Cardioembolic but not other stroke subtypes predict mortality independent of stroke severity at presentation
Latha Ganti Stead, Rachel M Gilmore, M Fernanda Bellolio, Anunaya Jain, Alejandro A Rabinstein, Wyatt W Decker, Dipti Agarwal, Robert D Brown Jr, Latha Ganti Stead, Rachel M Gilmore, M Fernanda Bellolio, Anunaya Jain, Alejandro A Rabinstein, Wyatt W Decker, Dipti Agarwal, Robert D Brown Jr
Abstract
Introduction. Etiology of acute ischemic stroke (AIS) is known to significantly influence management, prognosis, and risk of recurrence. Objective. To determine if ischemic stroke subtype based on TOAST criteria influences mortality. Methods. We conducted an observational study of a consecutive cohort of patients presenting with AIS to a single tertiary academic center. Results. The study population consisted of 500 patients who resided in the local county or the surrounding nine-county area. No patients were lost to followup. Two hundred and sixty one (52.2%) were male, and the mean age at presentation was 73.7 years (standard deviation, SD = 14.3). Subtypes were as follows: large artery atherosclerosis 97 (19.4%), cardioembolic 144 (28.8%), small vessel disease 75 (15%), other causes 19 (3.8%), and unknown 165 (33%). One hundred and sixty patients died: 69 within the first 30 days, 27 within 31-90 days, 29 within 91-365 days, and 35 after 1 year. Low 90-, 180-, and 360-day survival was seen in cardioembolic strokes (67.1%, 65.5%, and 58.2%, resp.), followed for cryptogenic strokes (78.0%, 75.3%, and 71.1%). Interestingly, when looking into the cryptogenic category, those with insufficient information to assign a stroke subtype had the lowest survival estimate (57.7% at 90 days, 56.1% at 180 days, and 51.2% at 1 year). Conclusion. Cardioembolic ischemic stroke subtype determined by TOAST criteria predicts long-term mortality, even after adjusting for age and stroke severity.
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References
- Adams HP, Jr., Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. Toast. Trial of org 10172 in acute stroke treatment. Stroke. 1993;24:35–41.
- Kasner SE, Chalela JA, Luciano JM, et al. Reliability and validity of estimating the NIH stroke scale score from medical records. Stroke. 1999;30(8):1534–1537.
- Williams LS, Yilmaz EY, Lopez-Yunez AM. Retrospective assessment of initial stroke severity with the NIH stroke scale. Stroke. 2000;31(4):858–862.
- de Jong G, Van Raak L, Kessels F, Lodder J. Stroke subtype and mortality: a follow-up study in 998 patients with a first cerebral infarct. Journal of Clinical Epidemiology. 2003;56(3):262–268.
- Murat Sumer M, Erturk O. Ischemic stroke subtypes: risk factors, functional outcome and recurrence. Neurological Sciences. 2002;22(6):449–454.
- Bang OY, Lee PH, Joo SY, Lee JS, Joo IS, Huh K. Frequency and mechanisms of stroke recurrence after cryptogenic stroke. Annals of Neurology. 2003;54(2):227–234.
- Sprigg N, Gray LJ, Bath PMW, et al. Early recovery and functional outcome are related with causal stroke subtype: data from the Tinzaparin in acute ischemic stroke trial. Journal of Stroke and Cerebrovascular Diseases. 2007;16(4):180–184.
- Winter Y, Wolfram C, Schaeg M, et al. Evaluation of costs and outcome in cardioembolic stroke or TIA. Journal of Neurology. 2009;256(6):954–963.
- Cabral NL, Gonçalves ARR, Longo AL, et al. Incidence of stroke subtypes, prognosis and prevalence of risk factors in Joinville, Brazil: a 2 year community based study. Journal of Neurology, Neurosurgery and Psychiatry. 2009;80(7):755–761.
- Lavados PM, Sacks C, Prina L, et al. Incidence, case-fatality rate, and prognosis of ischaemic stroke subtypes in a predominantly Hispanic-Mestizo population in Iquique, Chile (PISCIS project): a community-based incidence study. The Lancet Neurology. 2007;6(2):140–148.
Source: PubMed