Young Dae Kim1, Myoung-Jin Cha1,2, Jinkwon Kim1, Dong Hyun Lee1,3, Hye Sun Lee4, Chung Mo Nam5, Hyo Suk Nam1, Ji Hoe Heo1. 1. Department of Neurology, Yonsei University College of Medicine, Seoul, Korea. 2. Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea. 3. Department of Neurology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea. 4. Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea. 5. Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
Abstract
BACKGROUND: Multiple potential causes of stroke may coexist in ischemic stroke patients, which may affect long-term outcome. AIM: We investigated whether there are differences in long-term mortality among stroke patients with coexisting potential causes. METHODS: We evaluated the long-term all-cause mortality and stroke or cardiovascular mortality of ischemic stroke patients with multiple potential stroke mechanisms, large artery atherosclerosis, cardioembolism, small vessel occlusion, and negative evaluation admitted to a single center between January 1996 and December 2008. Mortality data were obtained from a National Death Certificate system. RESULTS: Total 3533 patients were included in this study: 286 multiple potential mechanisms (138 large artery atherosclerosis + cardioembolism, 105 small vessel occlusion + large artery atherosclerosis, 43 small vessel occlusion + cardioembolism), 1045 large artery atherosclerosis, 701 cardioembolism, 606 small vessel occlusion, and 895 negative evaluation. During a mean follow-up of 3.9 years, as referenced to small vessel occlusion mortality rate, the adjusted mortality hazard ratio was 4.387 (95% confidence interval 3.157-6.096) for large artery atherosclerosis + cardioembolism group, 3.903 (95% confidence interval 3.032-5.024) for cardioembolism group, and 2.121 (95% confidence interval 1.655-2.717) for large artery atherosclerosis. The risk of long-term ischemic stroke mortality or cardiovascular mortality also showed comparable findings: highest in the large artery atherosclerosis + cardioembolism, followed by cardioembolism, and large artery atherosclerosis groups. However, the outcome of small vessel occlusion + large artery atherosclerosis or small vessel occlusion + cardioembolism group was not significantly different from that of small vessel occlusion. CONCLUSIONS: Coexisting potential causes of ischemic stroke impact on long-term mortality. Identification of coexisting potential causes may help to predict stroke outcomes and to guide planning secondary prevention strategies.
BACKGROUND: Multiple potential causes of stroke may coexist in ischemic strokepatients, which may affect long-term outcome. AIM: We investigated whether there are differences in long-term mortality among strokepatients with coexisting potential causes. METHODS: We evaluated the long-term all-cause mortality and stroke or cardiovascular mortality of ischemic strokepatients with multiple potential stroke mechanisms, large artery atherosclerosis, cardioembolism, small vessel occlusion, and negative evaluation admitted to a single center between January 1996 and December 2008. Mortality data were obtained from a National Death Certificate system. RESULTS: Total 3533 patients were included in this study: 286 multiple potential mechanisms (138 large artery atherosclerosis + cardioembolism, 105 small vessel occlusion + large artery atherosclerosis, 43 small vessel occlusion + cardioembolism), 1045 large artery atherosclerosis, 701 cardioembolism, 606 small vessel occlusion, and 895 negative evaluation. During a mean follow-up of 3.9 years, as referenced to small vessel occlusion mortality rate, the adjusted mortality hazard ratio was 4.387 (95% confidence interval 3.157-6.096) for large artery atherosclerosis + cardioembolism group, 3.903 (95% confidence interval 3.032-5.024) for cardioembolism group, and 2.121 (95% confidence interval 1.655-2.717) for large artery atherosclerosis. The risk of long-term ischemic stroke mortality or cardiovascular mortality also showed comparable findings: highest in the large artery atherosclerosis + cardioembolism, followed by cardioembolism, and large artery atherosclerosis groups. However, the outcome of small vessel occlusion + large artery atherosclerosis or small vessel occlusion + cardioembolism group was not significantly different from that of small vessel occlusion. CONCLUSIONS: Coexisting potential causes of ischemic stroke impact on long-term mortality. Identification of coexisting potential causes may help to predict stroke outcomes and to guide planning secondary prevention strategies.
Authors: Pardes Habib; Ann-Sophie Stamm; Joerg B Schulz; Arno Reich; Alexander Slowik; Sandro Capellmann; Michael Huber; Thomas Wilhelm Journal: Int J Mol Sci Date: 2019-10-31 Impact factor: 5.923