S. Greisenegger - Academia.edu (original) (raw)

Papers by S. Greisenegger

Stroke, 2002

Background and Purpose— Statins reduce the risk of myocardial infarction and stroke in patients w... more Background and Purpose— Statins reduce the risk of myocardial infarction and stroke in patients with vascular disease. Inappropriate serum lipid determination and underuse of statins have been documented in patients with coronary artery disease. Evaluation of hyperlipidemia and treatment with statins in patients with recent ischemic cerebrovascular events have not yet been investigated. Methods— We determined the frequency of total cholesterol (TC) and low-density lipoprotein cholesterol measurements and the use of statins in a multicenter prospective cohort study of 1743 patients with acute ischemic stroke or transient ischemic attack (TIA). Using multivariate logistic regression analysis, we determined the influence of several clinical variables on lipid measurements and the prescription of statins at hospital discharge. Results— TC was measured in 90% and low-density lipoprotein cholesterol was measured in 48% of the patients. Differences between the centers accounted for most of...

The Lancet. Neurology, Jan 28, 2018

Patent foramen ovale (PFO) is a contributor to embolic stroke of undetermined source (ESUS). Subg... more Patent foramen ovale (PFO) is a contributor to embolic stroke of undetermined source (ESUS). Subgroup analyses from previous studies suggest that anticoagulation could reduce recurrent stroke compared with antiplatelet therapy. We hypothesised that anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, would reduce the risk of recurrent ischaemic stroke compared with aspirin among patients with PFO enrolled in the NAVIGATE ESUS trial. NAVIGATE ESUS was a double-blinded, randomised, phase 3 trial done at 459 centres in 31 countries that assessed the efficacy and safety of rivaroxaban versus aspirin for secondary stroke prevention in patients with ESUS. For this prespecified subgroup analysis, cohorts with and without PFO were defined on the basis of transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE). The primary efficacy outcome was time to recurrent ischaemic stroke between treatment groups. The primary safety outcome was major bleeding,...

Stroke; a journal of cerebral circulation, 2015

Premature death after transient ischemic attack or stroke is more often because of heart disease ... more Premature death after transient ischemic attack or stroke is more often because of heart disease or cancer than stroke. Previous studies found blood biomarkers not usefully predictive of nonfatal stroke but possibly of all-cause death. This association might be explained by potentially treatable occult cardiac disease or cancer. We therefore aimed to validate the association of a panel of biomarkers with all-cause death, particularly cardiac death and cancer death, despite the absence of associations with risk of nonfatal vascular events. Fifteen biomarkers were measured in 929 consecutive patients in a population-based study (Oxford Vascular Study), recruited from 2002 and followed up to 2013. Associations were determined by Cox regression. Model discrimination was assessed by c-statistic and the integrated discrimination improvement. During 5560 patient-years of follow-up, none of the biomarkers predicted risk of nonfatal vascular events. However, soluble tumor necrosis factor α r...

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin, 2014

ABSTRACT Purpose: To relate the occurrence of incontinence due to acute ischemic stroke (AIS) by ... more ABSTRACT Purpose: To relate the occurrence of incontinence due to acute ischemic stroke (AIS) by demographic factors, concomitant diseases, and severity of stroke and to investigate the associations of incontinence due to stroke with early clinical outcome within the first week after event. Materials and Methods: Of 2 659 consecutive inpatients with AIS who were admitted within 72 h of symptom onset, patients with de novo incontinence after event (n = 303, m:f = 131: 172, age: median = 74a, min = 25, max = 95) were analyzed in comparison to continent patients (n = 1 494, m: f = 877: 617, age: median = 67a, min = 18, max = 93). The occurrence of incontinence due to stroke was measured by history taking and clinical examination. The occurrence of incontinence due to stroke was analyzed in relation to concomitant diseases, medical complications occurring within the 1st week after admission, the National Institute of Health Stroke Scale 24-36 h after admission (NIHSS), and the modified Rankin Scale at 5-7 days after admission (mRS). Results: In patients admitted due to acute stroke age (p < 0.0001), NIHSS (p < 0.0001), fever prior to stroke (p = 0.0070), dementia prior to stroke (p = 0.0246), and female sex (p = 0.0391) were associated with incontinence. A stepwise logistic regression model identified NIHSS (p < 0.0001), age (p = 0.0052), incontinence (p = 0.0076), female sex (p = 0.0128), and prior stroke (p = 0.0275) as significant risk factors for a mRS = 3. As compared to continent patients these patients were significantly more affected from complications like fever (8 % vs. 1.5 %, p < 0.0001), pneumonia (7 % vs. 0.7 %, p < 0.0001), heart failure (6 % vs. 0.5 %, p < 0.0001), hemorrhagic transformation of ischemic stroke (4 % vs. 0.3 %, p < 0.0001), and urinary tract infection (4 % vs. 0.5 %, p < 0.0007). Conclusions: In comparison to continent patients, incontinent patients had a worse functional outcome, more early vascular complications, and infections. Higher age and stroke severity may be predisposing factors for poor functional outcome.

Stroke, 2012

Background and Purpose-We compared among young patients with ischemic stroke the distribution of ... more Background and Purpose-We compared among young patients with ischemic stroke the distribution of vascular risk factors among sex, age groups, and 3 distinct geographic regions in Europe. Methods-We included patients with first-ever ischemic stroke aged 15 to 49 years from existing hospital-or population-based prospective or consecutive young stroke registries involving 15 cities in 12 countries. Geographic regions were defined as northern (Finland, Norway), central (Austria,

Stroke, 2004

Background and Purpose— Increased mean platelet volume (MPV), indicating higher platelet reactivi... more Background and Purpose— Increased mean platelet volume (MPV), indicating higher platelet reactivity, is associated with an increased risk of myocardial infarction. Higher levels of MPV have been found in patients with acute ischemic stroke than in control subjects. Data from smaller studies regarding an association between MPV and stroke severity and outcome have been controversial. If such an association exists, MPV might help to identify patients at increased risk of a severe course of acute cerebrovascular disease. Methods— Within a multicenter, cross-sectional study nested in a cohort, we analyzed the relation between MPV and stroke severity as determined by the modified Rankin Scale after 1 week in 776 patients with acute ischemic stroke or transient ischemic attack. By multivariate logistic regression modeling, we determined the influence of MPV on stroke severity, adjusting for potential confounding factors. Results— Patients within the highest quintile of MPV had a significa...

Stroke, 2014

A lthough increasing rates of patients with acute ischemic stroke (IS) receive recombinant tissue... more A lthough increasing rates of patients with acute ischemic stroke (IS) receive recombinant tissue plasminogen activator (rt-PA) treatment, 1,2 a substantial proportion of patients is still left untreated. Many of these patients are excluded based on criteria lacking a clear scientific basis. 3 Apart from missing the time window of 4.5 hours, a frequent reason for withholding treatment is presentation with mild deficit. 4,5 Previous studies detected poor outcome in ≈29% of patients with mild or rapidly improving symptoms not receiving thrombolysis. 6-8 To date, patients with mild stroke were underrepresented in randomized studies of rt-PA. 9,10 In the recently published Third International Stroke Trial (IST-3), a significant trend toward larger effects of treatment in more severe strokes was found, and no benefit of rt-PA treatment was detected in the subgroup of patients with mild stroke. 9 However, the study was underpowered to analyze subgroup effects. Moreover, the term mild deficit has not been clearly defined across previous studies and several different definitions have been used. 9-13 We analyzed within a prospective nationwide cohort of patients with acute IS (Austrian Stroke Unit Registry, ASUR) whether patients with mild deficit benefited from thrombolysis by comparing matched pairs of patients with mild deficit with and without rt-PA treatment. Patients and Methods Patients Since 2003, a growing network of Austrian stroke units is collecting data on standard characteristics and acute management of all patients with stroke admitted to 1 of the currently 35 participating centers. Experienced stroke neurologists are performing data collection and rating using standardized definitions for variables and scores. To ensure high data quality, immediate data entry is obligatory. Evaluations were done at the time of admission to and discharge from the stroke unit and supplemented by a 3-month follow-up call. The resulting Web-based database includes online plausibility checks. In the biannual meetings of stroke neurologists, details about scoring procedures and variable assessment are thoroughly discussed. Details on this Background and Purpose-Apart from missing the approved time window of 4.5 hours, one frequent cause for withholding recombinant tissue plasminogen activator (rt-PA) treatment in patients with ischemic stroke is presentation with mild deficit on admission. We analyzed in a large cohort of patients whether rt-PA treatment is beneficial for this group of patients. Methods-From a total of 54 917 patients with ischemic stroke prospectively enrolled in the Austrian Stroke Unit Registry, 890 patients with mild deficit defined as ≤5 points in the National Institutes of Health Stroke Scale treated with and without rt-PA were matched for age, sex, prestroke disability, stroke severity, hypertension, diabetes mellitus, hypercholesterolemia, stroke cause, and clinical stroke syndrome. Functional outcome was assessed using the modified Rankin Scale at 3 months. For data visualization, weighted averages of outcome differences were computed for all age severity combinations and mapped to a color. For quantification of effect sizes, numbers need to treat were calculated. Results-rt-PA-treated patients with mild deficit had a better outcome after 3 months compared with matched cases without rt-PA treatment (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.17-1.89; P<0.001). In rt-PA-treated patients with mild deficit, the numbers need to treat ranged from 8 to 14. Improvement achieved by rt-PA treatment was observed along the entire age range. Conclusions-In our study, intravenous rt-PA treatment was beneficial for patients with mild deficit. Given the observational nature of these results, our data might serve as an incentive for future randomized controlled trials to provide a basis for optimal patient selection. (Stroke. 2014;45:765-769.

Stroke, 2007

Background and Purpose— A Thr>Pro polymorphism at codon 715 in the coding region of the P-sele... more Background and Purpose— A Thr>Pro polymorphism at codon 715 in the coding region of the P-selectin gene has recently been described. Individuals carrying the Pro715 allele were reported to have a reduced risk of myocardial infarction. A possible association of this polymorphism with the risk of ischemic stroke is currently under discussion. Methods— We investigated the prevalence of the 715 Thr>Pro polymorphism in 450 patients aged younger than 60 years with ischemic stroke or transient ischemic attack and in 450 controls without vascular disease matched for age and gender. We also investigated possible interactions of the polymorphism with other vascular risk factors, stroke severity and stroke etiology. Results— The distribution of the two allelic variants of the 715Thr>Pro polymorphism did not differ significantly between patients and control subjects (78% versus 81% for Thr/Thr, 21% versus 18% for Thr/Pro and 1% versus 1% for Pro/Pro in patients and controls, respective...

Stroke, 2003

Background and Purpose-Data regarding hereditary influences on stroke remain controversial. We in... more Background and Purpose-Data regarding hereditary influences on stroke remain controversial. We investigated possible associations of a family history of stroke with clinical parameters in a large cohort of well-documented patients with ischemic cerebrovascular events, with special reference to sex-specific differences. Methods-We analyzed the association between a maternal and/or paternal history of stroke and clinical parameters in 1564 patients with known maternal and paternal history of stroke and suffering from ischemic stroke or transient ischemic attack within the Vienna Stroke Registry. Results-Patients with a maternal history of stroke were significantly more often female (54%) than those without (44%; Pϭ0.003). Hypertension was more prevalent in female patients with than in those without a maternal history of stroke (87% versus 74%; Pϭ0.001). These associations remained significant after multivariate adjustment (adjusted odds ratio, 1.9; 95% CI, 1.1 to 3.5; Pϭ0.024). Of those female patients with an echocardiogram (nϭ225), those with a maternal history of stroke more often had left ventricular hypertrophy (48%) than those without (20%) (adjusted odds ratio, 3.6; 95% CI, 1.5 to 8.2; Pϭ0.003). In contrast, hypertension was equally prevalent in male patients with or without a maternal history of stroke (75% versus 74%; Pϭ0.754). We found no significant associations of clinical parameters with a paternal history of stroke. Conclusions-Our results indicate a sex-specific relationship between a maternal history of stroke and the prevalence of hypertension and left ventricular hypertrophy in female patients with ischemic cerebrovascular events. (Stroke. 2003; 34:2114-2119.

Stroke, 2005

Background and Purpose-Headache is a common symptom in acute ischemic and hemorrhagic stroke, but... more Background and Purpose-Headache is a common symptom in acute ischemic and hemorrhagic stroke, but many aspects of its association with other clinical factors are controversial. Methods-We analyzed characteristics of headache symptoms at stroke onset and associations between headache at stroke onset and at several clinical parameters in 2196 patients experiencing ischemic stroke or transient ischemic attack within a multicenter hospital-based stroke registry. Results-Five hundred eighty-eight (27%) patients experienced headache at stroke onset. In a multivariate analysis, headache at stroke onset was positively associated with female sex, history of migraine, younger age, cerebellar stroke (but not with other brain stem locations), and blood pressure values on admission Ͻ120 mm Hg systolic and Ͻ70 mm Hg diastolic. It showed no significant association with stroke severity measured by the modified Rankin Scale at days 5 to 7 after the event, presumed etiology, or time of day. Conclusions-Our results, derived from a large number of systematically documented patients with acute ischemic cerebrovascular events, show no association of headache with stroke etiology or outcome. Our results indicate that the previously described association of headache with vertebrobasilar stroke is mainly because of its association with cerebellar stroke. We could confirm previously described associations of headache at stroke onset with younger age and a history of migraine, implicating a careful evaluation of young patients with a focal neurological deficit and a history of migraine to avoid misclassification as "complicated migraine." (Stroke. 2005;36:e1-e3.

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin, 2010

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin, 2013

Journal of the Neurological Sciences, 2013

Journal of the Neurological Sciences, 2004

Objective: Treatment with statins reduces the risk of ischemic stroke among patients at increased... more Objective: Treatment with statins reduces the risk of ischemic stroke among patients at increased risk for vascular disease. Recent experimental data suggest neuroprotective properties of statins in acute cerebral ischemia. We investigated whether a premedication with statins is associated with a better outcome in patients with acute ischemic cerebrovascular events. Methods: Within a cross-sectional study, nested in a cohort we identified 1691 patients with a recent ischemic stroke or transient ischemic attack. Clinical severity of the vascular event was evaluated by the modified Rankin Scale (mRS) after 1 week. By means of multivariate logistic regression modeling, we determined the influence of prior statin use on stroke severity with adjustment for potential confounding factors. Results: Severe stroke, defined as a modified Rankin Scale of 5 or 6 (n = 231; 14%), was less frequent in patients receiving statin treatment before the event (6% vs. 14%, OR = 0.37; 95% CI 0.19 to 0.74; p = 0.004). This association remained significant after adjustment for confounding factors. We found a significant interaction between the presence of diabetes and the effect of pretreatment with statins on stroke outcome. Of the patients with diabetes, none of those on statin treatment but 16% of those without a statin had a bad outcome. After exclusion of the group of diabetic patients with prior statin medication, the protective effect was reduced and not statistically significant anymore. Conclusions: Pretreatment with statins seems to be associated with reduced clinical severity in patients with acute ischemic cerebrovascular events, particularly in patients with diabetes.

Journal of Neurology, 2006

It is unclear whether prior therapy with antiplatelet agents (APA) is associated with a better ou... more It is unclear whether prior therapy with antiplatelet agents (APA) is associated with a better outcome in patients with acute ischemic cerebrovascular events. Within a multi-center cross-sectional study, nested in a cohort we analyzed the relation between prior therapy with APA and stroke severity in 1643 patients with acute ischemic stroke or TIA. Clinical severity of the vascular event was evaluated by the National Institutes of Health Stroke Scale on admission (NIHSS1) and after 1 week (NIHSS2). By means of analysis of variance we analyzed a possible association of APA with stroke severity and interactions regarding stroke severity between APA and other clinical measures. 475 patients (29 %) received aspirin prior to the cerebrovascular event, 51 patients (3 %) ticlopidine or clopidogrel and 26 patients (1.6%) aspirin combined with extended release dipyridamole. 66% (1091) of patients did not take any antiplatelet medication. Neither the NIHSS1 nor the NIHSS2 nor the change of stroke severity between these time points (NIHSS1- NIHSS2) was associated with prior APA medication. We did not find significant interactions between APA use and clinical measures regarding stroke severity. Our results do not indicate that prior therapy with APA is associated with a better outcome in acute ischemic cerebrovascular events. There were no interactions found with other features that were associated with stroke severity.

European Journal of Neurology, 2013

Risk factors for IS in young adults differ between genders and evolve with age, but data on the a... more Risk factors for IS in young adults differ between genders and evolve with age, but data on the age- and gender-specific differences by stroke etiology are scare. These features were compared based on individual patient data from 15 European stroke centers. Stroke etiology was reported in detail for 3331 patients aged 15-49 years with first-ever IS according to Trial of Org in Acute Stroke Treatment (TOAST) criteria: large-artery atherosclerosis (LAA), cardioembolism (CE), small-vessel occlusion (SVO), other determined etiology, or undetermined etiology. CE was categorized into low- and high-risk sources. Other determined group was divided into dissection and other non-dissection causes. Comparisons were done using logistic regression, adjusting for age, gender, and center heterogeneity. Etiology remained undetermined in 39.6%. Other determined etiology was found in 21.6%, CE in 17.3%, SVO in 12.2%, and LAA in 9.3%. Other determined etiology was more common in females and younger patients, with cervical artery dissection being the single most common etiology (12.8%). CE was more common in younger patients. Within CE, the most frequent high-risk sources were atrial fibrillation/flutter (15.1%) and cardiomyopathy (11.5%). LAA, high-risk sources of CE, and SVO were more common in males. LAA and SVO showed an increasing frequency with age. No significant etiologic distribution differences were found amongst southern, central, or northern Europe. The etiology of IS in young adults has clear gender-specific patterns that change with age. A notable portion of these patients remains without an evident stroke mechanism according to TOAST criteria.