Risk Stratification for Recurrence and Mortality in Embolic Stroke of Undetermined Source
Date
2016Language
en
Keyword
Abstract
Background and Purpose - The risk of stroke recurrence in patients with Embolic Stroke of Undetermined Source (ESUS) is high, and the optimal antithrombotic strategy for secondary prevention is unclear. We investigated whether congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and stroke or transient ischemic attack (TIA; CHADS 2) and CHA 2 DS 2 -VASc scores can stratify the long-term risk of ischemic stroke/TIA recurrence and death in ESUS. Methods - We pooled data sets of 11 stroke registries from Europe and America. ESUS was defined according to the Cryptogenic Stroke/ESUS International Working Group. Cox regression analyses were performed to investigate if prestroke CHADS 2 and congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or TIA, vascular disease, age 65-74 years, sex category (CHA 2 DS 2 -VASc) scores were independently associated with the risk of ischemic stroke/TIA recurrence or death. The Kaplan-Meier product limit method was used to estimate the cumulative probability of ischemic stroke/TIA recurrence and death in different strata of the CHADS 2 and CHA 2 DS 2 -VASc scores. Results - One hundred fifty-nine (5.6% per year) ischemic stroke/TIA recurrences and 148 (5.2% per year) deaths occurred in 1095 patients (median age, 68 years) followed-up for a median of 31 months. Compared with CHADS 2 score 0, patients with CHADS 2 score 1 and CHADS 2 score >1 had higher risk of ischemic stroke/TIA recurrence (hazard ratio [HR], 2.38; 95% confidence interval [CI], 1.41-4.00 and HR, 2.72; 95% CI, 1.68-4.40, respectively) and death (HR, 3.58; 95% CI, 1.80-7.12, and HR, 5.45; 95% CI, 2.86-10.40, respectively). Compared with low-risk CHA 2 DS 2 -VASc score, patients with high-risk CHA 2 DS 2 -VASc score had higher risk of ischemic stroke/TIA recurrence (HR, 3.35; 95% CI, 1.94-5.80) and death (HR, 13.0; 95% CI, 4.7-35.4). Conclusions - The risk of recurrent ischemic stroke/TIA and death in ESUS is reliably stratified by CHADS 2 and CHA 2 DS 2 -VASc scores. Compared with the low-risk group, patients in the high-risk CHA 2 DS 2 -VASc group have much higher risk of ischemic stroke recurrence/TIA and death, approximately 3-fold and 13-fold, respectively. © 2016 American Heart Association, Inc.
Collections
Related items
Showing items related by title, author, creator and subject.
-
Surgical and functional outcome of olfactory groove meningiomas: Lessons from the past experience and strategy development
Fountas K.N., Hadjigeorgiou G.F., Kapsalaki E.Z., Paschalis T., Rizea R., Ciurea A.V. (2018)Object: Olfactory groove meningiomas (OGMs) constitute a unique subset of intracranial meningiomas, since they usually remain clinically silent for a long period of time, and they may be of large size upon their diagnosis. ... -
Real-world data on Len/Dex combination at second-line therapy of multiple myeloma: treatment at biochemical relapse is a significant prognostic factor for progression-free survival
Katodritou E., Kyrtsonis M.-C., Delimpasi S., Kyriakou D., Symeonidis A., Spanoudakis E., Vasilopoulos G., Anagnostopoulos A., Kioumi A., Zikos P., Aktypi A., Briasoulis E., Megalakaki A., Repousis P., Adamopoulos I., Gogos D., Kotsopoulou M., Pappa V., Papadaki E., Fotiou D., Nikolaou E., Giannopoulou E., Hatzimichael E., Giannakoulas N., Douka V., Kokoviadou K., Timotheatou D., Terpos E. (2018)We evaluated progression-free survival (PFS) rate of patients treated with lenalidomide/dexamethasone (Len/Dex), the efficacy of the combination, and the prognostic significance of treatment at biochemical vs. clinical ... -
Primary High-Grade Non-Muscle-Invasive Bladder Cancer: High NFκB Expression in Tumor Specimens Distinguishes Patients Who are at Risk for Disease Progression
Mitrakas L., Gravas S., Papandreou C., Koukoulis G., Karasavvidou F., Dimakopoulos G., Weingärtner K., Karatzas A., Zachos I., Tzortzis V. (2019)To investigate the potential prognostic role of NFκB expression in primary high-grade non-muscle-invasive bladder cancer. Patients with primary high-grade non-muscle-invasive bladder cancer who received induction and ...