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

Background and purpose Embolic 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 we...

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Bibliographic Details
Published in:European journal of neurology Vol. 25; no. 3; pp. 535 - 541
Main Authors: Martinez‐Majander, N., Aarnio, K., Pirinen, J., Lumikari, T., Nieminen, T., Lehto, M., Sinisalo, J., Kaste, M., Tatlisumak, T., Putaala, J.
Format: Journal Article
Language:English
Published: England John Wiley & Sons, Inc 01-03-2018
Subjects:
1st-ever ischemic-stroke
Adolescent
Adult
Adults
Arteriosclerosis
Atherosclerosis
Atherosclerosis - complications
Atherosclerosis - epidemiology
brain infarction
Brain Ischemia - epidemiology
Brain Ischemia - etiology
Cardiovascular diseases
Cerebral Small Vessel Diseases - complications
Cerebral Small Vessel Diseases - epidemiology
Cohort Studies
embolic stroke of undetermined source
Embolism - complications
Embolism - epidemiology
esus
events
Female
Follow-Up Studies
Health risk assessment
Health risks
Humans
Life tables
Male
Middle Aged
Mortality
Neurosciences
Neurovetenskaper
outcome
patent foramen ovale
Patients
Recurrence
Registries
registry
risk
Risk analysis
Risk Factors
Stroke
Stroke - epidemiology
Stroke - etiology
Subgroups
Young Adult
Young adults
risk factors
brain infarction
embolic stroke of undetermined source
young adult
stroke
outcome
middle-aged
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Summary:Background and purpose Embolic 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. Methods Patients 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. Results Of 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. Conclusions In 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.
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ISSN:1351-5101
1468-1331
DOI:10.1111/ene.13540