Incidence, characteristics and outcomes in patients with embolic stroke of undetermined source: A population-based study
Embolic stroke of undetermined source (ESUS) represents a subgroup of cryptogenic ischemic stroke (CS) distinguished by high probability of an underlying embolic mechanism. There are scarce population-based data regarding the incidence, characteristics and outcomes of ESUS. Consecutive patients incl...
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| Veröffentlicht in: | Journal of the neurological sciences 2019-06, Vol.401, p.5-11 |
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| creator | Tsivgoulis, Georgios Kargiotis, Odysseas Katsanos, Aristeidis H. Patousi, Athanasia Mavridis, Dimitris Tsokani, Sofia Pikilidou, Maria Birbilis, Theodosis Mantatzis, Michael Zompola, Christina Triantafyllou, Sokratis Papanas, Nikolaos Skendros, Panagiotis Terzoudi, Aikaterini Georgiadis, George S. Maltezos, Efstratios Piperidou, Charitomeni Tsioufis, Konstantinos Heliopoulos, Ioannis Vadikolias, Konstantinos |
| description | Embolic stroke of undetermined source (ESUS) represents a subgroup of cryptogenic ischemic stroke (CS) distinguished by high probability of an underlying embolic mechanism. There are scarce population-based data regarding the incidence, characteristics and outcomes of ESUS. Consecutive patients included with first-ever ischemic stroke of undetermined cause in the previously published population-based Evros Stroke Registry were further subdivided into ESUS and non-ESUS CS. Crude and adjusted [according to the European Standard Population (ESP), WHO and Segi population] incidence rates (IR) for ESUS and non-ESUS CS were calculated. Baseline characteristics, admission stroke severity (assessed using NIHSS-score), stroke recurrence and functional outcomes [determined by modified Rankin Scale (mRS) scores], were recorded during the 1-year follow-up period. We identified 21 and 242 cases with ESUS (8% of CS) and non-ESUS CS. The crude and ESP-adjusted IR for ESUS were 17.5 (95%CI: 10–25) and 16.6 (95%CI: 10–24) per 100,000 person-years. Patients with ESUS were younger (p |
| doi_str_mv | 10.1016/j.jns.2019.04.008 |
| format | Article |
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•Population-based data on incidence, characteristics and outcomes of ESUS are scarce.•Patients in the Evros Stroke Registry were subdivided into ESUS and non-ESUS CS.•ESUS subtype was independently related to lower admission stroke severity.•ESUS subtype was not related to 1-year mortality, recurrence or functional outcome.</description><identifier>ISSN: 0022-510X</identifier><identifier>EISSN: 1878-5883</identifier><identifier>DOI: 10.1016/j.jns.2019.04.008</identifier><identifier>PMID: 30986703</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Anticoagulation ; Atrial fibrillation ; Cryptogenic stroke ; Embolic stroke of undetermined source ; Incidence rate ; Mortality ; Population-based ; Recurrence</subject><ispartof>Journal of the neurological sciences, 2019-06, Vol.401, p.5-11</ispartof><rights>2019</rights><rights>Copyright © 2019. Published by Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-68c45c394af3687859b521b49a7db56f088f29540c9cba5b86d6b935c32e92ad3</citedby><cites>FETCH-LOGICAL-c353t-68c45c394af3687859b521b49a7db56f088f29540c9cba5b86d6b935c32e92ad3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022510X19301650$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30986703$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tsivgoulis, Georgios</creatorcontrib><creatorcontrib>Kargiotis, Odysseas</creatorcontrib><creatorcontrib>Katsanos, Aristeidis H.</creatorcontrib><creatorcontrib>Patousi, Athanasia</creatorcontrib><creatorcontrib>Mavridis, Dimitris</creatorcontrib><creatorcontrib>Tsokani, Sofia</creatorcontrib><creatorcontrib>Pikilidou, Maria</creatorcontrib><creatorcontrib>Birbilis, Theodosis</creatorcontrib><creatorcontrib>Mantatzis, Michael</creatorcontrib><creatorcontrib>Zompola, Christina</creatorcontrib><creatorcontrib>Triantafyllou, Sokratis</creatorcontrib><creatorcontrib>Papanas, Nikolaos</creatorcontrib><creatorcontrib>Skendros, Panagiotis</creatorcontrib><creatorcontrib>Terzoudi, Aikaterini</creatorcontrib><creatorcontrib>Georgiadis, George S.</creatorcontrib><creatorcontrib>Maltezos, Efstratios</creatorcontrib><creatorcontrib>Piperidou, Charitomeni</creatorcontrib><creatorcontrib>Tsioufis, Konstantinos</creatorcontrib><creatorcontrib>Heliopoulos, Ioannis</creatorcontrib><creatorcontrib>Vadikolias, Konstantinos</creatorcontrib><title>Incidence, characteristics and outcomes in patients with embolic stroke of undetermined source: A population-based study</title><title>Journal of the neurological sciences</title><addtitle>J Neurol Sci</addtitle><description>Embolic stroke of undetermined source (ESUS) represents a subgroup of cryptogenic ischemic stroke (CS) distinguished by high probability of an underlying embolic mechanism. There are scarce population-based data regarding the incidence, characteristics and outcomes of ESUS. Consecutive patients included with first-ever ischemic stroke of undetermined cause in the previously published population-based Evros Stroke Registry were further subdivided into ESUS and non-ESUS CS. Crude and adjusted [according to the European Standard Population (ESP), WHO and Segi population] incidence rates (IR) for ESUS and non-ESUS CS were calculated. Baseline characteristics, admission stroke severity (assessed using NIHSS-score), stroke recurrence and functional outcomes [determined by modified Rankin Scale (mRS) scores], were recorded during the 1-year follow-up period. We identified 21 and 242 cases with ESUS (8% of CS) and non-ESUS CS. The crude and ESP-adjusted IR for ESUS were 17.5 (95%CI: 10–25) and 16.6 (95%CI: 10–24) per 100,000 person-years. Patients with ESUS were younger (p < .001) and had lower median admission NIHSS-scores (p < .001). Functional outcomes were more favorable in ESUS at 28, 90 and 365 days. ESUS was independently (p = .033) associated with lower admission NIHSS-scores (unstandardized linear regression coefficient: -13.34;95%CI: -23.34, −3.35) on multiple linear regression models. ESUS was not related to 1-year stroke recurrence, mortality and functional improvement on multivariable analyses. In conclusion we found that ESUS cases represented 8% of CS patients in this population-based study. Despite the fact that ESUS was independently related to lower admission stroke severity, there was no association of ESUS with long-term outcomes.
•Population-based data on incidence, characteristics and outcomes of ESUS are scarce.•Patients in the Evros Stroke Registry were subdivided into ESUS and non-ESUS CS.•ESUS subtype was independently related to lower admission stroke severity.•ESUS subtype was not related to 1-year mortality, recurrence or functional outcome.</description><subject>Anticoagulation</subject><subject>Atrial fibrillation</subject><subject>Cryptogenic stroke</subject><subject>Embolic stroke of undetermined source</subject><subject>Incidence rate</subject><subject>Mortality</subject><subject>Population-based</subject><subject>Recurrence</subject><issn>0022-510X</issn><issn>1878-5883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9kMFu1DAURS0EotPCB7BBXrIg4dlOMjasqgpKpUpsQGJnOfaL6iGxg-0U-vd4NIUlq7d491zpHkJeMWgZsOHdoT2E3HJgqoWuBZBPyI7JvWx6KcVTsgPgvOkZfD8j5zkfAGCQUj0nZwKUHPYgduT3TbDeYbD4lto7k4wtmHwu3mZqgqNxKzYumKkPdDXFYyiZ_vLljuIyxtlbmkuKP5DGiW7BYaUXH9DRHLdk8T29pGtct7miMTSjycdX2dzDC_JsMnPGl4_3gnz79PHr1efm9sv1zdXlbWNFL0ozSNv1VqjOTGKo03o19pyNnTJ7N_bDBFJOXPUdWGVH049ycMOoREU4Km6cuCBvTr1rij83zEUvPlucZxMwbllzzoALEHxfo-wUtSnmnHDSa_KLSQ-agT4K1wddheujcA2drsIr8_qxfhsXdP-Iv4Zr4MMpgHXkvceks_VH384ntEW76P9T_wfm1pL2</recordid><startdate>20190615</startdate><enddate>20190615</enddate><creator>Tsivgoulis, Georgios</creator><creator>Kargiotis, Odysseas</creator><creator>Katsanos, Aristeidis H.</creator><creator>Patousi, Athanasia</creator><creator>Mavridis, Dimitris</creator><creator>Tsokani, Sofia</creator><creator>Pikilidou, Maria</creator><creator>Birbilis, Theodosis</creator><creator>Mantatzis, Michael</creator><creator>Zompola, Christina</creator><creator>Triantafyllou, Sokratis</creator><creator>Papanas, Nikolaos</creator><creator>Skendros, Panagiotis</creator><creator>Terzoudi, Aikaterini</creator><creator>Georgiadis, George S.</creator><creator>Maltezos, Efstratios</creator><creator>Piperidou, Charitomeni</creator><creator>Tsioufis, Konstantinos</creator><creator>Heliopoulos, Ioannis</creator><creator>Vadikolias, Konstantinos</creator><general>Elsevier B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20190615</creationdate><title>Incidence, characteristics and outcomes in patients with embolic stroke of undetermined source: A population-based study</title><author>Tsivgoulis, Georgios ; Kargiotis, Odysseas ; Katsanos, Aristeidis H. ; Patousi, Athanasia ; Mavridis, Dimitris ; Tsokani, Sofia ; Pikilidou, Maria ; Birbilis, Theodosis ; Mantatzis, Michael ; Zompola, Christina ; Triantafyllou, Sokratis ; Papanas, Nikolaos ; Skendros, Panagiotis ; Terzoudi, Aikaterini ; Georgiadis, George S. ; Maltezos, Efstratios ; Piperidou, Charitomeni ; Tsioufis, Konstantinos ; Heliopoulos, Ioannis ; Vadikolias, Konstantinos</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-68c45c394af3687859b521b49a7db56f088f29540c9cba5b86d6b935c32e92ad3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Anticoagulation</topic><topic>Atrial fibrillation</topic><topic>Cryptogenic stroke</topic><topic>Embolic stroke of undetermined source</topic><topic>Incidence rate</topic><topic>Mortality</topic><topic>Population-based</topic><topic>Recurrence</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tsivgoulis, Georgios</creatorcontrib><creatorcontrib>Kargiotis, Odysseas</creatorcontrib><creatorcontrib>Katsanos, Aristeidis H.</creatorcontrib><creatorcontrib>Patousi, Athanasia</creatorcontrib><creatorcontrib>Mavridis, Dimitris</creatorcontrib><creatorcontrib>Tsokani, Sofia</creatorcontrib><creatorcontrib>Pikilidou, Maria</creatorcontrib><creatorcontrib>Birbilis, Theodosis</creatorcontrib><creatorcontrib>Mantatzis, Michael</creatorcontrib><creatorcontrib>Zompola, Christina</creatorcontrib><creatorcontrib>Triantafyllou, Sokratis</creatorcontrib><creatorcontrib>Papanas, Nikolaos</creatorcontrib><creatorcontrib>Skendros, Panagiotis</creatorcontrib><creatorcontrib>Terzoudi, Aikaterini</creatorcontrib><creatorcontrib>Georgiadis, George S.</creatorcontrib><creatorcontrib>Maltezos, Efstratios</creatorcontrib><creatorcontrib>Piperidou, Charitomeni</creatorcontrib><creatorcontrib>Tsioufis, Konstantinos</creatorcontrib><creatorcontrib>Heliopoulos, Ioannis</creatorcontrib><creatorcontrib>Vadikolias, Konstantinos</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the neurological sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tsivgoulis, Georgios</au><au>Kargiotis, Odysseas</au><au>Katsanos, Aristeidis H.</au><au>Patousi, Athanasia</au><au>Mavridis, Dimitris</au><au>Tsokani, Sofia</au><au>Pikilidou, Maria</au><au>Birbilis, Theodosis</au><au>Mantatzis, Michael</au><au>Zompola, Christina</au><au>Triantafyllou, Sokratis</au><au>Papanas, Nikolaos</au><au>Skendros, Panagiotis</au><au>Terzoudi, Aikaterini</au><au>Georgiadis, George S.</au><au>Maltezos, Efstratios</au><au>Piperidou, Charitomeni</au><au>Tsioufis, Konstantinos</au><au>Heliopoulos, Ioannis</au><au>Vadikolias, Konstantinos</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence, characteristics and outcomes in patients with embolic stroke of undetermined source: A population-based study</atitle><jtitle>Journal of the neurological sciences</jtitle><addtitle>J Neurol Sci</addtitle><date>2019-06-15</date><risdate>2019</risdate><volume>401</volume><spage>5</spage><epage>11</epage><pages>5-11</pages><issn>0022-510X</issn><eissn>1878-5883</eissn><abstract>Embolic stroke of undetermined source (ESUS) represents a subgroup of cryptogenic ischemic stroke (CS) distinguished by high probability of an underlying embolic mechanism. There are scarce population-based data regarding the incidence, characteristics and outcomes of ESUS. Consecutive patients included with first-ever ischemic stroke of undetermined cause in the previously published population-based Evros Stroke Registry were further subdivided into ESUS and non-ESUS CS. Crude and adjusted [according to the European Standard Population (ESP), WHO and Segi population] incidence rates (IR) for ESUS and non-ESUS CS were calculated. Baseline characteristics, admission stroke severity (assessed using NIHSS-score), stroke recurrence and functional outcomes [determined by modified Rankin Scale (mRS) scores], were recorded during the 1-year follow-up period. We identified 21 and 242 cases with ESUS (8% of CS) and non-ESUS CS. The crude and ESP-adjusted IR for ESUS were 17.5 (95%CI: 10–25) and 16.6 (95%CI: 10–24) per 100,000 person-years. Patients with ESUS were younger (p < .001) and had lower median admission NIHSS-scores (p < .001). Functional outcomes were more favorable in ESUS at 28, 90 and 365 days. ESUS was independently (p = .033) associated with lower admission NIHSS-scores (unstandardized linear regression coefficient: -13.34;95%CI: -23.34, −3.35) on multiple linear regression models. ESUS was not related to 1-year stroke recurrence, mortality and functional improvement on multivariable analyses. In conclusion we found that ESUS cases represented 8% of CS patients in this population-based study. Despite the fact that ESUS was independently related to lower admission stroke severity, there was no association of ESUS with long-term outcomes.
•Population-based data on incidence, characteristics and outcomes of ESUS are scarce.•Patients in the Evros Stroke Registry were subdivided into ESUS and non-ESUS CS.•ESUS subtype was independently related to lower admission stroke severity.•ESUS subtype was not related to 1-year mortality, recurrence or functional outcome.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>30986703</pmid><doi>10.1016/j.jns.2019.04.008</doi><tpages>7</tpages></addata></record> |
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| subjects | Anticoagulation Atrial fibrillation Cryptogenic stroke Embolic stroke of undetermined source Incidence rate Mortality Population-based Recurrence |
| title | Incidence, characteristics and outcomes in patients with embolic stroke of undetermined source: A population-based study |
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