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Stroke subtype predicts outcome in young and middle-aged stroke sufferers
P Redfors1, K Jood, L Holmegaard
1Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Acta Neurologica Scandinavica
|February 21, 2012
Summary
Stroke subtype significantly impacts recurrence and mortality risk in young to middle-aged adults. Large-vessel disease carries the highest risk, while small-vessel disease and cryptogenic strokes show lower rates.
Area of Science:
- Neurology
- Cardiovascular Research
- Epidemiology
Background:
- Limited studies examine long-term outcomes of ischemic stroke (IS) in young and middle-aged individuals based on etiologic subtypes.
- The Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS) investigated these outcomes.
Purpose of the Study:
- To report 2-year outcomes after ischemic stroke in young and middle-aged patients.
- To analyze the relationship between etiologic stroke subtypes and long-term prognosis.
Main Methods:
- The study included 600 patients with IS before age 70.
- Etiologic subtypes were classified using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria.
- Recurrent vascular events, transient ischemic attacks (TIAs), coronary events, and mortality were tracked for 2 years. Functional outcome was assessed using the modified Rankin Scale (mRS).
Main Results:
- After 2 years, 9.2% experienced recurrent stroke, 2.5% had a TIA, 0.7% had a coronary event, and 4.0% died.
- Recurrence and mortality rates varied significantly by stroke subtype, with large-vessel disease (LVD) showing the highest rates.
- LVD independently predicted a composite outcome of recurrent stroke, TIA, coronary event, and/or death, irrespective of risk factors or stroke severity.
Conclusions:
- Stroke subtype is a significant predictor of recurrent vascular events and mortality 2 years post-stroke in younger and middle-aged individuals.
- Etiologic subtype independently predicts outcomes, regardless of cardiovascular risk factors and stroke severity.
- Considering the etiologic subtype of IS is crucial for risk assessment in clinical practice and future research.
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