Embolic strokes of undetermined source in young adults: baseline characteristics and long-term outcome
Embolic strokes of undetermined source in young adults: baseline characteristics and long-term outcome
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DOI：
10.1111/ene.13540
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发表时间：
2018-03-01
影响因子：
5.1
通讯作者：
Putaala, J.
中科院分区：
文献类型：
--
作者：
Martinez-Majander, N.;Aarnio, K.;Putaala, J.
背景和目的不明原因栓塞性脑卒中（ESUS）是一个新的疾病，尚未在年轻脑卒中患者中进行深入研究。ESUS和其他病因亚组之间的血管事件和全因死亡率的临床特征和长期风险进行了compared.MethodsPatients与ESUS被确定在赫尔辛基青年中风登记处的1008例患者中，年龄在15-49岁的首次缺血性中风，和主要终点被定义为复发性中风，复合血管事件和全因死亡率。每个终点的累积15年的风险进行了分析与生命表和调整后的风险是基于考克斯比例风险analysis.ResultsOf 971名符合条件的患者，203（20.9%）被归类为ESUS。与其他改良吐司组相比，他们更年轻（中位年龄40岁，四分位数间距32-46 vs. 45岁，39-47），女性更常见（43.3% vs. 35.7%），心血管风险因素更少。中位随访时间为10.1年，与其他吐司组相比，ESUS组患者的复发性卒中和复合血管事件累积风险第二低，死亡率最低。大动脉粥样硬化和小血管疾病进行了显着更高的风险比ESUS复发性卒中，而没有显着差异出现在高风险来源和ESUS.ConclusionsIn我们的队列，ESUS患者更年轻，心血管危险因素负担较轻，一般更好的长期结果相比，其他原因的突发性卒中。ESUS和高风险心源性栓塞之间复发性卒中的相似风险可能表明其病理生理学相似。
Background and purposeEmbolic strokes of undetermined source (ESUS) are a recent entity, not yet thoroughly investigated in young stroke patients. The clinical characteristics and long-term risks of vascular events and all-cause mortality between young-onset ESUS and other aetiological subgroups were compared.MethodsPatients with ESUS were identified amongst the 1008 patients aged 15-49 years with first-ever ischaemic stroke in Helsinki Young Stroke Registry, and primary end-points were defined as recurrent stroke, composite vascular events and all-cause mortality. Cumulative 15-year risks for each end-point were analysed with life tables and adjusted risks were based on Cox proportional hazard analyses.ResultsOf the 971 eligible patients, 203 (20.9%) were classified as ESUS. They were younger (median age 40 years, interquartile range 32-46 vs. 45 years, 39-47), more often female (43.3% vs. 35.7%) and had fewer cardiovascular risk factors than other modified TOAST groups. With a median follow-up time of 10.1 years, ESUS patients had the second lowest cumulative risk of recurrent stroke and composite vascular events and lowest mortality compared to other TOAST groups. Large-artery atherosclerosis and small vessel disease carried significantly higher risk for recurrent stroke than did ESUS, whilst no difference appeared between cardioembolism from high-risk sources and ESUS.ConclusionsIn our cohort, ESUS patients were younger and had milder cardiovascular risk factor burden and generally better long-term outcome compared to other causes of young-onset stroke. The comparable risk of recurrent stroke between ESUS and high-risk sources of cardioembolism might suggest similarities in their pathophysiology.