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Long-term mortality in patients with stroke of undetermined etiology

Hyo Suk Nam1, Hyeon Chang Kim, Young Dae Kim

  • 1Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.

Stroke
|August 31, 2012
PubMed

Insights

Determining stroke etiology is crucial for prevention. Incomplete evaluations in acute ischemic stroke patients were linked to significantly higher long-term mortality, underscoring the need for thorough etiological work-up.

Area of Science:

  • Neurology
  • Cardiovascular Research
  • Public Health

Background:

  • Stroke etiology determination is vital for effective stroke prevention strategies.
  • A significant proportion of acute ischemic stroke cases have undetermined causes.
  • Accurate etiological classification impacts patient prognosis and management.

Purpose of the Study:

  • To investigate the long-term mortality and causes of death in patients with acute ischemic stroke based on etiological classification.
  • To compare mortality rates in stroke patients with the general Korean population.
  • To assess the impact of incomplete etiological evaluation on patient outcomes.

Main Methods:

  • A 10-year prospective enrollment of consecutive acute ischemic stroke patients.
  • Stroke etiology classification using the Trial of ORG 10172 in Acute Stroke Treatment criteria.
  • Long-term mortality and cause of death ascertainment via death certificates and standardized mortality ratio calculation.

Main Results:

  • 37% of 3278 enrolled patients had undetermined stroke subtypes (negative, multiple, or incomplete evaluation).
  • Poor functional outcome at 3 months was more frequent in patients with incomplete evaluation (49.6%) compared to other subtypes (24.5%).
  • Patients with incomplete evaluation exhibited the highest cumulative death rates (35.7% within 3 years), with multivariate analysis showing their mortality was second only to cardioembolism.

Conclusions:

  • Incomplete etiological evaluation in acute ischemic stroke is associated with high long-term mortality.
  • Thorough etiological work-up is essential for accurate stroke subtyping and prognostic assessment.
  • Understanding stroke etiology improves patient management and guides prevention efforts.
Abstract

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