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C. Cantú-Brito et al.

Letters to the editor


with atrial fibrillation: full text: a report of the patients with IS and TIA. Here, we arrive on time for thrombolysis, but
American College of Cardiology/American present information on acute care and o1% of patients receive this manage-
Heart Association Task Force on practice
guidelines and the European Society of Car-
one-year outcome of the IS cohort. ment, a characteristic of developing
diology Committee for Practice Guidelines. A total of 1376 patients (52% women, countries (2). We observed that most
Europace 2006; 8:651–745. mean age 685-years) were registered IS cases are of undetermined aetiology,
2 Page RL, Wilkinson WE, Clair WK, from January 2005 to June 2006. Of which denounces a low use of diagnostic
McCarthy EA, Pritchett EL. Asymptomatic
these cases, 1246 (91%) corresponded resources. Knowledge is needed for ac-
arrhythmias in patients with symptomatic
paroxysmal atrial fibrillation and paroxysmal to IS (mean NIHSS at admission: 128 tion; thus, multitask efforts are impera-
supraventricular tachycardia. Circulation points) and 130 (9%) to TIA. Risk tive to change this scenario in low-
1994; 89:224–7. factors, acute care practices, IS subtypes income countries (3).
3 Hindricks G, Pokushalov E, Urban L et al. and long-term management were re-
Performance of a new leadless implantable corded. Five visits were completed dur- Carlos Cantú-Brito1,
cardiac monitor in detecting and quantifying
atrial fibrillation. Results of the XPECT trial. ing one-year of follow-up. José L. Ruiz-Sandoval2,
Circ Arrhythm Electrophysiol 2010; 3:141–7. Main risk factors were hypertension Luis M. Murillo-Bonilla3,
(65%), obesity (51%) and diabetes Erwin Chiquete4, Carolina
(35%). IS mechanisms were registered León-Jiménez5, Antonio Arauz6,
as follows (see Table 1): 8% large-artery Jorge Villarreal-Careaga7,
The first Mexican multicenter atherosclerosis, 20% cardioembolism, Fernando Barinagarrementeria8,
register on ischaemic stroke 20% lacunes, 5% miscellaneous mechan- Alma Ramos-Moreno9,
(The PREMIER Study): isms and 41% undetermined aetiology. and the PREMIER Investigators
demographics, risk factors Only 06% patients received IV throm- 1
Department of Neurology, Instituto Nacional
and outcome bolysis (23% arriving in o3 h after de Ciencias Medicas y Nutricion Salvador
stroke onset) and 1% endarterectomies Zubiran, Mexico City, México
2
The readers of the International Journal or stentings. The 30-day case fatality rate Department of Neurology, Hospital Civil de
of Stroke may be interested to know that in IS patients was 15%. One year after the Guadalajara ‘Fray Antonio Alcalde’,
brain infarction, one-third of the pa- Guadalajara, México
in Mexico, information on acute care 3
Department of Neurology, Facultad de
and long-term outcome of patients tients had mRS 0–1 (functionally inde- Medicina, Universidad Autónoma de
with ischaemic stroke (IS) and transient pendent), one-third had mRS 2–5 Guadalajara, Guadalajara, México
4
ischaemic attack (TIA) is still unknown. (dependent) and another third died. Department of Internal Medicine, Hospital
The Mexican PREMIER registry, a multi- The one-year recurrence rate (1183 acute Civil de Guadalajara ‘Fray Antonio Alcalde’,
Guadalajara, México
centre first-step stroke surveillance sys- survivors) was 11%. 5
Department of Neurology, Hospital Valentı́n
tem, was designed to investigate on risk As shown here, largely modifiable Gomez Farı́as, Zapopan, México
factors, acute care, secondary prevention risk factors are responsible for IS in 6
Stroke Clinic, Instituto Nacional de Neurologı́a
strategies and long-term outcome of Mexico (1). A quarter of IS patients y Neurocirugı́a, Mexico City, México

Table 1 Gender, stroke severity on admission and short-term clinical outcome by aetiological subtypes of ischaemic stroke patients (n 5 1246)

LAA Lacunar CE Mixed Other Undetermined


Total (n 5 105, (n 5 250, (n 5 246, (n 5 69, (n 5 63, (n 5 513, P
(n 5 1246) 84%) 201%) 197%) 55%) 51%) 412%) value

Gender (%)
Female 516 438 436 610 536 635 509
Male 484 562 564 390 464 365 491 0001
Age, median 71 (58–80) 75 (66–78) 69 (59–76) 75 (62–83) 76 (67–85) 48 (34–65) 70 (58–80) o0001
(interquartile range), years
NIHSS score (%) n 5 1223 n 5 105 n 5 240 n 5 242 n 5 68 n 5 59 n 5 509
r8 395 476 692 306 412 407 277
9–18 365 343 275 355 338 407 417 o0001
418 240 181 33 339 250 186 306
30-day outcome (%)
mRS: 0–1 228 229 356 171 217 381 175
mRS: 2–3 311 352 528 260 377 254 218 o0001
mRS: 4–5 310 333 76 358 319 254 402
Death 152 86 40 211 87 111 205 o0001
Data were missing for 23 patients.CE, cardioembolism; LAA, large-artery atherosclerosis; NIHSS, National Institutes of Health stroke scale.

& 2011 The Authors.


International Journal of Stroke & 2011 World Stroke Organization Vol 6, February 2011, 90–94 93
Letters to the editor C. Cantú-Brito et al.

7
Department of Neurology, Hospital General de DOI: 10.1111/j.1747-4949.2010.00549.x 2 Durai Pandian J, Padma V, Vijaya P, Sylaja PN,
Culiacán, Culiacan, México Murthy JM. Stroke and thrombolysis in
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Department of Neurology, Hospital Angeles de developing countries. Int J Stroke 2007; 2:
Querétaro, Querétaro, México 17–26.
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Strategic Clinical Research, Mexico City, México References 3 Mendis S. Prevention and care of stroke in
low- and middle-income countries; the need
Correspondence: Carlos Cantú-Brito, 1 Cantu-Brito C, Majersik JJ, Sánchez BN et al. for a public health perspective. Int J Stroke
Department of Neurology, Instituto Nacional Hospitalized stroke surveillance in the com- 2010; 5:86–91.
de Ciencias Médicas y Nutrición Salvador munity of Durango, Mexico: the brain attack
Zubirán, Vasco de Quiroga #15, Col. Sección surveillance in Durango study. Stroke 2010;
XVI, Tlalpan, Mexico City 14439, Mexico. 41:878–84.
E-mail: carloscantu_brito@hotmail.com

& 2011 The Authors.


94 International Journal of Stroke & 2011 World Stroke Organization Vol 6, February 2011, 90–94