Risk Stratification for Recurrence and Mortality in Embolic Stroke of Undetermined Source

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

doi:10.1161/STROKEAHA.116.013713

Risk Stratification for Recurrence and Mortality in Embolic Stroke of Undetermined Source

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

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

63 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: The risk of stroke recurrence in patients with Embolic Stroke of Undetermined Source (ESUS) is high, and the optimal antithrombotic strategy for secondary prevention is unclear. We investigated whether congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and stroke or transient ischemic attack (TIA; CHADS2) and CHA2DS2-VASc scores can stratify the long-term risk of ischemic stroke/TIA recurrence and death in ESUS.

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.

Original language	English
Journal	Stroke
Volume	47
Issue number	9
Pages (from-to)	2278-2285
Number of pages	8
ISSN	0039-2499
DOIs	https://doi.org/10.1161/STROKEAHA.116.013713
Publication status	Published - 2016
Externally published	Yes

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Journal Article

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10.1161/STROKEAHA.116.013713

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Ntaios, G., Vemmos, K., Lip, G. Y. H., Koroboki, E., Manios, E., Vemmou, A., Rodríguez-Campello, A., Cuadrado-Godia, E., Giralt-Steinhauer, E., Arnao, V., Caso, V., Paciaroni, M., Diez-Tejedor, E., Fuentes, B., Pérez Lucas, J., Arauz, A., Ameriso, S. F., Hawkes, M. A., Pertierra, L., ... Papavasileiou, V. (2016). Risk Stratification for Recurrence and Mortality in Embolic Stroke of Undetermined Source. Stroke, 47(9), 2278-2285. https://doi.org/10.1161/STROKEAHA.116.013713

@article{3f569a3fadda48b38fff48363fbcee3d,

title = "Risk Stratification for Recurrence and Mortality in Embolic Stroke of Undetermined Source",

abstract = "BACKGROUND AND PURPOSE: The risk of stroke recurrence in patients with Embolic Stroke of Undetermined Source (ESUS) is high, and the optimal antithrombotic strategy for secondary prevention is unclear. We investigated whether congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and stroke or transient ischemic attack (TIA; CHADS2) and CHA2DS2-VASc scores can stratify the long-term risk of ischemic stroke/TIA recurrence and death in ESUS.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.",

keywords = "Journal Article",

author = "George Ntaios and Konstantinos Vemmos and Lip, {Gregory Y H} and Eleni Koroboki and Efstathios Manios and Anastasia Vemmou and Ana Rodr{\'i}guez-Campello and Elisa Cuadrado-Godia and Eva Giralt-Steinhauer 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 Hawkes, {Maximiliano A} and Luc{\'i}a Pertierra and Maia G{\'o}mez-Schneider 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 Konstantinos Makaritsis and Vasileios Papavasileiou",

note = "{\textcopyright} 2016 American Heart Association, Inc.",

year = "2016",

doi = "10.1161/STROKEAHA.116.013713",

language = "English",

volume = "47",

pages = "2278--2285",

journal = "Stroke",

issn = "0039-2499",

publisher = "Lippincott Williams & Wilkins",

number = "9",

}

Ntaios, G, Vemmos, K, Lip, GYH, Koroboki, E, Manios, E, Vemmou, A, Rodríguez-Campello, A, Cuadrado-Godia, E, Giralt-Steinhauer, E, Arnao, V, Caso, V, Paciaroni, M, Diez-Tejedor, E, Fuentes, B, Pérez Lucas, J, Arauz, A, Ameriso, SF, Hawkes, MA, Pertierra, L, Gómez-Schneider, M, Bandini, F, Chavarria Cano, B, Iglesias Mohedano, AM, García Pastor, A, Gil-Núñez, A, Putaala, J, Tatlisumak, T, Barboza, MA, Athanasakis, G, Makaritsis, K & Papavasileiou, V 2016, 'Risk Stratification for Recurrence and Mortality in Embolic Stroke of Undetermined Source', Stroke, vol. 47, no. 9, pp. 2278-2285. https://doi.org/10.1161/STROKEAHA.116.013713

TY - JOUR

T1 - Risk Stratification for Recurrence and Mortality in Embolic Stroke of Undetermined Source

AU - Ntaios, George

AU - Vemmos, Konstantinos

AU - Lip, Gregory Y H

AU - Koroboki, Eleni

AU - Manios, Efstathios

AU - Vemmou, Anastasia

AU - Rodríguez-Campello, Ana

AU - Cuadrado-Godia, Elisa

AU - Giralt-Steinhauer, Eva

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 - Hawkes, Maximiliano A

AU - Pertierra, Lucía

AU - Gómez-Schneider, Maia

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 - Makaritsis, Konstantinos

AU - Papavasileiou, Vasileios

PY - 2016

Y1 - 2016

N2 - BACKGROUND AND PURPOSE: The risk of stroke recurrence in patients with Embolic Stroke of Undetermined Source (ESUS) is high, and the optimal antithrombotic strategy for secondary prevention is unclear. We investigated whether congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and stroke or transient ischemic attack (TIA; CHADS2) and CHA2DS2-VASc scores can stratify the long-term risk of ischemic stroke/TIA recurrence and death in ESUS.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.

AB - BACKGROUND AND PURPOSE: The risk of stroke recurrence in patients with Embolic Stroke of Undetermined Source (ESUS) is high, and the optimal antithrombotic strategy for secondary prevention is unclear. We investigated whether congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and stroke or transient ischemic attack (TIA; CHADS2) and CHA2DS2-VASc scores can stratify the long-term risk of ischemic stroke/TIA recurrence and death in ESUS.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.

KW - Journal Article

U2 - 10.1161/STROKEAHA.116.013713

DO - 10.1161/STROKEAHA.116.013713

M3 - Journal article

C2 - 27507859

SN - 0039-2499

VL - 47

SP - 2278

EP - 2285

JO - Stroke

JF - Stroke

IS - 9

ER -

Risk Stratification for Recurrence and Mortality in Embolic Stroke of Undetermined Source

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