NDLI: Overlap of diseases underlying ischemic stroke: the ASCOD phenotyping.

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Overlap of diseases underlying ischemic stroke: the ASCOD phenotyping.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Meseguer, Elena Sirimarco, Gaia Adraï, Valérie Amarenco, Pierre Lavallée, Philippa C. Cabrejo, Lucie Guidoux, Céline Mazighi, Mikael Olivot, Jean-Marc Klein, Isabelle F. Steg, Philippe Gabriel Labreuche, Julien Touboul, Pierre-Jean Ratani, Samina Abboud, Halim Kusmierek, Jérôme
Description	Country affiliation: France Author Affiliation: Sirimarco G ( Paris-Diderot University, Sorbonne Paris Cité, Paris, France.)
Abstract	BACKGROUND AND PURPOSE: ASCOD phenotyping (A, atherosclerosis; S, small vessel disease; C, cardiac pathology; O, other causes; and D, dissection) assigns a degree of likelihood to every potential cause (1 for potentially causal, 2 for causality is uncertain, 3 for unlikely causal but disease is present, 0 for absence of disease, and 9 for insufficient workup to rule out the disease) commonly encountered in ischemic stroke. We used ASCOD to investigate the overlap of underlying vascular diseases and their prognostic implication. METHODS: A single rater applied ASCOD in 405 patients enrolled in the Asymptomatic Myocardial Ischemia in Stroke and Atherosclerotic Disease study. RESULTS: A was present in 90% of patients (A1=43% and A2=15%), C in 52% (C1=23% and C2=14%), and S in 66% (S1=11% and S2=2%). On the basis of grades 1 and 2, 25% of patients had multiple underlying diseases, and 80% when all 3 grades were considered. The main overlap was found between A and C; among C1 patients, A was present in 92% of cases (A1=28%, A2=20%, and A3=44%). Conversely, among A1 patients, C was present in 47% of cases (C1=15%, C2=15%, and C3=17%). Grades for C were associated with gradual increase in the 3-year risk of vascular events, whereas risks were similar across A grades, meaning that the mere presence of atherosclerotic disease qualifies for high risk, regardless the degree of likelihood for A. CONCLUSIONS: ASCOD phenotyping shows that the large overlap among the 3 main diseases, and the high prevalence of any form of atherosclerotic disease, reinforces the need to systematically control atherosclerotic risk factors in all ischemic strokes.
ISSN	00392499
e-ISSN	15244628
Journal	Stroke
Issue Number	9
Volume Number	44
Language	English
Publisher	Lippincott Williams & Wilkins (on behalf of the American Heart Association)
Publisher Date	2013-09-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Atherosclerosis Epidemiology Brain Ischemia Cardiovascular Diseases Phenotype Stroke Diagnosis Classification Comorbidity Heart Diseases Prognosis Research Support, Non-u.s. Gov't Discipline Cardiology
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine Neuroscience Advanced and Specialized Nursing Neurology (clinical)

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