WSO - April 2024 - 462

462
International Journal of Stroke 19(4)
surface of the plaque with a base width and a maximum
depth of ⩾ 2 mm was defined as an ulcerative plaque. Any
plaque with a thickness of ⩾ 4 mm or ulceration or having
mobile components was defined as a complex aortic
atheroma.9
Follow-up and outcomes
Patients visited our center after 3 months and thereafter
every 1 for 3 years after enrollment. This study reported the
3-month and 1-year outcomes. Findings from physical
examinations, treatments, clinical events, and modified
Rankin Scale (mRS) scores were recorded at follow-up visits.
A relative or caregiver was interviewed via telephone if
the patient could not be reached for a follow-up. The primary
outcomes were a composite of major adverse cardiovascular
events (MACEs), including nonfatal stroke,
nonfatal acute coronary syndrome, major peripheral artery
disease, and vascular deaths. Vascular deaths were defined
as deaths due to CAD or stroke and sudden death. The secondary
outcomes included mRS scores. Good functional
outcomes were defined as an mRS score of 0, 1, or 2.
Statistical analysis
Quantitative variables were expressed as means (standard
deviations) or medians (interquartile ranges (IQR)) for normally
and non-normally distributed data, respectively.
Qualitative variables were presented as frequencies (percentages).
The comparisons among multiple groups were
performed using one-way analysis of variance or the
Kruskal-Wallis test for quantitative variables and the chisquare
test for qualitative variables, as appropriate. Event
rates were estimated using the Kaplan-Meier method, and
intergroup differences were assessed using the log-rank
test. For a given outcome, patients who died of causes other
than the outcomes were censored at the time of death. The
current analysis did not include events that occurred after
1 year of follow-up. To identify predictors of good functional
prognosis, we performed multiple logistic regression
analysis with adjustments for age, sex, hypertension, diabetes
mellitus, dyslipidemia, current smoking status, NIHSS
score at admission, the day of the baseline CD34+ cell
measurement from the onset of stroke, and statin use at discharge.
The area under the receiver operating characteristic
curve (AUC) was used to assess the predictive value of circulating
CD34+ cell levels for good functional outcomes.
Statistical significance was set at p < 0.05 for all analyses.
Results
A total of 1089 patients were enrolled in this study. We
excluded 25 patients who met the exclusion criteria (stroke
mimics as final diagnosis, enrolled more than 1 week after
stroke onset, lack of data due to transfer to another hospital,
International Journal of Stroke, 19(4)
or duplicate registration), 97 patients with transient
ischemic attack, 381 patients without the data regarding the
number of CD34+ cells on admission, 43 patients on the
day of a baseline CD34+ cell measurement from the onset
of stroke beyond the 10th day, and 19 patients who were not
reachable for a follow-up. Thus, 524 patients were included
in the present analysis (Figure 1).
Among the 524 patients (mean age, 71.3 years; male,
60.1%), the mean (standard deviation) level of circulating
CD34+ cells was 0.93 (0.94)/µL. The median number of
the day of a CD34+ cell measurement at the baseline from
the onset of stroke was 3 (IQR; 2-5). Patients were divided
into three groups according to the tertiles of CD34+ cell
levels (Tertile 1, <0.51/µL; Tertile 2, 0.51-0.96/µL; and
Tertile 3, >0.96/µL). The differences in the median of the
day of a baseline CD34+ cell measurement were insignificant
among these groups (median (IQR) 2 (3-5), 2 (3-5),
and 2 (3-5) in Tertiles 1, 2, and 3, respectively; p = 0.63)
(Supplemental Figure I).
Table 1 shows the baseline patient characteristics.
Compared with patients in the lowest tertile group, those in
the highest tertile group were likely to be young, smokers,
and have hypertension and dyslipidemia. The serum triglyceride
levels and NIHSS score at admission were higher
and lower, respectively, in the highest tertile group than
those in the lowest tertile group. The differences in the distributions
of prior mRS scores and ischemic stroke subtypes
between the groups were insignificant.
The data on medication use at discharge and during surgery
are presented in Table 2. Patients in the highest tertile
group used antiplatelet and lipid-lowering agents, especially
statins, more frequently than those in the lowest tertile
group. The differences in the use of anticoagulants,
antihypertensive agents, or glucose-lowering agents
between the groups were insignificant.
Event risk
Among the 524 patients, vascular events occurred in 69
patients within 1 year (event rate, 13.2%; 95% CI, 10.6-
16.4%). According to the Kaplan-Meier method, the number
of circulating CD34+ cells was not associated with the
risks of MACEs (annual rate, 15.0% vs 13.4% vs 12.6%;
log-`rank` p = 0.70), stroke (annual rate, 13.3% vs 11.1% vs
11.3%; log-`rank` p = 0.71), or all-cause death (annual rate,
10.3% vs 6.5% vs 6.0%; log-`rank` p = 0.23) (Figure 2).
Functional prognosis
Figure 3 illustrated distributions of the mRS scores at
3 months and 1 year after stroke. The median mRS scores at
3 months and 1 year were 2 (IQR, 1-4) and 3 (1-4) in Tertile
1, 1 (1-3) and 2 (1-4) in Tertile 2, and 1 (0-2) and 1 (0-3)
in Tertile 3, respectively. The mRS scores at 3 months and
1 year were lower in the highest tertile group than those in
WSO - April 2024

Table of Contents for the Digital Edition of WSO - April 2024
