Risk Stratification for Recurrence and Mortality in Embolic Stroke of Undetermined Source.
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Ntaios George, Vemmos Konstantinos, Lip Gregory Y H, Koroboki Eleni, Manios Efstathios, Vemmou Anastasia, Rodríguez-Campello Ana, Cuadrado-Godia Elisa, Giralt-Steinhauer Eva, Arnao Valentina, Caso Valeria, Paciaroni Maurizio, Diez-Tejedor Exuperio, Fuentes Blanca, Pérez Lucas Josefa, Arauz Antonio, Ameriso Sebastian F, Hawkes Maximiliano A, Pertierra Lucía, Gómez-Schneider Maia, Bandini Fabio, Chavarria Cano Beatriz, Iglesias Mohedano Ana Maria, García Pastor Andrés, Gil-Núñez Antonio, Putaala Jukka, Tatlisumak Turgut, Barboza Miguel A, Athanasakis George, Makaritsis Konstantinos, Papavasileiou Vasileios
Аннотация
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 CHADS2 and congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or TIA, vascular disease, age 65-74 years, sex category (CHA2DS2-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 CHADS2 and CHA2DS2-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 CHADS2 score 0, patients with CHADS2 score 1 and CHADS2 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 CHA2DS2-VASc score, patients with high-risk CHA2DS2-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 CHADS2 and CHA2DS2-VASc scores. Compared with the low-risk group, patients in the high-risk CHA2DS2-VASc group have much higher risk of ischemic stroke recurrence/TIA and death, approximately 3-fold and 13-fold, respectively.