Association of ischaemic stroke subtype with long-term cardiovascular events
G Ntaios1, V Papavasileiou1, K Makaritsis1
1Department of Medicine, Medical School, University of Thessaly, Larissa, Greece.
Insights
Large-artery atherosclerotic stroke and cardioembolic stroke pose the highest risks for future cardiovascular events. All ischemic stroke types, except potentially large-artery atherosclerotic stroke, increase stroke recurrence risk.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Ischemic stroke is a leading cause of death and disability worldwide.
- Previous research has not definitively established the cardiovascular risk associated with all subtypes of ischemic stroke.
- Understanding subtype-specific risks is crucial for targeted prevention and management strategies.
Purpose of the Study:
- To investigate the association between different ischemic stroke subtypes and subsequent cardiovascular risk.
- To compare the long-term cardiovascular outcomes across various ischemic stroke classifications.
Main Methods:
- Utilized data from the Athens Stroke Registry (1993-2010) for consecutive ischemic stroke patients.
- Classified stroke subtypes using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria.
- Assessed outcomes including cardiovascular mortality, all-cause mortality, myocardial infarction, and stroke recurrence over a 10-year follow-up period.
- Employed Kaplan-Meier and Cox proportional hazards models for survival and risk factor analysis.
Main Results:
- Follow-up data for 2,730 patients revealed 10-year cardiovascular mortality rates were similar or higher in cardioembolic (46.6%), lacunar (22.1%), and undetermined stroke (35.2%) compared to large-artery atherosclerotic (LAA) stroke (28.7%).
- All ischemic stroke subtypes, except LAA, demonstrated a higher probability of 10-year stroke recurrence.
- Cox analysis indicated that non-LAA stroke types were associated with similar or increased risks for overall mortality, cardiovascular mortality, stroke recurrence, and composite cardiovascular outcomes compared to LAA stroke.
Conclusions:
- Large-artery atherosclerotic stroke and cardioembolic stroke are linked to the highest risks of future cardiovascular events.
- Cardioembolic stroke carries a cardiovascular risk at least as high as large-artery atherosclerotic stroke.
- All ischemic stroke subtypes warrant close cardiovascular monitoring due to varying degrees of associated risks.
Background And Purpose:
There is no strong evidence that all ischaemic stroke types are associated with high cardiovascular risk. Our aim was to investigate whether all ischaemic stroke types are associated with high cardiovascular risk.
Methods:
All consecutive patients with ischaemic stroke registered in the Athens Stroke Registry between 1 January 1993 and 31 December 2010 were categorized according to the TOAST classification and were followed up for up to 10 years. Outcomes assessed were cardiovascular and all-cause mortality, myocardial infarction, stroke recurrence, and a composite cardiovascular outcome consisting of myocardial infarction, angina pectoris, acute heart failure, sudden cardiac death, stroke recurrence and aortic aneurysm rupture. The Kaplan-Meier product limit method was used to estimate the probability of each end-point in each patient group. Cox proportional hazards models were used to determine the independent covariates of each end-point.
Results:
Two thousand seven hundred and thirty patients were followed up for 48.1 ± 41.9 months. The cumulative probabilities of 10-year cardiovascular mortality in patients with cardioembolic stroke [46.6%, 95% confidence interval (CI) 40.6-52.8], lacunar stroke (22.1%, 95% CI 16.2-28.0) or undetermined stroke (35.2%, 95% CI 27.8-42.6) were either similar to or higher than those of patients with large-artery atherosclerotic stroke (LAA) (28.7%, 95% CI 22.4-35.0). Compared with LAA, all other TOAST types had a higher probability of 10-year stroke recurrence. In Cox proportional hazards analysis, compared with patients with LAA, patients with any other stroke type were associated with similar or higher risk for the outcomes of overall mortality, cardiovascular mortality, stroke recurrence and composite cardiovascular outcome.
Conclusions:
Large-artery atherosclerotic stroke and cardioembolic stroke are associated with the highest risk for future cardiovascular events, with the latter carrying at least as high a risk as LAA stroke.
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