2023
Recent Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy for Acute Ischemic Stroke
Mac Grory B, Holmes D, Matsouaka R, Shah S, Chang C, Rison R, Jindal J, Holmstedt C, Logan W, Corral C, Mackey J, Gee J, Bonovich D, Walker J, Gropen T, Benesch C, Dissin J, Pandey H, Wang D, Unverdorben M, Hernandez A, Reeves M, Smith E, Schwamm L, Bhatt D, Saver J, Fonarow G, Peterson E, Xian Y. Recent Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy for Acute Ischemic Stroke. JAMA 2023, 329: 2038-2049. PMID: 37338878, PMCID: PMC10282891, DOI: 10.1001/jama.2023.8073.Peer-Reviewed Original ResearchConceptsRisk of sICHSymptomatic intracranial hemorrhageVitamin K antagonistsAcute ischemic strokeSecondary end pointsEndovascular thrombectomyVKA useIschemic strokeHospital mortalityEnd pointIntracranial hemorrhageOral vitamin K antagonistsVitamin K antagonist useGuidelines-Stroke programPrior VKA usePrimary end pointObservational cohort studyLarge vessel occlusionRisk of complicationsAmerican Heart AssociationUse of anticoagulantsSignificant differencesHospital presentationSICH riskAntagonist use
2022
Sex Differences in Endovascular Therapy for Ischemic Stroke: Results From the Get With The Guidelines–Stroke Registry
Demel S, Reeves M, Xu H, Xian Y, Mac Grory B, Fonarow G, Matsouaka R, Smith E, Saver J, Schwamm L. Sex Differences in Endovascular Therapy for Ischemic Stroke: Results From the Get With The Guidelines–Stroke Registry. Stroke 2022, 53: 3099-3106. PMID: 35880521, DOI: 10.1161/strokeaha.122.038491.Peer-Reviewed Original ResearchConceptsEndovascular therapyIschemic strokeHealth Stroke Scale scoreTreatment ratesGuidelines-Stroke hospitalsGuidelines-Stroke registryStroke Scale scoreAcute ischemic strokeSex differencesLarge vessel occlusionMultivariable regression analysisIschemic stroke dischargesEVT useHospital deathHospital mortalityASA guidelinesVessel occlusionOdds ratioScale scoreStroke dischargesSignificant sex differencesWomenNational InstituteMenStatistical adjustment
2021
Clinical Characteristics, Management, and In-Hospital Outcomes in Patients With Stroke or Transient Ischemic Attack in China
Gu H, Yang X, Wang C, Zhao X, Wang Y, Liu L, Meng X, Jiang Y, Li H, Liu C, Wangqin R, Fonarow G, Schwamm L, Xian Y, Li Z, Wang Y. Clinical Characteristics, Management, and In-Hospital Outcomes in Patients With Stroke or Transient Ischemic Attack in China. JAMA Network Open 2021, 4: e2120745. PMID: 34387677, PMCID: PMC8363916, DOI: 10.1001/jamanetworkopen.2021.20745.Peer-Reviewed Original ResearchMeSH KeywordsAgedChinaFemaleHospital MortalityHumansIschemic Attack, TransientMaleQuality ImprovementStrokeConceptsTransient ischemic attackChinese Stroke Center AllianceMajor adverse cardiovascular eventsHospital clinical outcomesQuality improvement studyIschemic strokeIntracerebral hemorrhageIschemic attackClinical characteristicsClinical outcomesPoor outcomeIntravenous recombinant tissue plasminogen activatorTemporal improvementRecombinant tissue plasminogen activatorAdverse cardiovascular eventsIn-Hospital OutcomesUse of anticoagulantsComposite scoreImprovement studyTissue plasminogen activatorMean composite scoreHealth care systemHospital complicationsTIA admissionsTIA careAssociation Between Hospital Volumes and Clinical Outcomes for Patients With Nontraumatic Subarachnoid Hemorrhage
Leifer D, Fonarow G, Hellkamp A, Baker D, Hoh B, Prabhakaran S, Schoeberl M, Suter R, Washington C, Williams S, Xian Y, Schwamm L. Association Between Hospital Volumes and Clinical Outcomes for Patients With Nontraumatic Subarachnoid Hemorrhage. Journal Of The American Heart Association 2021, 10: e018373. PMID: 34325522, PMCID: PMC8475679, DOI: 10.1161/jaha.120.018373.Peer-Reviewed Original ResearchConceptsAnnual case volumeComprehensive Stroke Center (CSC) certificationStroke center certificationNational Inpatient SampleSubarachnoid hemorrhageNontraumatic subarachnoid hemorrhageCase volumeHospital mortalityClinical outcomesPoor outcomeCenter certificationSAH casesBetter outcomesVolume thresholdHospital annual case volumeHospital case volumeCases/yearBackground Previous studiesLogistic regression modelsSAH hospitalizationsHospital volumeAneurysm obliterationInpatient SampleOdds ratioImproved outcomesAcute Ischemic Stroke in Patients With COVID-19
Srivastava P, Zhang S, Xian Y, Xu H, Rutan C, Alger H, Walchok J, Williams J, de Lemos J, Decker-Palmer M, Alhanti B, Elkind M, Messé S, Smith E, Schwamm L, Fonarow G. Acute Ischemic Stroke in Patients With COVID-19. Stroke 2021, 52: 1826-1829. PMID: 33728926, DOI: 10.1161/strokeaha.121.034301.Peer-Reviewed Original ResearchClinical Characteristics and Outcomes Associated With Oral Anticoagulant Use Among Patients Hospitalized With Intracerebral Hemorrhage
Xian Y, Zhang S, Inohara T, Grau-Sepulveda M, Matsouaka RA, Peterson ED, Piccini JP, Smith EE, Sheth KN, Bhatt DL, Fonarow GC, Schwamm LH. Clinical Characteristics and Outcomes Associated With Oral Anticoagulant Use Among Patients Hospitalized With Intracerebral Hemorrhage. JAMA Network Open 2021, 4: e2037438. PMID: 33591368, PMCID: PMC7887660, DOI: 10.1001/jamanetworkopen.2020.37438.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAnticoagulantsCase-Control StudiesCerebral HemorrhageCohort StudiesDependent AmbulationDrug Therapy, CombinationDual Anti-Platelet TherapyFactor Xa InhibitorsFemaleFunctional StatusHospicesHospital MortalityHumansMaleMiddle AgedOdds RatioPatient DischargePlatelet Aggregation InhibitorsRegistriesRisk FactorsWarfarinConceptsOral anticoagulant useOral anticoagulantsFXa inhibitorsHospital mortalityAnticoagulant useCohort studyIndependent ambulationMRS scoreIntracerebral hemorrhageGuidelines-Stroke registryCardiovascular risk factorsHospital mortality riskFactor Xa inhibitorsConcomitant warfarinOral anticoagulationAnticoagulation therapyAntiplatelet therapyHospital outcomesClinical characteristicsRankin ScaleSecondary outcomesPrimary outcomeRisk factorsWorse outcomesHigh prevalence
2020
Safety and Outcomes of Intravenous tPA in Acute Ischemic Stroke Patients With Prior Stroke Within 3 Months
Shah S, Liang L, Kosinski A, Hernandez A, Schwamm L, Smith E, Fonarow G, Bhatt D, Feng W, Peterson E, Xian Y. Safety and Outcomes of Intravenous tPA in Acute Ischemic Stroke Patients With Prior Stroke Within 3 Months. Circulation Cardiovascular Quality And Outcomes 2020, 13: e006031. PMID: 31903770, DOI: 10.1161/circoutcomes.119.006031.Peer-Reviewed Original ResearchMeSH KeywordsAdministrative Claims, HealthcareAgedAged, 80 and overBrain IschemiaDatabases, FactualFemaleFibrinolytic AgentsHospital MortalityHumansInfusions, IntravenousIntracranial HemorrhagesMaleMedicareRecurrenceRegistriesRetrospective StudiesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTime FactorsTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsAcute ischemic stroke patientsPrior ischemic strokeSymptomatic intracranial hemorrhageIschemic stroke patientsPrior strokeHospital mortalityIntravenous tPAIschemic strokeIntracranial hemorrhageStroke patientsGuidelines-Stroke hospitalsHigher stroke severityGood functional outcomeHistory of strokeRetrospective observational studyYears of ageCardiovascular comorbiditiesStroke providersStroke severityUnadjusted riskFunctional outcomeHigh prevalenceObservational studyMedicare claimsElevated risk
2019
Recent Myocardial Infarction is Associated With Increased Risk in Older Adults With Acute Ischemic Stroke Receiving Thrombolytic Therapy
Inohara T, Liang L, Kosinski A, Smith E, Schwamm L, Hernandez A, Bhatt D, Fonarow G, Peterson E, Xian Y. Recent Myocardial Infarction is Associated With Increased Risk in Older Adults With Acute Ischemic Stroke Receiving Thrombolytic Therapy. Journal Of The American Heart Association 2019, 8: e012450. PMID: 31327296, PMCID: PMC6761665, DOI: 10.1161/jaha.119.012450.Peer-Reviewed Original ResearchConceptsRecombinant tissue-type plasminogen activatorRecent myocardial infarctionAcute ischemic strokeHistory of MIRisk of mortalityMyocardial infarctionAIS patientsIschemic strokeIntravenous recombinant tissue-type plasminogen activatorST-segment elevation myocardial infarctionSegment elevation myocardial infarctionMultivariate logistic regression modelGuidelines-Stroke hospitalsOnly medical therapyElevation myocardial infarctionTissue-type plasminogen activatorLogistic regression modelsHospital mortalityHospital outcomesSevere strokeMedical therapyThrombolytic therapyHigh riskInfarctionPatientsThrombolysis in young adults with stroke: Findings from Get With The Guidelines-Stroke.
Dodds J, Xian Y, Sheng S, Fonarow G, Bhatt D, Matsouaka R, Schwamm L, Peterson E, Smith E. Thrombolysis in young adults with stroke: Findings from Get With The Guidelines-Stroke. Neurology 2019, 92: e2784-e2792. PMID: 31092622, DOI: 10.1212/wnl.0000000000007653.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeTissue plasminogen activatorIschemic strokeOlder patientsYounger patientsYears of ageSymptomatic intracranial hemorrhage rateYoung adultsGuidelines-Stroke registryIntracranial hemorrhage rateGuidelines-StrokeHospital mortalityHospital arrivalHemorrhage rateIntracranial hemorrhageMultivariable modelPatientsBetter outcomesStrokePlasminogen activatorTPA treatmentTreatmentAdultsAgeOutcomesIntravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Patients With History of Stroke Plus Diabetes Mellitus
Ehrlich M, Liang L, Xu H, Kosinski A, Hernandez A, Schwamm L, Smith E, Fonarow G, Bhatt D, Peterson E, Xian Y. Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Patients With History of Stroke Plus Diabetes Mellitus. Stroke 2019, 50: 1497-1503. PMID: 31035901, PMCID: PMC6538420, DOI: 10.1161/strokeaha.118.024172.Peer-Reviewed Original ResearchConceptsIntravenous tissue-type plasminogen activatorSymptomatic intracerebral hemorrhageAcute ischemic strokeHistory of strokeTissue-type plasminogen activatorIschemic stroke patientsDiabetes mellitusIschemic strokeIntracerebral hemorrhagePlasminogen activatorStroke patientsUnadjusted ratesAcute ischemic stroke patientsBaseline clinical factorsConcomitant diabetes mellitusECASS III trialGuidelines-Stroke registryPrior ischemic strokeCardiovascular risk factorsHospital mortalityPrior strokeSevere strokeIII trialsClinical factorsRisk factorsComparison of Clinical Care and In-Hospital Outcomes of Asian American and White Patients With Acute Ischemic Stroke
Song S, Liang L, Fonarow G, Smith E, Bhatt D, Matsouaka R, Xian Y, Schwamm L, Saver J. Comparison of Clinical Care and In-Hospital Outcomes of Asian American and White Patients With Acute Ischemic Stroke. JAMA Neurology 2019, 76: 430-439. PMID: 30667466, PMCID: PMC6459126, DOI: 10.1001/jamaneurol.2018.4410.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAsianBrain IschemiaFemaleFibrinolytic AgentsHealthcare DisparitiesHospital MortalityHumansHydroxymethylglutaryl-CoA Reductase InhibitorsIntracranial HemorrhagesLogistic ModelsMaleMiddle AgedMultivariate AnalysisPatient DischargeQuality of Health CareRetrospective StudiesSeverity of Illness IndexStrokeStroke RehabilitationThrombolytic TherapyTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeUnited StatesWhite PeopleConceptsAcute ischemic strokeAsian American patientsIschemic strokeWhite patientsAmerican patientsClinical outcomesHospital mortalityStroke severityAmerican Heart Association/American Stroke AssociationIntravenous tissue plasminogen activator administrationTissue plasminogen activator administrationMultivariable logistic regression modelGreater stroke severityGuidelines-Stroke programGWTG-Stroke hospitalsIntensive statin therapyOverall stroke incidenceIn-Hospital OutcomesSevere ischemic strokeWorse functional outcomeAmerican Stroke AssociationQuality improvement registryLogistic regression modelsRace/ethnicityStatin therapyUse, Temporal Trends, and Outcomes of Endovascular Therapy After Interhospital Transfer in the United States
Shah S, Xian Y, Sheng S, Zachrison KS, Saver JL, Sheth KN, Fonarow GC, Schwamm LH, Smith EE. Use, Temporal Trends, and Outcomes of Endovascular Therapy After Interhospital Transfer in the United States. Circulation 2019, 139: 1568-1577. PMID: 30700144, PMCID: PMC6816244, DOI: 10.1161/circulationaha.118.036509.Peer-Reviewed Original ResearchConceptsEndovascular therapyInterhospital transferHospital outcomesIschemic strokeMultivariable logistic regression modelSymptomatic intracranial hemorrhageAcute ischemic strokeComprehensive stroke centerLarge vessel occlusionRisk-adjusted modelsLogistic regression modelsEVT outcomesGuidelines-StrokeHospital mortalityStroke centersIndependent ambulationPivotal trialsStroke careIntracranial hemorrhageVessel occlusionEVT casesStroke systemsWhite racePatientsFurther evaluationRelation of Admission Blood Pressure to In-hospital and 90-Day Outcomes in Patients Presenting With Transient Ischemic Attack
Bangalore S, Schwamm L, Smith E, Hellkamp A, Xian Y, Schulte P, Saver J, Fonarow G, Bhatt D, Committee and Investigators F. Relation of Admission Blood Pressure to In-hospital and 90-Day Outcomes in Patients Presenting With Transient Ischemic Attack. The American Journal Of Cardiology 2019, 123: 1083-1095. PMID: 30685057, DOI: 10.1016/j.amjcard.2018.12.037.Peer-Reviewed Original ResearchConceptsTransient ischemic attackSystolic blood pressureAdmission blood pressureDiastolic blood pressureMean arterial pressureBlood pressureIschemic attackPulse pressureHospital outcomesPostdischarge outcomesArterial pressureLower admission systolic blood pressureAdmission systolic blood pressureHigher admission blood pressureLower systolic blood pressureGuidelines-Stroke registryMajor cardiovascular eventsAdmission systolicPostdischarge mortalityCardiovascular eventsCardiovascular readmissionHospital deathInverse associationHigh riskPatients
2018
Temperature and Precipitation Associate With Ischemic Stroke Outcomes in the United States
Chu SY, Cox M, Fonarow GC, Smith EE, Schwamm L, Bhatt DL, Matsouaka RA, Xian Y, Sheth KN. Temperature and Precipitation Associate With Ischemic Stroke Outcomes in the United States. Journal Of The American Heart Association 2018, 7: e010020. PMID: 30571497, PMCID: PMC6404452, DOI: 10.1161/jaha.118.010020.Peer-Reviewed Original ResearchShock Index Predicts Patient‐Related Clinical Outcomes in Stroke
Myint P, Sheng S, Xian Y, Matsouaka R, Reeves M, Saver J, Bhatt D, Fonarow G, Schwamm L, Smith E. Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke. Journal Of The American Heart Association 2018, 7: e007581. PMID: 30371191, PMCID: PMC6222962, DOI: 10.1161/jaha.117.007581.Peer-Reviewed Original ResearchConceptsShock indexClinical outcomesWorse outcomesPatient-related clinical outcomesHealth Stroke ScaleBlood pressure componentsAcute stroke casesRankin Scale scoreSystolic blood pressureUseful prognostic indicatorMortality prediction modelIndividual stroke subtypesLinear spline modelsHospital mortalityHospital outcomesHospital stayStroke ScaleAcute strokeDischarge destinationBlood pressureStroke subtypesPoint of carePoor outcomePrognostic valueStroke casesRates, Characteristics, and Outcomes of Patients Transferred to Specialized Stroke Centers for Advanced Care
Ali S, Fonarow G, Liang L, Xian Y, Smith E, Bhatt D, Schwamm L. Rates, Characteristics, and Outcomes of Patients Transferred to Specialized Stroke Centers for Advanced Care. Circulation Cardiovascular Quality And Outcomes 2018, 11: e003359. PMID: 30354551, DOI: 10.1161/circoutcomes.116.003359.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCentralized Hospital ServicesDisability EvaluationFemaleHealthcare DisparitiesHospital MortalityHumansMaleMiddle AgedPatient AdmissionPatient TransferRecovery of FunctionRegistriesRetrospective StudiesRisk AssessmentRisk FactorsStrokeTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsSpecialized stroke centersStroke centersHospital mortalityAIS casesPrevious stroke/transient ischemic attackStroke/transient ischemic attackHealth Stroke Scale scoreHigher median National InstitutesWorse short-term outcomesAcute ischemic stroke careGuidelines-Stroke registryMedian National InstitutesOutcomes of patientsStroke Scale scoreTransient ischemic attackShort-term outcomesIschemic stroke careTransfer of patientsMidwest teaching hospitalInstitutional mortality ratesIschemic attackMultivariable adjustmentBaseline characteristicsRankin ScaleClinical outcomesQuality of care for ischemic stroke in China vs India: Findings from national clinical registries.
Li Z, Pandian J, Sylaja P, Wang Y, Zhao X, Liu L, Wang C, Khurana D, Srivastava M, Kaul S, Arora D, Schwamm L, Wang Y, Singhal A. Quality of care for ischemic stroke in China vs India: Findings from national clinical registries. Neurology 2018, 91: e1348-e1354. PMID: 30158158, PMCID: PMC6177271, DOI: 10.1212/wnl.0000000000006291.Peer-Reviewed Original ResearchConceptsChina National Stroke Registry IIGreater stroke severityStroke risk factorsRisk factorsStroke severityClinical outcomesStroke careIndian patientsAcademic stroke centerNational clinical registryIschemic stroke patientsBurden of strokeIschemic stroke careDifferent risk factorsQuality of careHospital mortalityIschemic strokeStroke centersAcute managementStroke patientsStroke ProjectChinese patientsClinical registryWorse outcomesAcademic hospitalEffect of a Multifaceted Quality Improvement Intervention on Hospital Personnel Adherence to Performance Measures in Patients With Acute Ischemic Stroke in China: A Randomized Clinical Trial
Wang Y, Li Z, Zhao X, Wang C, Wang X, Wang D, Liang L, Liu L, Wang C, Li H, Shen H, Bettger J, Pan Y, Jiang Y, Yang X, Zhang C, Han X, Meng X, Yang X, Kang H, Yuan W, Fonarow G, Peterson E, Schwamm L, Xian Y, Wang Y. Effect of a Multifaceted Quality Improvement Intervention on Hospital Personnel Adherence to Performance Measures in Patients With Acute Ischemic Stroke in China: A Randomized Clinical Trial. JAMA 2018, 320: 245-254. PMID: 29959443, DOI: 10.1001/jama.2018.8802.Peer-Reviewed Original ResearchConceptsMultifaceted quality improvement interventionAcute ischemic strokeQuality improvement interventionsEvidence-based performance measuresIschemic strokeImprovement interventionsControl groupUsual careClinical trialsIntervention groupEvidence-based stroke careCluster-randomized clinical trialClinical vascular eventsCo-primary outcomesLong-term outcomesHospital mortalityStroke RegistryVascular eventsSecondary outcomesPrimary outcomeStroke careCare protocolsClinical pathwayMAIN OUTCOMEPatientsComparison of Acute Ischemic Stroke Care and Outcomes Between Comprehensive Stroke Centers and Primary Stroke Centers in the United States
Man S, Zhao X, Uchino K, Hussain M, Smith E, Bhatt D, Xian Y, Schwamm L, Shah S, Khan Y, Fonarow G. Comparison of Acute Ischemic Stroke Care and Outcomes Between Comprehensive Stroke Centers and Primary Stroke Centers in the United States. Circulation Cardiovascular Quality And Outcomes 2018, 11: e004512. PMID: 29794035, PMCID: PMC5978771, DOI: 10.1161/circoutcomes.117.004512.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBrain IschemiaCertificationComprehensive Health CareDelivery of Health Care, IntegratedEmergency Service, HospitalEndovascular ProceduresFemaleHospital MortalityHospitalsHumansMaleMiddle AgedOutcome and Process Assessment, Health CarePatient AdmissionPatient TransferQuality ImprovementQuality Indicators, Health CareRecovery of FunctionRegistriesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTreatment OutcomeUnited StatesConceptsPrimary stroke centerEmergency department admissionsStroke center certificationAcute ischemic strokeIschemic stroke careStroke centersStroke careDepartment admissionsHospital mortalityHospital outcomesIntravenous tPAIschemic strokeCenter certificationTPA timeComprehensive Stroke Center (CSC) certificationAcute ischemic stroke careMultivariable logistic regression modelAcute reperfusion therapyAcute stroke triageBrain Attack CoalitionDefect-free careComprehensive stroke centerOverall care qualityLogistic regression modelsGuidelines-StrokeAssociation of Intracerebral Hemorrhage Among Patients Taking Non–Vitamin K Antagonist vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital Mortality
Inohara T, Xian Y, Liang L, Matsouaka R, Saver J, Smith E, Schwamm L, Reeves M, Hernandez A, Bhatt D, Peterson E, Fonarow G. Association of Intracerebral Hemorrhage Among Patients Taking Non–Vitamin K Antagonist vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital Mortality. JAMA 2018, 319: 463-473. PMID: 29372247, PMCID: PMC5839299, DOI: 10.1001/jama.2017.21917.Peer-Reviewed Original ResearchConceptsHospital mortalityDual antiplatelet agentsIntracerebral hemorrhagePrior useOral anticoagulantsAntiplatelet agentsLower riskVitamin K Antagonist Oral AnticoagulantsK Antagonist Oral AnticoagulantsNon-vitamin K antagonistsGuidelines-Stroke hospitalsPrior antiplatelet therapyHospital mortality rateOral anticoagulant useRetrospective cohort studyWarfarin-treated patientsUse of OACInteraction p valuePrior strokeAnticoagulation therapyAntiplatelet therapyK antagonistsAnticoagulant useCohort studyHospital arrival