Detailed Information on Publication Record
2022
Evaluating Rates of Recurrent Ischemic Stroke Among Young Adults With Embolic Stroke of Undetermined Source The Young ESUS Longitudinal Cohort Study
PERERA, K. S., DD. BOASQUEVISQUE, P. RAO MELACINI, A. TAYLOR, A. CHENG et. al.Basic information
Original name
Evaluating Rates of Recurrent Ischemic Stroke Among Young Adults With Embolic Stroke of Undetermined Source The Young ESUS Longitudinal Cohort Study
Authors
PERERA, K. S. (guarantor), DD. BOASQUEVISQUE, P. RAO MELACINI, A. TAYLOR, A. CHENG, G. J. HANKEY, S. LEE, J. M. FABREGAS, S. F. AMERISO, T. S. FIELD, A. ARAUZ, S. B. COUTTS, M. ARNOLD, Robert MIKULÍK (203 Czech Republic, belonging to the institution), D. TONI, J. MANDZIA, R. C. VELTKAMP, E. MESEGUER, K. G. HAEUSLER and R. G. HART
Edition
JAMA neurology, Chicago, IL, American Medical Association, 2022, 2168-6149
Other information
Language
English
Type of outcome
Článek v odborném periodiku
Field of Study
30210 Clinical neurology
Country of publisher
United States of America
Confidentiality degree
není předmětem státního či obchodního tajemství
References:
Impact factor
Impact factor: 29.000
RIV identification code
RIV/00216224:14110/22:00126256
Organization unit
Faculty of Medicine
UT WoS
000770397500002
Keywords in English
Ischemic Stroke; Embolic Stroke; Young Adults
Tags
International impact, Reviewed
Změněno: 14/7/2022 10:47, Mgr. Tereza Miškechová
Abstract
V originále
IMPORTANCE Cryptogenic strokes constitute approximately 40% of ischemic strokes in young adults, and most meet criteria for the embolic stroke of undetermined source (ESUS). Two randomized clinical trials, NAVIGATE ESUS and RESPECT ESUS, showed a high rate of stroke recurrence in older adults with ESUS but the prognosis and prognostic factors among younger individuals with ESUS is uncertain. OBJECTIVE To determine rates of and factors associated with recurrent ischemic stroke and death and new-onset atrial fibrillation (AF) among young adults. DESIGN, SETTING, AND PARTICIPANTS This multicenter longitudinal cohort study with enrollment from October 2017 to October 2019 and a mean follow-up period of 12 months ending in October 2020 included 41 stroke research centers in 13 countries. Consecutive patients 50 years and younger with a diagnosis of ESUS were included. Of 576 screened, 535 participants were enrolled after 1 withdrew consent, 41 were found to be ineligible, and 2 were excluded for other reasons. The final follow-up visit was completed by 520 patients. MAIN OUTCOMES AND MEASURES Recurrent ischemic stroke and/or death, recurrent ischemic stroke, and prevalence of patent foramen ovale (PFO). RESULTS The mean (SD) age of participants was 40.4 (7.3) years, and 297 (56%) participants were male. The most frequent vascular risk factors were tobacco use (240 patients [45%]), hypertension (118 patients [22%]), and dyslipidemia (109 patients [20%]). PFO was detected in 177 participants (50%) who had transthoracic echocardiograms with bubble studies. Following initial ESUS, 468 participants (88%) were receiving antiplatelet therapy, and 52 (10%) received anticoagulation. The recurrent ischemic stroke and death rate was 2.19 per 100 patient-years, and the ischemic stroke recurrence rate was 1.9 per 100 patient-years. Of the recurrent strokes, 9 (64%) were ESUS, 2 (14%) were cardioembolic, and 3 (21%) were of other determined cause. AF was detected in 15 participants (2.8%; 95% CI, 1.6-4.6). In multivariate analysis, the following were associated with recurrent ischemic stroke: history of stroke or transient ischemic attack (hazard ratio, 5.3; 95% CI, 1.8-15), presence of diabetes (hazard ratio, 4.4; 95% CI, 1.5-13), and history of coronary artery disease (hazard ratio, 10; 95% CI, 4.8-22). CONCLUSIONS AND RELEVANCE In this large cohort of young adult patients with ESUS, there was a relatively low rate of subsequent ischemic stroke and a low frequency of new-onset AF. Most recurrent strokes also met the criteria for ESUS, suggesting the need for future studies to improve our understanding of the underlying stroke mechanism in this population.