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Editorial |

Preventing Death One Stroke at a Time

Mark J. Alberts, MD
JAMA. 2011;305(4):408-409. doi:10.1001/jama.2011.29.
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In the 21st century, preventing deaths due to medical illness is an increasingly difficult task. Much of the low-hanging fruit has already been harvested; improvements in medical care are now measured as prevention of subsequent morbidities, not prevention of deaths. For example, the use of coronary artery stenting vs angioplasty alone does not reduce overall mortality.1 Use of intravenous tissue plasminogen activator (IV-TPA) for acute ischemic stroke improves neurologic outcomes but does not prevent death.2 Among symptomatic patients, carotid endarterectomy vs medical therapy does not prevent death.3 However, in this issue of JAMA, a report from Xian and colleagues4 using data from New York State found that patients with acute ischemic stroke (n = 15 297) who were admitted to a designated primary stroke center (PSC) had a statistically significant 2.5% absolute reduction in adjusted 30-day all-cause mortality compared with patients admitted to nondesignated hospitals (n = 15 650). This finding is important for several reasons.

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