Relevance of stroke subtype in vascular risk prediction.

A. Ois, E. Cuadrado-Godia, A. Rodriguez-Campello, E. Giralt-Steinhauer, J. Jimenez-Conde, M. Lopez-Cuina, M. Ley, C. Soriano, J. Roquer
Neurology. 2013-07-03; 81(6): 575-580
DOI: 10.1212/wnl.0b013e31829e6f37

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1. Neurology. 2013 Aug 6;81(6):575-80. doi: 10.1212/WNL.0b013e31829e6f37. Epub 2013
Jul 3.

Relevance of stroke subtype in vascular risk prediction.

Ois A(1), Cuadrado-Godia E, Rodríguez-Campello A, Giralt-Steinhauer E,
Jiménez-Conde J, Lopez-Cuiña M, Ley M, Soriano C, Roquer J.

Author information:
(1)Neurology Department, Hospital del Mar, Spain. *protected email*

OBJECTIVE: To ascertain the risk of a new vascular event (NVE) occurring after
ischemic stroke and evaluate differences in risk based on stroke subtype.
METHODS: This was a prospective observational study of consecutive patients with
nonfatal stroke recruited at a single tertiary stroke center with follow-up
ranging from 2 to 5 years (average, 31 ± 15.9 months). An NVE (vascular death,
nonfatal stroke or myocardial infarction, and hospitalization for other
atherothrombotic events) was defined according to criteria used in a previously
developed large multicenter register of atherothrombotic patients (Reduction of
Atherothrombosis for Continued Health Registry [REACH]). We analyzed age, sex,
and atherosclerotic burden (AB) based on a number of vascular risk factors,
affected vascular areas, and stroke subtype according to Stop Stroke Study Trial
of Org 10172 in acute stroke treatment (SSS-TOAST) criteria in cardioaortic,
large artery atherosclerosis (LAA), unclassified (more than one causal
mechanism), small-artery disease (SAD), and undetermined (without cause) stroke
categories.
RESULTS: The final cohort consisted of 748 patients. An NVE occurred in 162
patients (21.7%), equivalent to a rate of 0.084 events per patient/year.
Multivariate analysis revealed that higher NVE risk was associated with AB and 3
stroke subtypes, namely cardioaortic (hazard ratio [HR] = 2.58; 95% confidence
interval [CI] 1.27-5.22), LAA (HR = 4.17; 95% CI 2.03-8.56), and unclassified (HR
= 5.70; 95% CI 2.49-13.08). Patients with SAD or stroke of undetermined cause had
lower NVE risk.
CONCLUSIONS: Patients who survive stroke are at increased risk for NVEs. The risk
for NVE varies according to stroke subtype.

DOI: 10.1212/WNL.0b013e31829e6f37
PMCID: PMC3775680
PMID: 23825174 [Indexed for MEDLINE]


Auteurs Bordeaux Neurocampus