Bruce Ovbiagele

Myongji Hospital, Kōyō, Gyeonggi Province, South Korea

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Publications (253)1262.7 Total impact

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    ABSTRACT: Stroke Prognostication by Using Age and NIHSS score (SPAN-100 index) facilitates stroke outcomes. We assessed imaging markers associated with the SPAN-100 index and their additional impact on outcome determination. Of 273 consecutive patients with acute ischemic stroke (<4.5 hours), 55 were characterized as SPAN-100-positive (age +NIHSS score ≥ 100). A comprehensive imaging review evaluated differences, using the presence of the hyperattenuated vessel sign, ASPECTS, clot burden score, collateral score, CBV, CBF, and MTT. The primary outcome assessed was favorable outcome (mRS ≤ 2). Secondary outcomes included recanalization, lack of neurologic improvement, and hemorrhagic transformation. Uni- and multivariate analyses assessed factors associated with favorable outcome. Area under the curve evaluated predictors of favorable clinical outcome. Compared with the SPAN-100-negative group, the SPAN-100-positive group (55/273; 20%) demonstrated larger CBVs (<0.001), poorer collaterals (P < .001), and increased hemorrhagic transformation rates (56.0% versus 36%, P = .02) despite earlier time to rtPA (P = .03). Favorable outcome was less common among patients with SPAN-100-positive compared with SPAN-100-negative (10.9% versus 42.2%; P < .001). Multivariate regression revealed poorer outcome for SPAN-100-positive (OR = 0.17; 95% CI, 0.06-0.38; P = .001), clot burden score (OR = 1.14; 95% CI, 1.05-1.25; P < .001), and CBV (OR = 0.58; 95% CI, 0.46-0.72; P = .001). The addition of the clot burden score and CBV improved the predictive value of SPAN-100 alone for favorable outcome from 60% to 68% and 74%, respectively. SPAN-100-positivity predicts a lower likelihood of favorable outcome and increased hemorrhagic transformation. CBV and clot burden score contribute to poorer outcomes among high-risk patients and improve stroke-outcome prediction. © 2015 American Society of Neuroradiology.
    AJNR. American journal of neuroradiology. 01/2015;
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    ABSTRACT: Urinary creatinine excretion rate (CER) is an established marker of muscle mass. Low CER has been linked to poor coronary artery disease outcomes, but a link between CER and acute stroke prognosis has not been previously explored. We prospectively collected data from patients with acute stroke (ischemic or hemorrhagic) within 24 hours from symptom onset in a Neurological and Neurosurgery Intensive Care Unit in Taiwan. Baseline CER (mg/d) was calculated by urine creatinine concentration in morning spot urine multiplies 24-hour urine volume on the second day of admission. Patients were divided into 3 tertiles with highest, middle, and lowest CER. Primary endpoint was poor outcome defined as modified Rankin Scale 3-6 at 6 months. Among 156 critically ill acute stroke patients meeting study entry criteria, average age was 67.9 years, and 83 (53.2%) patients had ischemic stroke. Patients with lowest CER (vs. highest CER) had a high risk of poor outcome at 6-month after adjustment (odds ratio 4.96, 95% confidence interval 1.22 to 20.15, p value = 0.025). In conclusion, low baseline CER, a marker of muscle mass, was independently associated with poor 6-month outcome among critically ill acute stroke patients. We speculate that preservation of muscle mass through exercise or protein-energy supplement might be helpful for improving prognosis in severe stroke patients.
    Current neurovascular research. 01/2015;
  • Jong-Ho Park, Bruce Ovbiagele
    Nature Reviews Neurology 12/2014; · 15.52 Impact Factor
  • Jong-Ho Park, Hyung-Min Kwon, Bruce Ovbiagele
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    ABSTRACT: Recently, Pooled Cohort Risk (PCR) equations, which incorporate new sex- and race-specific estimates of the 10-year risk for atherosclerotic cardiovascular disease (ASCVD) including stroke, for ASCVD-free adults were introduced. Given the importance of secondary stroke prevention and benefit of a potential tool to readily identify stroke patients at high intermediate-term vascular risk for appropriate treatment, we evaluated the prediction and discrimination of the PCR and Framingham Cardiovascular Risk (FCR) equations after a recent stroke. We conducted an analysis of Vitamin Intervention for Stroke Prevention dataset of 3555 recent non-cardioembolic stroke patients aged ≥35years and followed for 2years. Subjects were categorized as having low-PCR/low-FCR (<20%), high-PCR/high-FCR (≥20%), and known-ASCVD. Independent associations of high-PCR/high-FCR with recurrent stroke (primary outcome) and stroke/coronary heart disease (CHD)/vascular death (secondary outcomes) were assessed. Both PCR and FCR were independently related to both outcomes: compared with low-PCR, high-PCR was associated with stroke (adjusted hazard ratio, 1.79; 95% CI, 1.25-2.57) and stroke/CHD/vascular death (2.05; 1.55-2.70). Compared with low-FCR, high-FCR was associated with stroke (2.06; 1.34-3.16) and stroke/CHD/vascular death (1.57; 1.12-2.20). The c-statistic of PCR/FCR as a continuous variable for stroke was 0.56 (95% CI, 0.54-0.58) and 0.56 (0.54-0.57), respectively and for stroke/CHD/vascular death was 0.62 (0.60-0.63) and 0.61 (0.59-0.63), respectively. Both PCR and FCR are significant predictors of recurrent vascular events among patients after a recent non-cardioembolic stroke, but neither one of them is an optimal model for discriminating intermediate-term ASCVD prediction among stroke patients already receiving secondary stroke prevention. Copyright © 2014. Published by Elsevier B.V.
    Journal of the Neurological Sciences 12/2014; · 2.26 Impact Factor
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    ABSTRACT: There is insufficient evidence on which to base a recommendation for optimal antiplatelet therapy following a stroke while on aspirin. The objective was to compare clopidogrel initiation vs aspirin reinitiation for vascular risk reduction among patients with ischaemic stroke on aspirin at the time of their index stroke. Retrospective. We conducted a nationwide cohort study by retrieving all hospitalised patients (≥18 years) with a primary diagnosis of ischaemic stroke between 2003 and 2009 from Taiwan National Health Insurance Research Database. Among 3862 patients receiving aspirin before the index ischaemic stroke and receiving either aspirin or clopidogrel after index stroke during follow-up period, 1623 were excluded due to a medication possession ratio <80%. Also, 355 were excluded due to history of atrial fibrillation, valvular heart disease or coagulopathy. Therefore, 1884 patients were included in our final analysis. Patients were categorised into two groups based on whether clopidogrel or aspirin was prescribed during the follow-up period. Follow-up was from time of the index stroke to admission for recurrent stroke or myocardial infarction, death or the end of 2010. The primary end point was hospitalisation due to a new-onset major adverse cardiovascular event (MACE: composite of any stroke or myocardial infarction). The leading secondary end point was any recurrent stroke. Compared to aspirin, clopidogrel was associated with a lower occurrence of future MACE (HR=0.54, 95% CI 0.43 to 0.68, p<0.001, number needed to treat: 8) and recurrent stroke (HR=0.54, 95% CI 0.42 to 0.69, p<0.001, number needed to treat: 9) after adjustment of relevant covariates. Among patients with an ischaemic stroke while taking aspirin, clopidogrel initiation was associated with fewer recurrent vascular events than aspirin reinitiation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    BMJ Open 12/2014; 4(12):e006672. · 2.06 Impact Factor
  • Bruce Ovbiagele
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    ABSTRACT: According to the World Health Organization (WHO), more than 80% of worldwide diabetes (DM)-related deaths presently occur in low- and middle-income countries (LMIC), and left unchecked these DM-related deaths will likely double over the next 20years. Cardiovascular disease (CVD) is the most prevalent and detrimental complication of DM: doubling the risk of CVD events (including stroke) and accounting for up to 80% of DM-related deaths. Given the aforementioned, interventions targeted at reducing CVD risk among people with DM are integral to limiting DM-related morbidity and mortality in LMIC, a majority of which are located in Sub-Saharan Africa (SSA). However, SSA is contextually unique: socioeconomic obstacles, cultural barriers, under-diagnosis, uncoordinated care, and shortage of physicians currently limit the capacity of SSA countries to implement CVD prevention among people with DM in a timely and sustainable manner. This article proposes a theory-based framework for conceptualizing integrated protocol-driven risk factor patient self-management interventions that could be adopted or adapted in future studies among hospitalized stroke patients with DM encountered in SSA. These interventions include systematic health education at hospital discharge, use of post-discharge trained community lay navigators, implementation of nurse-led group clinics and administration of health technology (personalized phone text messaging and home tele-monitoring), all aimed at increasing patient self-efficacy and intrinsic motivation for sustained adherence to therapies proven to reduce CVD event risk. Copyright © 2014 Elsevier B.V. All rights reserved.
    Journal of the Neurological Sciences 11/2014; · 2.26 Impact Factor
  • Jong-Ho Park, Bruce Ovbiagele
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    ABSTRACT: To investigate the effect of optimal combination of evidence-based drug therapies including antihypertensive agents, lipid modifiers, and antithrombotic agents on risk of recurrent vascular events after stroke. We analyzed the database of a multicenter trial involving 3,680 recent noncardioembolic stroke patients aged 35 years or older and followed for 2 years. Patients were categorized by appropriateness level 0 to III depending on the number of drugs prescribed divided by the number of drugs potentially indicated for each patient (0 = none of the indicated medications prescribed and III = all indicated medications prescribed). Independent associations of medication appropriateness level with recurrent stroke (primary outcome), stroke/coronary heart disease/vascular death as major vascular events (secondary outcome), and death (tertiary outcome) were assessed. The unadjusted rate of stroke declined with increasing medication appropriateness level (15.9% for level 0, 10.3% for level I, 8.6% for level II, and 7.3% for level III). Compared with level 0: the adjusted hazard ratio of stroke for level I was 0.51 (95% confidence interval, 0.21-1.25), level II 0.50 (0.23-1.09), and level III 0.39 (0.18-0.84); of stroke/coronary heart disease/vascular death for level I 0.60 (0.32-1.14), level II 0.45 (0.25-0.80), and level III 0.39 (0.22-0.69); and of death for level I 0.89 (0.30-2.64), level II 0.71 (0.26-1.93), and level III 0.35 (0.13-0.96). Optimal combination of secondary prevention medication classes after a recent noncardioembolic stroke is associated with a significantly lower risk of stroke, major vascular events, and death. © 2014 American Academy of Neurology.
    Neurology 11/2014; · 8.30 Impact Factor
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    ABSTRACT: The new pooled cohort risk (PCR) equations is sex- and race-specific estimates of the 10-year risk of atherosclerotic cardiovascular events among disease-free adults. Little is known about the association between the PCR model and presence of silent brain infarction (SBI).
    Stroke 10/2014; 45(12). · 6.02 Impact Factor
  • Bruce Ovbiagele
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    ABSTRACT: Over the last 4 decades, rates of stroke occurrence in low- and middle-income countries (LMIC) have roughly doubled, whereas they have substantively decreased in high-income countries. Most of these LMIC are in Sub-Saharan Africa (SSA) where the burden of stroke will probably continue to rise over the next few decades because of an ongoing epidemiologic transition. Moreover, SSA is circumstantially distinct: socioeconomic obstacles, cultural barriers, underdiagnosis, uncoordinated care, and shortage of physicians impede the ability of SSA countries to implement cardiovascular disease prevention among people with diabetes mellitus in a timely and sustainable manner. Reducing the burden of stroke in SSA may necessitate an initial emphasis on high-risk individuals motivated to improve their health, multidisciplinary care coordination initiatives with clinical decision support, evidence-based interventions tailored for cultural relevance, task shifting from physicians to nurses and other health providers, use of novel patient-accessible tools, and a multilevel approach that incorporates individual- and system-level components. This article proposes a theory-based integrated blood pressure (BP) self-management intervention called Phone-based Intervention under Nurse Guidance after Stroke (PINGS) that could be tested among hospitalized stroke patients with poorly controlled hypertension encountered in SSA. PINGS would comprise the implementation of nurse-run BP control clinics and administration of health technology (personalized phone text messaging and home telemonitoring), aimed at boosting patient self-efficacy and intrinsic motivation for sustained adherence to antihypertensive medications. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
    Journal of Stroke and Cerebrovascular Diseases 10/2014; · 1.99 Impact Factor
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    ABSTRACT: To optimize the translation of clinical trial evidence that antihypertensive treatment reduces recurrent stroke risk into clinical practice, it is important to assess the frequency of long-term antihypertensive drug persistence after stroke and identify the factors associated with low persistence. Structured telephone interviews to determine antihypertensive regimen persistence 1-year post-stroke hospitalization were conducted in 270 stroke survivors, of which 212 (78.5%) were discharged on antihypertensive therapy (two thirds on >1 drug class). Continued use of any antihypertensive agent at 1 year of follow-up was relatively high (87.3%); however, persistence on all or two or more drug classes prescribed at discharge was relatively low (38.7%). Continued use varied by drug class, with the highest rates among angiotensin-converting enzyme inhibitor (69.1%) and the lowest rates among diuretic (24.4%) users. Black patients (adjusted odds ratio, 0.35; 95% confidence interval, 0.16-0.78) and those with a high comorbidity burden (adjusted odds ratio , 0.39; 95% confidence interval, 0.18-0.86) were less likely to exhibit persistence on prescribed treatments 1-year post-stroke hospitalization. These results indicate the need for further study to identify appropriate persistence of antihypertensive therapies for secondary stroke prevention and to investigate reasons for racial disparities in persistence on prescribed treatments in a real-world clinical setting.
    Journal of Clinical Hypertension 10/2014; · 2.96 Impact Factor
  • Bruce Ovbiagele, Gustavo Saposnik
    JAMA Neurology 10/2014; 71(10):1326. · 7.01 Impact Factor
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    ABSTRACT: The use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) diagnostic codes can identify racial disparities in ischemic stroke hospitalizations; however, inclusion of revascularization procedure codes as acute stroke events may affect the magnitude of the risk difference. This study assesses the impact of excluding revascularization procedure codes in the ICD-9 definition of ischemic stroke, compared with the traditional inclusive definition, on racial disparity estimates for stroke incidence and recurrence.
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 09/2014; · 1.99 Impact Factor
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    ABSTRACT: The safety of intravenous thrombolysis in ischemic stroke (IS) patients with chronic kidney disease (CKD) is uncertain. We assessed whether CKD is associated with bleeding complications after intravenous tissue-type plasminogen activator administration to patients with IS.
    Circulation Cardiovascular Quality and Outcomes 09/2014; · 5.66 Impact Factor
  • Jong-Ho Park, Juneyoung Lee, Bruce Ovbiagele
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    ABSTRACT: Expert consensus guidelines recommend low-density lipoprotein cholesterol as the primary serum lipid target for recurrent stroke risk reduction. However, mounting evidence suggests that other lipid parameters might be additional therapeutic targets or at least also predict cardiovascular risk. Little is known about the effects of nontraditional lipid variables on recurrent stroke risk.
    Stroke 09/2014; 45(11). · 6.02 Impact Factor
  • Mayowa O. Owolabi, Bruce Ovbiagele
    Journal of the Neurological Sciences 09/2014; · 2.26 Impact Factor
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    ABSTRACT: Several studies have assessed the link between cognitive impairment and risk of future stroke, but results have been inconsistent. We conducted a systematic review and meta-analysis of cohort studies to determine the association between cognitive impairment and risk of future stroke.
    Canadian Medical Association Journal 08/2014; 186(14). · 5.81 Impact Factor
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    ABSTRACT: There is a paucity of information on clinical characteristics, care patterns, and clinical outcomes for hospitalized intracerebral hemorrhage (ICH) patients with chronic kidney disease (CKD). We assessed characteristics, care processes, and in-hospital outcome among ICH patients with CKD in the Get With the Guidelines-Stroke (GWTG-Stroke) program.
    Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association 08/2014; · 1.99 Impact Factor
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    ABSTRACT: RationaleStroke is the second-leading cause of death in low- and middle-income countries, but use of evidence-based therapies for stroke prevention in such countries, especially those in Africa, is extremely poor. This study is designed to enhance the implementation and sustainability of secondary stroke-preventive services following hospital discharge.Aim/HypothesisThe primary study aim is to test whether a Chronic Care Model-based initiative entitled the Tailored Hospital-based Risk reduction to Impede Vascular Events after Stroke (THRIVES) significantly improves blood pressure control after stroke.DesignThis prospective triple-blind randomized controlled trial will include a cohort of 400 patients with a recent stroke discharged from four medical care facilities in Nigeria. The culturally sensitive, system-appropriate intervention comprises patient report cards, phone text messaging, an educational video, and coordination of posthospitalization care.Study OutcomesThe primary outcome is improvement of blood pressure control. Secondary endpoints include control of other stroke risk factors, medication adherence, functional status, and quality of life. We will also perform a cost analysis of THRIVES from the viewpoint of government policy-makers.DiscussionWe anticipate that a successful intervention will serve as a scalable model of effective postdischarge chronic blood pressure management for stroke in sub-Saharan Africa and possibly for other symptomatic cardiovascular disease entities in the region.
    International Journal of Stroke 08/2014; · 4.03 Impact Factor
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    ABSTRACT: Objective. A better understanding of the manuscript peer-review process could improve the likelihood that research of the highest quality is funded and published. To this end, we aimed to assess consistency across reviewers’ recommendations; agreement between reviewers’ recommendations and editors’ final decisions; and reviewer- and editor-level factors influencing editorial decisions in STROKE Journal.Methods. We analyzed all initial original contributions submitted to STROKE from January 2004 through December 2011. All submissions were linked to the final editorial decision (accept vs. reject). We assessed the level of agreement between reviewers (intraclass correlation coefficient). We compared the initial editorial decision (accept, minor revision, major revision and reject) across reviewers’ recommendations. We performed a logistic regression analysis to identify reviewer- and editor-related factors related to acceptance as the final decision.Results. Of 12,902 original submissions to STROKE during the 8-year study period, the level of agreement between reviewers was between fair and moderate (intraclass correlation coefficient 0.55, 95%CI: 0.09-0.75). Likelihood of acceptance was less than 5% if at least one reviewer recommended a rejection. In the multivariable analysis, higher reviewer-assigned priority scores were related to greater odds of acceptance (OR 26.3, 95%CI: 23.2-29.8); while higher numbers of reviewers (OR 0.54 per additional reviewer, 95%CI: 0.50-0.59) and suggestions for reviewers by authors vs. no suggestions (OR 0.83, 95%CI: 0.73-0.94) had lesser odds of acceptance.Interpretation. This analysis of the peer-review process of STROKE identified several factors that might be targeted to improve the consistency and fairness of the overall process. ANN NEUROL 2014. © 2014 American Neurological Association
    Annals of Neurology 07/2014; · 11.91 Impact Factor
  • Andrea D Boan, Daniel T Lackland, Bruce Ovbiagele
    Stroke 07/2014; 45(8). · 6.02 Impact Factor

Publication Stats

3k Citations
1,262.70 Total Impact Points


  • 2014
    • Myongji Hospital
      Kōyō, Gyeonggi Province, South Korea
  • 2013–2014
    • Medical University of South Carolina
      Charleston, South Carolina, United States
    • Rancho Los Amigos Rehabilitation Center
      Downey, California, United States
  • 2011–2013
    • Chang Gung Memorial Hospital
      • Division of Neurology
      Taipei, Taipei, Taiwan
  • 2007–2013
    • University of Toronto
      • Division of Neurology
      Toronto, Ontario, Canada
    • Northwestern University
      • Feinberg School of Medicine
      Evanston, IL, United States
    • Temple University
      • Department of Medicine
      Philadelphia, PA, United States
  • 2012
    • Henan Provincial People’s Hospital
      Cheng, Henan Sheng, China
    • Loma Linda University
      • Division of General Internal Medicine and Geriatric Medicine
      Loma Linda, CA, United States
  • 2011–2012
    • University of California, San Diego
      • Department of Neurosciences
      San Diego, CA, United States
  • 2009–2012
    • Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
      Torrance, California, United States
    • Hospital Italiano de Buenos Aires
      • Department of Neurology
      Buenos Aires, Buenos Aires F.D., Argentina
    • Uniformed Services University of the Health Sciences
      • Department of Neurology
      Bethesda, MD, United States
  • 2007–2012
    • University of Southern California
      • Department of Neurology
      Los Angeles, CA, United States
  • 2008–2011
    • Sungkyunkwan University
      • Department of Neurology
      Seoul, Seoul, South Korea
    • Hallym University
      Sŏul, Seoul, South Korea
  • 2004–2011
    • Harbor-UCLA Medical Center
      Torrance, California, United States
  • 2003–2011
    • University of California, Los Angeles
      • • Center for Neurobiology of Stress
      • • Department of Neurology
      Los Angeles, CA, United States
    • Beth Israel Deaconess Medical Center
      • Department of Neurology
      Boston, MA, United States
  • 2010
    • Ajou University
      • Department of Neurology
      Seoul, Seoul, South Korea
  • 2009–2010
    • Samsung Medical Center
      • Department of Neurology
      Seoul, Seoul, South Korea
  • 2008–2010
    • Charles R. Drew University of Medicine and Science
      • • Family Medicine
      • • Department of Medicine
      Los Angeles, California, United States
  • 2006–2009
    • Children's Hospital Los Angeles
      • Division of Hospital Medicine
      Los Angeles, California, United States