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August 06, 2013; 81 (6) Article

Relevance of stroke subtype in vascular risk prediction

Angel Ois, Elisa Cuadrado-Godia, Ana Rodríguez-Campello, Eva Giralt-Steinhauer, Jordi Jiménez-Conde, Miguel Lopez-Cuiña, Miguel Ley, Carol Soriano, Jaume Roquer
First published July 3, 2013, DOI: https://doi.org/10.1212/WNL.0b013e31829e6f37
Angel Ois
From the Neurology Department, Hospital del Mar; Universitat Autònoma de Barcelona; Neurovascular Research, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain.
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Elisa Cuadrado-Godia
From the Neurology Department, Hospital del Mar; Universitat Autònoma de Barcelona; Neurovascular Research, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain.
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Ana Rodríguez-Campello
From the Neurology Department, Hospital del Mar; Universitat Autònoma de Barcelona; Neurovascular Research, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain.
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Eva Giralt-Steinhauer
From the Neurology Department, Hospital del Mar; Universitat Autònoma de Barcelona; Neurovascular Research, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain.
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Jordi Jiménez-Conde
From the Neurology Department, Hospital del Mar; Universitat Autònoma de Barcelona; Neurovascular Research, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain.
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Miguel Lopez-Cuiña
From the Neurology Department, Hospital del Mar; Universitat Autònoma de Barcelona; Neurovascular Research, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain.
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Miguel Ley
From the Neurology Department, Hospital del Mar; Universitat Autònoma de Barcelona; Neurovascular Research, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain.
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Carol Soriano
From the Neurology Department, Hospital del Mar; Universitat Autònoma de Barcelona; Neurovascular Research, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain.
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Jaume Roquer
From the Neurology Department, Hospital del Mar; Universitat Autònoma de Barcelona; Neurovascular Research, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain.
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Citation
Relevance of stroke subtype in vascular risk prediction
Angel Ois, Elisa Cuadrado-Godia, Ana Rodríguez-Campello, Eva Giralt-Steinhauer, Jordi Jiménez-Conde, Miguel Lopez-Cuiña, Miguel Ley, Carol Soriano, Jaume Roquer
Neurology Aug 2013, 81 (6) 575-580; DOI: 10.1212/WNL.0b013e31829e6f37

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Abstract

Objective: To ascertain the risk of a new vascular event (NVE) occurring after ischemic stroke and evaluate differences in risk based on stroke subtype.

Methods: This was a prospective observational study of consecutive patients with nonfatal stroke recruited at a single tertiary stroke center with follow-up ranging from 2 to 5 years (average, 31 ± 15.9 months). An NVE (vascular death, nonfatal stroke or myocardial infarction, and hospitalization for other atherothrombotic events) was defined according to criteria used in a previously developed large multicenter register of atherothrombotic patients (Reduction of Atherothrombosis for Continued Health Registry [REACH]). We analyzed age, sex, and atherosclerotic burden (AB) based on a number of vascular risk factors, affected vascular areas, and stroke subtype according to Stop Stroke Study Trial of Org 10172 in Acute Stroke Treatment (SSS-TOAST) criteria in cardioaortic, large artery atherosclerosis (LAA), unclassified (more than one causal mechanism), small-artery disease (SAD), and undetermined (without cause) stroke categories.

Results: The final cohort consisted of 748 patients. An NVE occurred in 162 patients (21.7%), equivalent to a rate of 0.084 events per patient/year. Multivariate analysis revealed that higher NVE risk was associated with AB and 3 stroke subtypes, namely cardioaortic (hazard ratio [HR] = 2.58; 95% confidence interval [CI] 1.27–5.22), LAA (HR = 4.17; 95% CI 2.03–8.56), and unclassified (HR = 5.70; 95% CI 2.49–13.08). Patients with SAD or stroke of undetermined cause had lower NVE risk.

Conclusions: Patients who survive stroke are at increased risk for NVEs. The risk for NVE varies according to stroke subtype.

GLOSSARY

AB=
atherosclerotic burden;
CAD=
coronary artery disease;
CE=
cardioaortic embolism;
CI=
confidence interval;
HR=
hazard ratio;
LAA=
large-artery atherosclerosis;
MI=
myocardial infarction;
NVE=
new vascular event;
PAD=
peripheral artery disease;
REACH=
Reduction of Atherothrombosis for Continued Health Registry;
SAD=
small-artery disease;
SSS-TOAST=
Stop Stroke Study Trial of Org 10172 in Acute Stroke Treatment

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Supplemental data at www.neurology.org

  • Received November 9, 2012.
  • Accepted in final form April 22, 2013.
  • © 2013 American Academy of Neurology
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