Article Figures & Data
- Figure 1
The study population flow chart. CNSR-III, Third China National Stroke Registry; DWI, diffusion-weighted imaging; TIA, transient ischaemic attack.
- Figure 2
The distribution of proportion of negative DWI patients in different NIHSS scores. Proportion of patients with no acute lesion at baseline DWI in different NIHSS scores. DWI, diffusion-weighted imaging; NIHSS, National Institute of Health Stroke Scale.
- Figure 3
Kaplan-Meier graphs for 1-year risk of recurrent stroke and stratified by stroke severity (NIHSS ≤5 vs NIHSS >5). The 1-year risk of stroke recurrence in overall patients (A), patients who had a mild stroke (B), and patients who had a major stroke (C) with negative DWI and those without. DWI, diffusion-weighted imaging; NIHSS, National Institute of Health Stroke Scale.
- Table 1
Study population baseline characteristics
DWI−
(n=932)DWI+
(n=11 094)P value Age, year 63 (57–72) 63 (54–70) 0.0045 Male 553 (59.33) 7691 (69.33) <0.0001 NIHSS at admission 2 (1–4) 4 (2–6) <0.0001 Time from event to enrolment, day 1 (0–3) 2 (1–4) <0.0001 Time from event to MRI, day 2 (1–4) 2 (1–4) 0.5317 Medical history Hypertension 591 (63.41) 7006 (63.15) 0.8740 Diabetes mellitus 208 (22.32) 2583 (23.28) 0.5026 Stroke 257 (27.58) 2396 (21.60) <0.0001 TIA 31 (3.33) 208 (1.87) 0.0023 Coronary artery disease 116 (12.45) 1081 (9.74) 0.0081 Atrial fibrillation 35 (3.76) 771 (6.95) 0.0002 Dyslipidaemia 88 (9.44) 819 (7.38) 0.0222 Current smoker 237 (25.43) 3593 (32.39) <0.0001 Heavy drinker 103 (11.05) 1601 (14.43) 0.0045 Treated with rt-PA 152 (16.31) 978 (8.82) <0.0001 Medication use at discharge Antiplatelet 860 (92.27) 10 083 (90.89) 0.1552 Anticoagulants 13 (1.39) 323 (2.91) 0.0070 Antihypertensive agent 395 (42.38) 5556 (50.08) <0.0001 Lipid-lowering agent 846 (90.77) 10 193 (91.88) 0.2374 TOAST classification <0.0001 Large artery atherosclerosis 194 (20.82) 3001 (27.05) Cardioembolism 50 (5.36) 670 (6.04) Small artery occlusion 0 (0.00) 2896 (26.10) Other determined aetiology 15 (1.61) 152 (1.37) Undetermined aetiology 673 (72.71) 4375 (39.44) Variables are shown as median (IQR) or number (%).
Time from event to enrolment is defined as the time from disease onset to patient signing an informed consent form.
DWI, diffusion-weighted imaging; NIHSS, National Institute of Health Stroke Scale; rt-PA, recombinant tissue plasminogen activator; TIA, transient ischaemic attack; TOAST, Trial of Org 10172 in Acute Stroke Treatment.
- Table 2
One-year prognosis of patients with DWI brain imaging (DWI+) and without (DWI−) stratified with stroke severity
Outcome DWI− DWI+ Model 1 Model 2 Events (%) Events (%) HR/OR (95% CI) P value HR/OR (95% CI) P value Total (n=12 026) (n=932) (n=11 094) Stroke recurrence 63 (6.76) 1096 (9.88) 0.65 (0.51 to 0.84) 0.0009 0.63 (0.49 to 0.82) 0.0006 New ischaemic stroke 57 (6.12) 1011 (9.11) 0.64 (0.49 to 0.83) 0.0009 0.60 (0.46 to 0.79) 0.0002 Recurrent haemorrhage stroke 6 (0.64) 101 (0.91) 0.72 (0.32 to 1.64) 0.4358 0.97 (0.41 to 2.27) 0.9386 Combined vascular event 69 (7.40) 1153 (10.39) 0.68 (0.53 to 0.86) 0.0017 0.72 (0.56 to 0.92) 0.0096 Death from any cause 16 (1.72) 372 (3.35) 0.47 (0.28 to 0.77) 0.0028 0.60 (0.36 to 0.995) 0.0480 Poor functional outcome* 65 (7.19) 1562 (14.42) 0.41 (0.32 to 0.54) <0.0001 0.57 (0.43 to 0.76) <0.0001 NIHSS ≤5 (n=8562) (n=809) (n=7753) Stroke recurrence 51 (6.30) 716 (9.24) 0.65 (0.49 to 0.87) 0.0033 0.60 (0.45 to 0.81) 0.0007 New ischaemic stroke 46 (5.69) 667 (8.60) 0.63 (0.47 to 0.85) 0.0025 0.57 (0.42 to 0.77) 0.0003 Recurrent haemorrhage stroke 5 (0.62) 58 (0.75) 0.85 (0.34 to 2.11) 0.7197 1.10 (0.42 to 2.87) 0.8495 Combined vascular event 57 (7.05) 750 (9.67) 0.70 (0.53 to 0.91) 0.0088 0.72 (0.55 to 0.95) 0.0209 Death from any cause 9 (1.11) 167 (2.15) 0.47 (0.24 to 0.92) 0.0276 0.47 (0.24 to 0.93) 0.0300 Poor functional outcome* 46 (5.82) 609 (8.03) 0.64 (0.47 to 0.88) 0.0052 0.63 (0.46 to 0.88) 0.0060 NIHSS >5 (n=3464) (n=123) (n=3341) Stroke recurrence 12 (9.76) 380 (11.37) 0.80 (0.45 to 1.42) 0.4448 0.85 (0.47 to 1.52) 0.5764 New ischaemic stroke 11 (8.94) 344 (10.30) 0.80 (0.44 to 1.47) 0.4770 0.85 (0.46 to 1.56) 0.5939 Recurrent haemorrhagic stroke 1 (0.81) 43 (1.29) 0.66 (0.09 to 4.81) 0.6829 0.70 (0.09 to 5.24) 0.7277 Combined vascular event 12 (9.76) 403 (12.06) 0.75 (0.42 to 1.33) 0.3277 0.78 (0.44 to 1.40) 0.4133 Death from any cause 7 (5.69) 205 (6.14) 0.81 (0.38 to 1.73) 0.5897 1.05 (0.48 to 2.26) 0.9107 Poor functional outcome* 19 (16.67) 953 (29.39) 0.41 (0.25 to 0.69) 0.0007 0.47 (0.28 to 0.81) 0.0061 Model 1: adjusted for age and sex.
Model 2: adjusted for age, sex, NIHSS at admission, event-to-enrolment time, medical history of stroke, TIA, coronary artery disease, atrial fibrillation, dyslipidaemia, current smoker, heavy drinker, treated with rt-PA, anticoagulants, antihypertensive agent and TOAST classification.
*Modified Rankin Scale score was missing for 292 patients at 1 year. Logistic regression analysis was conducted on the remaining population.
DWI, diffusion-weighted imaging; NIHSS, National Institute of Health Stroke Scale; rt-PA, recombinant tissue plasminogen activator; TIA, transient ischaemic attack; TOAST, Trial of Org 10172 in Acute Stroke Treatment.
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