title: Factors Related to Cardioembolism as Major Predictors of Poor Survival after First-Ever Middle Cerebral Artery Stroke Treated with Thrombolysis.
abstract: Prognostic factors related to mortality rates after stroke have been reported; however, most studies included different treatments and did not focus solely on ischemic stroke. The study aimed to report the short- and long-term survival and predictors of death in patients with first-ever ischemic stroke in the middle cerebral artery (MCA) territory, submitted to intravenous thrombolysis (IVT).
  
  
  
  A prospective observational cohort study of patients with first-ever ischemic stroke in the MCA territory treated with IVT from March 2010 to February 2015 was conducted, and patients were followed up until May 2015. The Kaplan-Meier method was used to estimate the cumulative case fatality rates. The potential prognostic factors were identified using Cox proportional hazards regression analysis.
  
  
  
  A total of 169 patients, 51% women of mean age of 64.1 ± 12.9 years were followed up for a median time of 23.6 (8.1-36.2) months. At the end of the study, 53 (31.4%) patients had died. The estimated cumulative case fatality rate was 41.8% for 5 years. Chronic heart failure (hazards ratio [HR] 2.89, 95% CI 1.43-5.84, p = 0.003), atrial fibrillation (HR 3.88, 95% CI 1.30-11.57, p = 0.015), and symptomatic intracerebral hemorrhage (SICH; HR 7.83, 95% CI 3.43-17.92, p < 0.001) were significant unfavorable independent outcome predictors. The most frequent cause of death was infection (46%).
  
  
  
  Stroke in the MCA territory has a high mortality rate, even in patients treated with IVT. SICH, atrial fibrillation, and chronic heart failure are modifiable factors related to cardioembolism that need to be aggressively targeted for improved outcomes after stroke.
authors.affiliation: Department of Neurology, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil.
authors.forename: Renata Dal-Prá
authors.initials: RD
authors.lastname: Ducci
authors.forename: Marcos Christiano
authors.initials: MC
authors.lastname: Lange
authors.forename: Viviane de Hiroki Flumignan
authors.initials: VH
authors.lastname: Zétola
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality; D001938:Brazil / Q000453:epidemiology; D002423:Cause of Death; D002543:Cerebral Hemorrhage / Q000401:mortality; D002908:Chronic Disease; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006331:Heart Diseases / Q000175:diagnosis / Q000401:mortality*; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D007262:Infusions, Intravenous; D020766:Intracranial Embolism / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents