Outcomes of the Indo-US Collaborative Stroke Project

The Indo-US Collaborative Stroke Project was designed to ascertain the burden of ischemic stroke in India. The project was a multicentre, hospital-based study which took place across five high-volume academic tertiary hospitals in India.

Between January 2012 and August 2014, data from 2,066 patients with ischemic stroke admitted less than two weeks after onset were prospectively collected. The investigators in India were trained by US site investigators at the Massachusetts General Hospital, Boston.

The study reported that:

  • The mean age of the participants was 58.3 + 14.7 years, suggesting that stoke affects the economically productive below-60-year age group.
  • 67.2% of the participants were men, indicating a higher stroke burden among males.
  • 24.5% of the participants had scores >16 on the National Institutes of Health (NIH) Stroke Scale.
  • The most common risk factors for ischemic stroke among the participants were as follows: hypertension (60.8%), diabetes mellitus (35.7%), and tobacco use, which included bidi and smokeless tobacco (32.2%).
  • The stroke etiological subtypes were as follows: large artery (29.9%), cardiac (24.9%), small artery (14.2%), other definite subtypes (3.4%), and undetermined subtypes (27.6%).
  • The multivariate analysis showed that diabetes mellitus predicted poor 90-day outcomes of ischemic stroke, while younger patients, those with lower NIH Stroke Scale scores, and those small-artery etiologies were associated with better 90-day outcomes.

These findings emphasize the need for urgent action to address the risk factors of ischemic stroke in India. The comprehensive data from this study will be potentially useful in refining India’s stroke clinical guidelines and in improving the provision of stroke care in India.