Age- and sex-specific analysis of patients with embolic stroke of undetermined source

George Ntaios; Gregory Y H Lip; Konstantinos Vemmos; Eleni Koroboki; Efstathios Manios; Anastasia Vemmou; Ana Rodríguez-Campello; Elisa Cuadrado-Godia; Jaume Roquer; Valentina Arnao; Valeria Caso; Maurizio Paciaroni; Exuperio Diez-Tejedor; Blanca Fuentes; Josefa Pérez Lucas; Antonio Arauz; Sebastian F Ameriso; Lucía Pertierra; Maia Gómez-Schneider; Maximiliano A Hawkes; Fabio Bandini; Beatriz Chavarria Cano; Ana Maria Iglesias Mohedano; Andrés García Pastor; Antonio Gil-Núñez; Jukka Putaala; Turgut Tatlisumak; Miguel A Barboza; George Athanasakis; Fotios Gioulekas; Konstantinos Makaritsis; Vasileios Papavasileiou

doi:10.1212/WNL.0000000000004199

Age- and sex-specific analysis of patients with embolic stroke of undetermined source

George Ntaios, Gregory Y H Lip, Konstantinos Vemmos, Eleni Koroboki, Efstathios Manios, Anastasia Vemmou, Ana Rodríguez-Campello, Elisa Cuadrado-Godia, Jaume Roquer, Valentina Arnao, Valeria Caso, Maurizio Paciaroni, Exuperio Diez-Tejedor, Blanca Fuentes, Josefa Pérez Lucas, Antonio Arauz, Sebastian F Ameriso, Lucía Pertierra, Maia Gómez-Schneider, Maximiliano A HawkesFabio Bandini, Beatriz Chavarria Cano, Ana Maria Iglesias Mohedano, Andrés García Pastor, Antonio Gil-Núñez, Jukka Putaala, Turgut Tatlisumak, Miguel A Barboza, George Athanasakis, Fotios Gioulekas, Konstantinos Makaritsis, Vasileios Papavasileiou

Research output: Contribution to journal › Journal article › Research › peer-review

37 Citations (Scopus)

Abstract

OBJECTIVE: To investigate whether the correlation of age and sex with the risk of recurrence and death seen in patients with previous ischemic stroke is also evident in patients with embolic stroke of undetermined source (ESUS).

METHODS: We pooled datasets of 11 stroke registries from Europe and America. ESUS was defined according to the Cryptogenic Stroke/ESUS International Working Group. We performed Cox regression and Kaplan-Meier product limit analyses to investigate whether age (<60, 60-80, >80 years) and sex were independently associated with the risk for ischemic stroke/TIA recurrence or death.

RESULTS: Ischemic stroke/TIA recurrences and deaths per 100 patient-years were 2.46 and 1.01 in patients <60 years old, 5.76 and 5.23 in patients 60 to 80 years old, 7.88 and 11.58 in those >80 years old, 3.53 and 3.48 in women, and 4.49 and 3.98 in men, respectively. Female sex was not associated with increased risk for recurrent ischemic stroke/TIA (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.84-1.58) or death (HR 1.35, 95% CI 0.97-1.86). Compared with the group <60 years old, the 60- to 80- and >80-year groups had higher 10-year cumulative probability of recurrent ischemic stroke/TIA (14.0%, 47.9%, and 37.0%, respectively, p < 0.001) and death (6.4%, 40.6%, and 100%, respectively, p < 0.001) and higher risk for recurrent ischemic stroke/TIA (HR 1.90, 95% CI 1.21-2.98 and HR 2.71, 95% CI 1.57-4.70, respectively) and death (HR 4.43, 95% CI 2.32-8.44 and HR 8.01, 95% CI 3.98-16.10, respectively).

CONCLUSIONS: Age, but not sex, is a strong predictor of stroke recurrence and death in ESUS. The risk is ≈3- and 8-fold higher in patients >80 years compared with those <60 years of age, respectively. The age distribution in the ongoing ESUS trials may potentially influence their power to detect a significant treatment association.

Original language	English
Journal	Neurology
Volume	89
Issue number	6
Pages (from-to)	532-539
Number of pages	8
ISSN	0028-3878
DOIs	https://doi.org/10.1212/WNL.0000000000004199
Publication status	Published - 2017
Externally published	Yes

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Journal Article

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10.1212/WNL.0000000000004199

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Ntaios, G., Lip, G. Y. H., Vemmos, K., Koroboki, E., Manios, E., Vemmou, A., Rodríguez-Campello, A., Cuadrado-Godia, E., Roquer, J., Arnao, V., Caso, V., Paciaroni, M., Diez-Tejedor, E., Fuentes, B., Pérez Lucas, J., Arauz, A., Ameriso, S. F., Pertierra, L., Gómez-Schneider, M., ... Papavasileiou, V. (2017). Age- and sex-specific analysis of patients with embolic stroke of undetermined source. Neurology, 89(6), 532-539. https://doi.org/10.1212/WNL.0000000000004199

@article{b109f2d54f8447109a824688d051bc78,

title = "Age- and sex-specific analysis of patients with embolic stroke of undetermined source",

abstract = "OBJECTIVE: To investigate whether the correlation of age and sex with the risk of recurrence and death seen in patients with previous ischemic stroke is also evident in patients with embolic stroke of undetermined source (ESUS).METHODS: We pooled datasets of 11 stroke registries from Europe and America. ESUS was defined according to the Cryptogenic Stroke/ESUS International Working Group. We performed Cox regression and Kaplan-Meier product limit analyses to investigate whether age (<60, 60-80, >80 years) and sex were independently associated with the risk for ischemic stroke/TIA recurrence or death.RESULTS: Ischemic stroke/TIA recurrences and deaths per 100 patient-years were 2.46 and 1.01 in patients <60 years old, 5.76 and 5.23 in patients 60 to 80 years old, 7.88 and 11.58 in those >80 years old, 3.53 and 3.48 in women, and 4.49 and 3.98 in men, respectively. Female sex was not associated with increased risk for recurrent ischemic stroke/TIA (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.84-1.58) or death (HR 1.35, 95% CI 0.97-1.86). Compared with the group <60 years old, the 60- to 80- and >80-year groups had higher 10-year cumulative probability of recurrent ischemic stroke/TIA (14.0%, 47.9%, and 37.0%, respectively, p < 0.001) and death (6.4%, 40.6%, and 100%, respectively, p < 0.001) and higher risk for recurrent ischemic stroke/TIA (HR 1.90, 95% CI 1.21-2.98 and HR 2.71, 95% CI 1.57-4.70, respectively) and death (HR 4.43, 95% CI 2.32-8.44 and HR 8.01, 95% CI 3.98-16.10, respectively).CONCLUSIONS: Age, but not sex, is a strong predictor of stroke recurrence and death in ESUS. The risk is ≈3- and 8-fold higher in patients >80 years compared with those <60 years of age, respectively. The age distribution in the ongoing ESUS trials may potentially influence their power to detect a significant treatment association.",

keywords = "Journal Article",

author = "George Ntaios and Lip, {Gregory Y H} and Konstantinos Vemmos and Eleni Koroboki and Efstathios Manios and Anastasia Vemmou and Ana Rodr{\'i}guez-Campello and Elisa Cuadrado-Godia and Jaume Roquer and Valentina Arnao and Valeria Caso and Maurizio Paciaroni and Exuperio Diez-Tejedor and Blanca Fuentes and {P{\'e}rez Lucas}, Josefa and Antonio Arauz and Ameriso, {Sebastian F} and Luc{\'i}a Pertierra and Maia G{\'o}mez-Schneider and Hawkes, {Maximiliano A} and Fabio Bandini and {Chavarria Cano}, Beatriz and {Iglesias Mohedano}, {Ana Maria} and {Garc{\'i}a Pastor}, Andr{\'e}s and Antonio Gil-N{\'u}{\~n}ez and Jukka Putaala and Turgut Tatlisumak and Barboza, {Miguel A} and George Athanasakis and Fotios Gioulekas and Konstantinos Makaritsis and Vasileios Papavasileiou",

note = "{\textcopyright} 2017 American Academy of Neurology.",

year = "2017",

doi = "10.1212/WNL.0000000000004199",

language = "English",

volume = "89",

pages = "532--539",

journal = "Neurology",

issn = "0028-3878",

publisher = "Lippincott Williams & Wilkins",

number = "6",

}

Ntaios, G, Lip, GYH, Vemmos, K, Koroboki, E, Manios, E, Vemmou, A, Rodríguez-Campello, A, Cuadrado-Godia, E, Roquer, J, Arnao, V, Caso, V, Paciaroni, M, Diez-Tejedor, E, Fuentes, B, Pérez Lucas, J, Arauz, A, Ameriso, SF, Pertierra, L, Gómez-Schneider, M, Hawkes, MA, Bandini, F, Chavarria Cano, B, Iglesias Mohedano, AM, García Pastor, A, Gil-Núñez, A, Putaala, J, Tatlisumak, T, Barboza, MA, Athanasakis, G, Gioulekas, F, Makaritsis, K & Papavasileiou, V 2017, 'Age- and sex-specific analysis of patients with embolic stroke of undetermined source', Neurology, vol. 89, no. 6, pp. 532-539. https://doi.org/10.1212/WNL.0000000000004199

TY - JOUR

T1 - Age- and sex-specific analysis of patients with embolic stroke of undetermined source

AU - Ntaios, George

AU - Lip, Gregory Y H

AU - Vemmos, Konstantinos

AU - Koroboki, Eleni

AU - Manios, Efstathios

AU - Vemmou, Anastasia

AU - Rodríguez-Campello, Ana

AU - Cuadrado-Godia, Elisa

AU - Roquer, Jaume

AU - Arnao, Valentina

AU - Caso, Valeria

AU - Paciaroni, Maurizio

AU - Diez-Tejedor, Exuperio

AU - Fuentes, Blanca

AU - Pérez Lucas, Josefa

AU - Arauz, Antonio

AU - Ameriso, Sebastian F

AU - Pertierra, Lucía

AU - Gómez-Schneider, Maia

AU - Hawkes, Maximiliano A

AU - Bandini, Fabio

AU - Chavarria Cano, Beatriz

AU - Iglesias Mohedano, Ana Maria

AU - García Pastor, Andrés

AU - Gil-Núñez, Antonio

AU - Putaala, Jukka

AU - Tatlisumak, Turgut

AU - Barboza, Miguel A

AU - Athanasakis, George

AU - Gioulekas, Fotios

AU - Makaritsis, Konstantinos

AU - Papavasileiou, Vasileios

PY - 2017

Y1 - 2017

N2 - OBJECTIVE: To investigate whether the correlation of age and sex with the risk of recurrence and death seen in patients with previous ischemic stroke is also evident in patients with embolic stroke of undetermined source (ESUS).METHODS: We pooled datasets of 11 stroke registries from Europe and America. ESUS was defined according to the Cryptogenic Stroke/ESUS International Working Group. We performed Cox regression and Kaplan-Meier product limit analyses to investigate whether age (<60, 60-80, >80 years) and sex were independently associated with the risk for ischemic stroke/TIA recurrence or death.RESULTS: Ischemic stroke/TIA recurrences and deaths per 100 patient-years were 2.46 and 1.01 in patients <60 years old, 5.76 and 5.23 in patients 60 to 80 years old, 7.88 and 11.58 in those >80 years old, 3.53 and 3.48 in women, and 4.49 and 3.98 in men, respectively. Female sex was not associated with increased risk for recurrent ischemic stroke/TIA (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.84-1.58) or death (HR 1.35, 95% CI 0.97-1.86). Compared with the group <60 years old, the 60- to 80- and >80-year groups had higher 10-year cumulative probability of recurrent ischemic stroke/TIA (14.0%, 47.9%, and 37.0%, respectively, p < 0.001) and death (6.4%, 40.6%, and 100%, respectively, p < 0.001) and higher risk for recurrent ischemic stroke/TIA (HR 1.90, 95% CI 1.21-2.98 and HR 2.71, 95% CI 1.57-4.70, respectively) and death (HR 4.43, 95% CI 2.32-8.44 and HR 8.01, 95% CI 3.98-16.10, respectively).CONCLUSIONS: Age, but not sex, is a strong predictor of stroke recurrence and death in ESUS. The risk is ≈3- and 8-fold higher in patients >80 years compared with those <60 years of age, respectively. The age distribution in the ongoing ESUS trials may potentially influence their power to detect a significant treatment association.

AB - OBJECTIVE: To investigate whether the correlation of age and sex with the risk of recurrence and death seen in patients with previous ischemic stroke is also evident in patients with embolic stroke of undetermined source (ESUS).METHODS: We pooled datasets of 11 stroke registries from Europe and America. ESUS was defined according to the Cryptogenic Stroke/ESUS International Working Group. We performed Cox regression and Kaplan-Meier product limit analyses to investigate whether age (<60, 60-80, >80 years) and sex were independently associated with the risk for ischemic stroke/TIA recurrence or death.RESULTS: Ischemic stroke/TIA recurrences and deaths per 100 patient-years were 2.46 and 1.01 in patients <60 years old, 5.76 and 5.23 in patients 60 to 80 years old, 7.88 and 11.58 in those >80 years old, 3.53 and 3.48 in women, and 4.49 and 3.98 in men, respectively. Female sex was not associated with increased risk for recurrent ischemic stroke/TIA (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.84-1.58) or death (HR 1.35, 95% CI 0.97-1.86). Compared with the group <60 years old, the 60- to 80- and >80-year groups had higher 10-year cumulative probability of recurrent ischemic stroke/TIA (14.0%, 47.9%, and 37.0%, respectively, p < 0.001) and death (6.4%, 40.6%, and 100%, respectively, p < 0.001) and higher risk for recurrent ischemic stroke/TIA (HR 1.90, 95% CI 1.21-2.98 and HR 2.71, 95% CI 1.57-4.70, respectively) and death (HR 4.43, 95% CI 2.32-8.44 and HR 8.01, 95% CI 3.98-16.10, respectively).CONCLUSIONS: Age, but not sex, is a strong predictor of stroke recurrence and death in ESUS. The risk is ≈3- and 8-fold higher in patients >80 years compared with those <60 years of age, respectively. The age distribution in the ongoing ESUS trials may potentially influence their power to detect a significant treatment association.

KW - Journal Article

U2 - 10.1212/WNL.0000000000004199

DO - 10.1212/WNL.0000000000004199

M3 - Journal article

C2 - 28687720

SN - 0028-3878

VL - 89

SP - 532

EP - 539

JO - Neurology

JF - Neurology

IS - 6

ER -

Age- and sex-specific analysis of patients with embolic stroke of undetermined source

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