Evaluating Rates of Recurrent Ischemic Stroke Among Young
Adults With Embolic Stroke of Undetermined Source The Young
ESUS Longitudinal Cohort Study

J 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:

URL

Impact factor

Impact factor: 29.000

RIV identification code

RIV/00216224:14110/22:00126256

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1001/jamaneurol.2022.0048

UT WoS

000770397500002

Keywords in English

Ischemic Stroke; Embolic Stroke; Young Adults

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.

Citovat

PERERA, K. S., 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, D. TONI, J. MANDZIA, R. C. VELTKAMP, E. MESEGUER, K. G. HAEUSLER and R. G. HART. Evaluating Rates of Recurrent Ischemic Stroke Among Young Adults With Embolic Stroke of Undetermined Source The Young ESUS Longitudinal Cohort Study. JAMA neurology. Chicago, IL: American Medical Association, 2022, vol. 79, No 5, p. 450-458. ISSN 2168-6149. Available from: https://dx.doi.org/10.1001/jamaneurol.2022.0048.

@article{1874639,
   author = {Perera, K. S. and Boasquevisque, DD. and Rao Melacini, P. and Taylor, A. and Cheng, A. and Hankey, G. J. and Lee, S. and Fabregas, J. M. and Ameriso, S. F. and Field, T. S. and Arauz, A. and Coutts, S. B. and Arnold, M. and Mikulík, Robert and Toni, D. and Mandzia, J. and Veltkamp, R. C. and Meseguer, E. and Haeusler, K. G. and Hart, R. G.},
   article_location = {Chicago, IL},
   article_number = {5},
   doi = {http://dx.doi.org/10.1001/jamaneurol.2022.0048},
   keywords = {Ischemic Stroke; Embolic Stroke; Young Adults},
   language = {eng},
   issn = {2168-6149},
   journal = {JAMA neurology},
   title = {Evaluating Rates of Recurrent Ischemic Stroke Among Young Adults With Embolic Stroke of Undetermined Source The Young ESUS Longitudinal Cohort Study},
   url = {https://jamanetwork.com/journals/jamaneurology/fullarticle/2790077},
   volume = {79},
   year = {2022}
}

TY  - JOUR
ID  - 1874639
AU  - Perera, K. S. - Boasquevisque, DD. - Rao Melacini, P. - Taylor, A. - Cheng, A. - Hankey, G. J. - Lee, S. - Fabregas, J. M. - Ameriso, S. F. - Field, T. S. - Arauz, A. - Coutts, S. B. - Arnold, M. - Mikulík, Robert - Toni, D. - Mandzia, J. - Veltkamp, R. C. - Meseguer, E. - Haeusler, K. G. - Hart, R. G.
PY  - 2022
TI  - Evaluating Rates of Recurrent Ischemic Stroke Among Young Adults With Embolic Stroke of Undetermined Source The Young ESUS Longitudinal Cohort Study
JF  - JAMA neurology
VL  - 79
IS  - 5
SP  - 450-458
EP  - 450-458
PB  - American Medical Association
SN  - 21686149
KW  - Ischemic Stroke
KW  - Embolic Stroke
KW  - Young Adults
UR  - https://jamanetwork.com/journals/jamaneurology/fullarticle/2790077
N2  - 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.
ER  -

PERERA, K. S., 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, D. TONI, J. MANDZIA, R. C. VELTKAMP, E. MESEGUER, K. G. HAEUSLER and R. G. HART. Evaluating Rates of Recurrent Ischemic Stroke Among Young Adults With Embolic Stroke of Undetermined Source The Young ESUS Longitudinal Cohort Study. \textit{JAMA neurology}. Chicago, IL: American Medical Association, 2022, vol.~79, No~5, p.~450-458. ISSN~2168-6149. Available from: https://dx.doi.org/10.1001/jamaneurol.2022.0048.

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