtypes, and risk factors of ischemic strokes in this country.


METHODS
Four academic centers (3 urban and 1 rural) participated in this project. The inclusion criteria for subjects included adults (>14 years) with acute neurologic deficit, consistent with clinical diagnosis of ischemic stroke and supported by neuroimaging.


RESULTS
Data were available for 874 subjects. Mean age of the subjects was 59.7 years, 60.5% were males, and 18% were young. Large vessel strokes were the most common subtype found in 31.7% subjects, followed by small vessel disease (25.7%) and cardioembolic strokes (10.4%). Almost 32% subjects had ill-defined etiology for their ischemic stroke. Dyslipidemia was a most common risk factor present in 83% patients. Data related to in-hospital complications were available for 808 subjects, of which 233 complications were recorded. Pneumonia was the most common of these seen in 105 (13%) subjects, followed by urinary tract infection (7.2%). Outcome at discharge was recorded for 697 subjects. Ninety-two had died during their hospital stay (13.2%). Only 36% subjects had a favorable outcome at discharge defined as a modified Rankin Scale (mRS) score of 2 or less. A total of 446 of 697 subjects had poor outcome at discharge (defined as an mRS score≥3).


CONCLUSIONS
Hypertension and dyslipidemia were the most common risk factors and large vessel atherosclerosis was the most common stroke etiology. Elderly patients were significantly more likely to have in-hospital complications, die during their hospital stay, and have a higher mRS score at discharge.
Department of Neurology (Medicine), Aga Khan University, Karachi, Pakistan.
Bhojo A
BA
Khealani
Department of Neurology (Medicine), Aga Khan University, Karachi, Pakistan.
Maria
M
Khan
Pakistan Institute of Medical Sciences, Islamabad, Pakistan.
Muhammad
M
Tariq
Liaquat National Hospital, Karachi, Pakistan.
Abdul
A
Malik
Shaheed Benazir Bhutto Medical University, Larkana, Pakistan.
Alam I
AI
Siddiqi
Department of Neurology (Medicine), Aga Khan University, Karachi, Pakistan.
Safia
S
Awan
Department of Neurology (Medicine), Aga Khan University, Karachi, Pakistan. Electronic address: mohammad.wasay@aku.edu.
Mohammad
M
Wasay
D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications*; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D016208:Databases, Factual; D050171:Dyslipidemias / Q000150:complications*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology
Pakistan; Stroke; ischemic; outcome; south Asia