The readers of the International Journal of Stroke may be interested to know that in Mexico, information on acute care and long-term outcome of patients with ischaemic stroke (IS) and transient ischaemic attack (TIA) is still unknown. TheMexicanPREMIERregistry, amulticentre first-step stroke surveillance system, was designed to investigate on risk factors, acute care, secondary prevention strategies and long-term outcome of patients with IS and TIA. Here, we present information on acute care and one-year outcome of the IS cohort.

1. Letters to the editor
´
C. Cantu-Brito et al.
with atrial fibrillation: full text: a report of the
American College of Cardiology/American
Heart Association Task Force on practice
guidelines and the European Society of Cardiology Committee for Practice Guidelines.
Europace 2006; 8:651–745.
2 Page RL, Wilkinson WE, Clair WK,
McCarthy EA, Pritchett EL. Asymptomatic
arrhythmias in patients with symptomatic
paroxysmal atrial fibrillation and paroxysmal
supraventricular tachycardia. Circulation
1994; 89:224–7.
3 Hindricks G, Pokushalov E, Urban L et al.
Performance of a new leadless implantable
cardiac monitor in detecting and quantifying
atrial fibrillation. Results of the XPECT trial.
Circ Arrhythm Electrophysiol 2010; 3:141–7.
patients with IS and TIA. Here, we
present information on acute care and
one-year outcome of the IS cohort.
A total of 1376 patients (52% women,
mean age 68Á5-years) were registered
from January 2005 to June 2006. Of
these cases, 1246 (91%) corresponded
to IS (mean NIHSS at admission: 12Á8
points) and 130 (9%) to TIA. Risk
factors, acute care practices, IS subtypes
and long-term management were recorded. Five visits were completed during one-year of follow-up.
Main risk factors were hypertension
(65%), obesity (51%) and diabetes
(35%). IS mechanisms were registered
as follows (see Table 1): 8% large-artery
atherosclerosis, 20% cardioembolism,
20% lacunes, 5% miscellaneous mechanisms and 41% undetermined aetiology.
Only 0Á6% patients received IV thrombolysis (23% arriving in o3 h after
stroke onset) and 1% endarterectomies
or stentings. The 30-day case fatality rate
in IS patients was 15%. One year after the
brain infarction, one-third of the patients had mRS 0–1 (functionally independent), one-third had mRS 2–5
(dependent) and another third died.
The one-year recurrence rate (1183 acute
survivors) was 11%.
As shown here, largely modifiable
risk factors are responsible for IS in
Mexico (1). A quarter of IS patients
The first Mexican multicenter
register on ischaemic stroke
(The PREMIER Study):
demographics, risk factors
and outcome
The readers of the International Journal
of Stroke may be interested to know that
in Mexico, information on acute care
and long-term outcome of patients
with ischaemic stroke (IS) and transient
ischaemic attack (TIA) is still unknown.
The Mexican PREMIER registry, a multicentre first-step stroke surveillance system, was designed to investigate on risk
factors, acute care, secondary prevention
strategies and long-term outcome of
arrive on time for thrombolysis, but
o1% of patients receive this management, a characteristic of developing
countries (2). We observed that most
IS cases are of undetermined aetiology,
which denounces a low use of diagnostic
resources. Knowledge is needed for action; thus, multitask efforts are imperative to change this scenario in lowincome countries (3).
´
Carlos Cantu-Brito1Ã,
´
Jose L. Ruiz-Sandoval2,
Luis M. Murillo-Bonilla3,
Erwin Chiquete4, Carolina
´
´
Leon-Jimenez5, Antonio Arauz6,
Jorge Villarreal-Careaga7,
Fernando Barinagarrementeria8,
Alma Ramos-Moreno9,
and the PREMIER Investigators
1
Department of Neurology, Instituto Nacional
de Ciencias Medicas y Nutricion Salvador
´
Zubiran, Mexico City, Mexico
2
Department of Neurology, Hospital Civil de
Guadalajara ‘Fray Antonio Alcalde’,
´
Guadalajara, Mexico
3
Department of Neurology, Facultad de
´
Medicina, Universidad Autonoma de
´
Guadalajara, Guadalajara, Mexico
4
Department of Internal Medicine, Hospital
Civil de Guadalajara ‘Fray Antonio Alcalde’,
´
Guadalajara, Mexico
5
´
Department of Neurology, Hospital Valentın
´
´
Gomez Farıas, Zapopan, Mexico
6
´
Stroke Clinic, Instituto Nacional de Neurologıa
´
´
y Neurocirugıa, Mexico City, Mexico
Table 1 Gender, stroke severity on admission and short-term clinical outcome by aetiological subtypes of ischaemic stroke patients (n 5 1246)
Total
(n 5 1246)
Gender (%)
Female
Male
Age, median
(interquartile range), years
NIHSS score (%)Ã
r8
9–18
418
30-day outcome (%)
mRS: 0–1
mRS: 2–3
mRS: 4–5
Death
LAA
(n 5 105,
8Á4%)
Lacunar
(n 5 250,
20Á1%)
CE
(n 5 246,
19Á7%)
Mixed
(n 5 69,
5Á5%)
Other
(n 5 63,
5Á1%)
Undetermined
(n 5 513,
41Á2%)
P
value
51Á6
48Á4
71 (58–80)
43Á8
56Á2
75 (66–78)
43Á6
56Á4
69 (59–76)
61Á0
39Á0
75 (62–83)
53Á6
46Á4
76 (67–85)
63Á5
36Á5
48 (34–65)
50Á9
49Á1
70 (58–80)
0Á001
o0Á001
n 5 1223
39Á5
36Á5
24Á0
n 5 105
47Á6
34Á3
18Á1
n 5 240
69Á2
27Á5
3Á3
n 5 242
30Á6
35Á5
33Á9
n 5 68
41Á2
33Á8
25Á0
n 5 59
40Á7
40Á7
18Á6
n 5 509
27Á7
41Á7
30Á6
22Á8
31Á1
31Á0
15Á2
22Á9
35Á2
33Á3
8Á6
35Á6
52Á8
7Á6
4Á0
17Á1
26Á0
35Á8
21Á1
21Á7
37Á7
31Á9
8Á7
38Á1
25Á4
25Á4
11Á1
17Á5
21Á8
40Á2
20Á5
o0Á001
o0Á001
o0Á001
ÃData 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

2. Letters to the editor
7
Department of Neurology, Hospital General de
´
´
Culiacan, Culiacan, Mexico
8
Department of Neurology, Hospital Angeles de
´
´
´
Queretaro, Queretaro, Mexico
9
´
Strategic Clinical Research, Mexico City, Mexico
´
Correspondence: Carlos Cantu-BritoÃ,
Department of Neurology, Instituto Nacional
´
´
de Ciencias Medicas y Nutricion Salvador
´
´
Zubiran, Vasco de Quiroga #15, Col. Seccion
XVI, Tlalpan, Mexico City 14439, Mexico.
E-mail: carloscantu_brito@hotmail.com
94
DOI: 10.1111/j.1747-4949.2010.00549.x
References
´
1 Cantu-Brito C, Majersik JJ, Sanchez BN et al.
Hospitalized stroke surveillance in the community of Durango, Mexico: the brain attack
surveillance in Durango study. Stroke 2010;
41:878–84.
´
C. Cantu-Brito et al.
2 Durai Pandian J, Padma V, Vijaya P, Sylaja PN,
Murthy JM. Stroke and thrombolysis in
developing countries. Int J Stroke 2007; 2:
17–26.
3 Mendis S. Prevention and care of stroke in
low- and middle-income countries; the need
for a public health perspective. Int J Stroke
2010; 5:86–91.
& 2011 The Authors.
International Journal of Stroke & 2011 World Stroke Organization Vol 6, February 2011, 90–94