Acute ischaemic stroke in the absence of established vascular risk factors: Patient characteristics, stroke mechanism and long‐term outcome
Background and purpose Some acute ischaemic stroke (AIS) patients do not display established vascular risk factors (EVRFs). The aim was to assess their clinical characteristics, stroke subtype etiological classification and long‐term outcome. Methods All consecutive AIS patients from the Acute Strok...
Gespeichert in:
| Veröffentlicht in: | European journal of neurology 2021-04, Vol.28 (4), p.1275-1283 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 1283 |
|---|---|
| container_issue | 4 |
| container_start_page | 1275 |
| container_title | European journal of neurology |
| container_volume | 28 |
| creator | Nannoni, Stefania Scherz‐Moussa Youma, Ali Amiguet, Michael Eskandari, Ashraf Strambo, Davide Michel, Patrik |
| description | Background and purpose
Some acute ischaemic stroke (AIS) patients do not display established vascular risk factors (EVRFs). The aim was to assess their clinical characteristics, stroke subtype etiological classification and long‐term outcome.
Methods
All consecutive AIS patients from the Acute Stroke Registry of Lausanne (2003–2018) were retrospectively analyzed with complete assessment of the following EVRFs: hypertension, diabetes, major cardioembolic sources, dyslipidemia, smoking, obesity, alcohol abuse, previous stroke/transient ischaemic attack and depression/psychosis. Patients without EVRFs were compared to patients with one or more EVRFs using appropriate statistical models.
Results
Of 4889 included patients, 103 (2.1%) had no EVRFs. In multiple regression analysis, patients without EVRFs were significantly younger (odds ratio [OR] 0.13; 95% confidence interval [CI] 0.08–0.20) and had more multiterritorial strokes (OR 3.38; 95% CI 1.26–9.05). Strokes were more often related to patent foramen ovale (PFO) (OR 3.02; 95% CI 1.44–6.32) and less to atherosclerosis, cardioembolism or small vessel disease. In patients |
| doi_str_mv | 10.1111/ene.14667 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2467841857</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2497979295</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3537-a26993bc4db3bb2866c8c0c88de67fead15675e6222f86e815981bf3417412da3</originalsourceid><addsrcrecordid>eNp1kctu1TAQhq0K1Bss-gLIEhsqkTa240u6q6rDRapaFrCOHGfS4zaxi-2AuuMFkHhGnqQDp2VRCXsx1synT7Z_Qg5YfcRwHUOAI9YopbfILlZTMSHYMzwLySrJarZD9nK-ruuaa15vkx0huGkkN7vk56lbClCf3drC7B3NJcUbbARa1kBtnyE4oHGkkIvtJ5_XMNBvNrtlsokmn2_oaF2JKZ_QT7Z4CIWiK2EPcFq8y28fpTPgJPg8UxsGOsVw9fvHL8RmGpfi4gwvyPPRThlePtR98uXd6vPZh-r88v3Hs9PzygkpdGW5alvRu2boRd9zo5QzrnbGDKD0CHZgUmkJinM-GgWGydawfhQN0w3jgxX75M3Ge5vi1wVf1s34AzBNNkBccscbpU3DjNSIvn6CXsclBbwdUq3GzVuJ1OGGcinmnGDsbpOfbbrrWN39yajDjLq_GSH76sG49DMM_8jHUBA43gDf_QR3_zd1q4vVRnkPzZadog</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2497979295</pqid></control><display><type>article</type><title>Acute ischaemic stroke in the absence of established vascular risk factors: Patient characteristics, stroke mechanism and long‐term outcome</title><source>Access via Wiley Online Library</source><creator>Nannoni, Stefania ; Scherz‐Moussa Youma, Ali ; Amiguet, Michael ; Eskandari, Ashraf ; Strambo, Davide ; Michel, Patrik</creator><creatorcontrib>Nannoni, Stefania ; Scherz‐Moussa Youma, Ali ; Amiguet, Michael ; Eskandari, Ashraf ; Strambo, Davide ; Michel, Patrik</creatorcontrib><description>Background and purpose
Some acute ischaemic stroke (AIS) patients do not display established vascular risk factors (EVRFs). The aim was to assess their clinical characteristics, stroke subtype etiological classification and long‐term outcome.
Methods
All consecutive AIS patients from the Acute Stroke Registry of Lausanne (2003–2018) were retrospectively analyzed with complete assessment of the following EVRFs: hypertension, diabetes, major cardioembolic sources, dyslipidemia, smoking, obesity, alcohol abuse, previous stroke/transient ischaemic attack and depression/psychosis. Patients without EVRFs were compared to patients with one or more EVRFs using appropriate statistical models.
Results
Of 4889 included patients, 103 (2.1%) had no EVRFs. In multiple regression analysis, patients without EVRFs were significantly younger (odds ratio [OR] 0.13; 95% confidence interval [CI] 0.08–0.20) and had more multiterritorial strokes (OR 3.38; 95% CI 1.26–9.05). Strokes were more often related to patent foramen ovale (PFO) (OR 3.02; 95% CI 1.44–6.32) and less to atherosclerosis, cardioembolism or small vessel disease. In patients <55 years old, PFO (OR 2.76; 95% CI 1.50–5.08) and contraceptive use in females (OR 2.75; 95% CI 1.40–5.41) were more frequent, whereas sleep apnea syndrome (OR 0.09; 95% CI 0.01–0.63) was less. In patients ≥55 years, female sex (OR 2.84; 95% CI 1.43–5.65) and active cancer (OR 3.27; 95% CI 1.34–7.94) were more prevalent. At 12 months, patients without EVRFs had worse adjusted functional outcome (Rankin shift ORadj 0.63; 95% CI 0.42–0.95) and higher rate of recurrence and death (adjusted hazard ratio 2.11; 95% CI 1.19–3.74).
Conclusions
In a consecutive cohort of AIS patients, only 2% showed no EVRFs. PFO and contraceptive use exhibited a strong association with the absence of EVRFs in younger patients and female sex and active cancer in elderly patients. Our findings highlight the importance of searching for previously unknown risk factors and/or unusual stroke mechanisms in patients without EVRFs.
Of a cohort of 4889 patients with acute ischaemic stroke, 2% showed no established vascular risk factors (EVRFs) after a comprehensive work‐up. The absence of EVRFs was independently associated with the presence of patent foramen ovale and contraceptive use in younger patients and with female sex and active cancer in elderly patients. Despite their more favorable risk profile, patients with stroke and no EVRFs had worse long‐term outcomes compared to patients with stroke and at least one EVRF.</description><identifier>ISSN: 1351-5101</identifier><identifier>EISSN: 1468-1331</identifier><identifier>DOI: 10.1111/ene.14667</identifier><identifier>PMID: 33284528</identifier><language>eng</language><publisher>England: John Wiley & Sons, Inc</publisher><subject>Abuse ; acute ischaemic stroke ; Alcohol abuse ; Apnea ; Arteriosclerosis ; Atherosclerosis ; Blood vessels ; Cancer ; Confidence intervals ; Contraceptives ; Diabetes mellitus ; Drug abuse ; Dyslipidemia ; Etiology ; Females ; Health risks ; Hypertension ; Mathematical models ; Mental disorders ; Multiple regression analysis ; Psychosis ; Risk analysis ; Risk factors ; Sex ; Sleep ; Sleep disorders ; Statistical analysis ; Statistical models ; Stroke ; stroke etiology ; stroke in the young ; Transient ischemic attack ; vascular risk factor</subject><ispartof>European journal of neurology, 2021-04, Vol.28 (4), p.1275-1283</ispartof><rights>2020 European Academy of Neurology</rights><rights>2020 European Academy of Neurology.</rights><rights>Copyright © 2021 European Academy of Neurology</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3537-a26993bc4db3bb2866c8c0c88de67fead15675e6222f86e815981bf3417412da3</citedby><cites>FETCH-LOGICAL-c3537-a26993bc4db3bb2866c8c0c88de67fead15675e6222f86e815981bf3417412da3</cites><orcidid>0000-0002-1825-1874</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fene.14667$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fene.14667$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33284528$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nannoni, Stefania</creatorcontrib><creatorcontrib>Scherz‐Moussa Youma, Ali</creatorcontrib><creatorcontrib>Amiguet, Michael</creatorcontrib><creatorcontrib>Eskandari, Ashraf</creatorcontrib><creatorcontrib>Strambo, Davide</creatorcontrib><creatorcontrib>Michel, Patrik</creatorcontrib><title>Acute ischaemic stroke in the absence of established vascular risk factors: Patient characteristics, stroke mechanism and long‐term outcome</title><title>European journal of neurology</title><addtitle>Eur J Neurol</addtitle><description>Background and purpose
Some acute ischaemic stroke (AIS) patients do not display established vascular risk factors (EVRFs). The aim was to assess their clinical characteristics, stroke subtype etiological classification and long‐term outcome.
Methods
All consecutive AIS patients from the Acute Stroke Registry of Lausanne (2003–2018) were retrospectively analyzed with complete assessment of the following EVRFs: hypertension, diabetes, major cardioembolic sources, dyslipidemia, smoking, obesity, alcohol abuse, previous stroke/transient ischaemic attack and depression/psychosis. Patients without EVRFs were compared to patients with one or more EVRFs using appropriate statistical models.
Results
Of 4889 included patients, 103 (2.1%) had no EVRFs. In multiple regression analysis, patients without EVRFs were significantly younger (odds ratio [OR] 0.13; 95% confidence interval [CI] 0.08–0.20) and had more multiterritorial strokes (OR 3.38; 95% CI 1.26–9.05). Strokes were more often related to patent foramen ovale (PFO) (OR 3.02; 95% CI 1.44–6.32) and less to atherosclerosis, cardioembolism or small vessel disease. In patients <55 years old, PFO (OR 2.76; 95% CI 1.50–5.08) and contraceptive use in females (OR 2.75; 95% CI 1.40–5.41) were more frequent, whereas sleep apnea syndrome (OR 0.09; 95% CI 0.01–0.63) was less. In patients ≥55 years, female sex (OR 2.84; 95% CI 1.43–5.65) and active cancer (OR 3.27; 95% CI 1.34–7.94) were more prevalent. At 12 months, patients without EVRFs had worse adjusted functional outcome (Rankin shift ORadj 0.63; 95% CI 0.42–0.95) and higher rate of recurrence and death (adjusted hazard ratio 2.11; 95% CI 1.19–3.74).
Conclusions
In a consecutive cohort of AIS patients, only 2% showed no EVRFs. PFO and contraceptive use exhibited a strong association with the absence of EVRFs in younger patients and female sex and active cancer in elderly patients. Our findings highlight the importance of searching for previously unknown risk factors and/or unusual stroke mechanisms in patients without EVRFs.
Of a cohort of 4889 patients with acute ischaemic stroke, 2% showed no established vascular risk factors (EVRFs) after a comprehensive work‐up. The absence of EVRFs was independently associated with the presence of patent foramen ovale and contraceptive use in younger patients and with female sex and active cancer in elderly patients. Despite their more favorable risk profile, patients with stroke and no EVRFs had worse long‐term outcomes compared to patients with stroke and at least one EVRF.</description><subject>Abuse</subject><subject>acute ischaemic stroke</subject><subject>Alcohol abuse</subject><subject>Apnea</subject><subject>Arteriosclerosis</subject><subject>Atherosclerosis</subject><subject>Blood vessels</subject><subject>Cancer</subject><subject>Confidence intervals</subject><subject>Contraceptives</subject><subject>Diabetes mellitus</subject><subject>Drug abuse</subject><subject>Dyslipidemia</subject><subject>Etiology</subject><subject>Females</subject><subject>Health risks</subject><subject>Hypertension</subject><subject>Mathematical models</subject><subject>Mental disorders</subject><subject>Multiple regression analysis</subject><subject>Psychosis</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Sex</subject><subject>Sleep</subject><subject>Sleep disorders</subject><subject>Statistical analysis</subject><subject>Statistical models</subject><subject>Stroke</subject><subject>stroke etiology</subject><subject>stroke in the young</subject><subject>Transient ischemic attack</subject><subject>vascular risk factor</subject><issn>1351-5101</issn><issn>1468-1331</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp1kctu1TAQhq0K1Bss-gLIEhsqkTa240u6q6rDRapaFrCOHGfS4zaxi-2AuuMFkHhGnqQDp2VRCXsx1synT7Z_Qg5YfcRwHUOAI9YopbfILlZTMSHYMzwLySrJarZD9nK-ruuaa15vkx0huGkkN7vk56lbClCf3drC7B3NJcUbbARa1kBtnyE4oHGkkIvtJ5_XMNBvNrtlsokmn2_oaF2JKZ_QT7Z4CIWiK2EPcFq8y28fpTPgJPg8UxsGOsVw9fvHL8RmGpfi4gwvyPPRThlePtR98uXd6vPZh-r88v3Hs9PzygkpdGW5alvRu2boRd9zo5QzrnbGDKD0CHZgUmkJinM-GgWGydawfhQN0w3jgxX75M3Ge5vi1wVf1s34AzBNNkBccscbpU3DjNSIvn6CXsclBbwdUq3GzVuJ1OGGcinmnGDsbpOfbbrrWN39yajDjLq_GSH76sG49DMM_8jHUBA43gDf_QR3_zd1q4vVRnkPzZadog</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Nannoni, Stefania</creator><creator>Scherz‐Moussa Youma, Ali</creator><creator>Amiguet, Michael</creator><creator>Eskandari, Ashraf</creator><creator>Strambo, Davide</creator><creator>Michel, Patrik</creator><general>John Wiley & Sons, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1825-1874</orcidid></search><sort><creationdate>202104</creationdate><title>Acute ischaemic stroke in the absence of established vascular risk factors: Patient characteristics, stroke mechanism and long‐term outcome</title><author>Nannoni, Stefania ; Scherz‐Moussa Youma, Ali ; Amiguet, Michael ; Eskandari, Ashraf ; Strambo, Davide ; Michel, Patrik</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3537-a26993bc4db3bb2866c8c0c88de67fead15675e6222f86e815981bf3417412da3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abuse</topic><topic>acute ischaemic stroke</topic><topic>Alcohol abuse</topic><topic>Apnea</topic><topic>Arteriosclerosis</topic><topic>Atherosclerosis</topic><topic>Blood vessels</topic><topic>Cancer</topic><topic>Confidence intervals</topic><topic>Contraceptives</topic><topic>Diabetes mellitus</topic><topic>Drug abuse</topic><topic>Dyslipidemia</topic><topic>Etiology</topic><topic>Females</topic><topic>Health risks</topic><topic>Hypertension</topic><topic>Mathematical models</topic><topic>Mental disorders</topic><topic>Multiple regression analysis</topic><topic>Psychosis</topic><topic>Risk analysis</topic><topic>Risk factors</topic><topic>Sex</topic><topic>Sleep</topic><topic>Sleep disorders</topic><topic>Statistical analysis</topic><topic>Statistical models</topic><topic>Stroke</topic><topic>stroke etiology</topic><topic>stroke in the young</topic><topic>Transient ischemic attack</topic><topic>vascular risk factor</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nannoni, Stefania</creatorcontrib><creatorcontrib>Scherz‐Moussa Youma, Ali</creatorcontrib><creatorcontrib>Amiguet, Michael</creatorcontrib><creatorcontrib>Eskandari, Ashraf</creatorcontrib><creatorcontrib>Strambo, Davide</creatorcontrib><creatorcontrib>Michel, Patrik</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nannoni, Stefania</au><au>Scherz‐Moussa Youma, Ali</au><au>Amiguet, Michael</au><au>Eskandari, Ashraf</au><au>Strambo, Davide</au><au>Michel, Patrik</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Acute ischaemic stroke in the absence of established vascular risk factors: Patient characteristics, stroke mechanism and long‐term outcome</atitle><jtitle>European journal of neurology</jtitle><addtitle>Eur J Neurol</addtitle><date>2021-04</date><risdate>2021</risdate><volume>28</volume><issue>4</issue><spage>1275</spage><epage>1283</epage><pages>1275-1283</pages><issn>1351-5101</issn><eissn>1468-1331</eissn><abstract>Background and purpose
Some acute ischaemic stroke (AIS) patients do not display established vascular risk factors (EVRFs). The aim was to assess their clinical characteristics, stroke subtype etiological classification and long‐term outcome.
Methods
All consecutive AIS patients from the Acute Stroke Registry of Lausanne (2003–2018) were retrospectively analyzed with complete assessment of the following EVRFs: hypertension, diabetes, major cardioembolic sources, dyslipidemia, smoking, obesity, alcohol abuse, previous stroke/transient ischaemic attack and depression/psychosis. Patients without EVRFs were compared to patients with one or more EVRFs using appropriate statistical models.
Results
Of 4889 included patients, 103 (2.1%) had no EVRFs. In multiple regression analysis, patients without EVRFs were significantly younger (odds ratio [OR] 0.13; 95% confidence interval [CI] 0.08–0.20) and had more multiterritorial strokes (OR 3.38; 95% CI 1.26–9.05). Strokes were more often related to patent foramen ovale (PFO) (OR 3.02; 95% CI 1.44–6.32) and less to atherosclerosis, cardioembolism or small vessel disease. In patients <55 years old, PFO (OR 2.76; 95% CI 1.50–5.08) and contraceptive use in females (OR 2.75; 95% CI 1.40–5.41) were more frequent, whereas sleep apnea syndrome (OR 0.09; 95% CI 0.01–0.63) was less. In patients ≥55 years, female sex (OR 2.84; 95% CI 1.43–5.65) and active cancer (OR 3.27; 95% CI 1.34–7.94) were more prevalent. At 12 months, patients without EVRFs had worse adjusted functional outcome (Rankin shift ORadj 0.63; 95% CI 0.42–0.95) and higher rate of recurrence and death (adjusted hazard ratio 2.11; 95% CI 1.19–3.74).
Conclusions
In a consecutive cohort of AIS patients, only 2% showed no EVRFs. PFO and contraceptive use exhibited a strong association with the absence of EVRFs in younger patients and female sex and active cancer in elderly patients. Our findings highlight the importance of searching for previously unknown risk factors and/or unusual stroke mechanisms in patients without EVRFs.
Of a cohort of 4889 patients with acute ischaemic stroke, 2% showed no established vascular risk factors (EVRFs) after a comprehensive work‐up. The absence of EVRFs was independently associated with the presence of patent foramen ovale and contraceptive use in younger patients and with female sex and active cancer in elderly patients. Despite their more favorable risk profile, patients with stroke and no EVRFs had worse long‐term outcomes compared to patients with stroke and at least one EVRF.</abstract><cop>England</cop><pub>John Wiley & Sons, Inc</pub><pmid>33284528</pmid><doi>10.1111/ene.14667</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-1825-1874</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1351-5101 |
| ispartof | European journal of neurology, 2021-04, Vol.28 (4), p.1275-1283 |
| issn | 1351-5101 1468-1331 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2467841857 |
| source | Access via Wiley Online Library |
| subjects | Abuse acute ischaemic stroke Alcohol abuse Apnea Arteriosclerosis Atherosclerosis Blood vessels Cancer Confidence intervals Contraceptives Diabetes mellitus Drug abuse Dyslipidemia Etiology Females Health risks Hypertension Mathematical models Mental disorders Multiple regression analysis Psychosis Risk analysis Risk factors Sex Sleep Sleep disorders Statistical analysis Statistical models Stroke stroke etiology stroke in the young Transient ischemic attack vascular risk factor |
| title | Acute ischaemic stroke in the absence of established vascular risk factors: Patient characteristics, stroke mechanism and long‐term outcome |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-29T13%3A01%3A21IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Acute%20ischaemic%20stroke%20in%20the%20absence%20of%20established%20vascular%20risk%20factors:%20Patient%20characteristics,%20stroke%20mechanism%20and%20long%E2%80%90term%20outcome&rft.jtitle=European%20journal%20of%20neurology&rft.au=Nannoni,%20Stefania&rft.date=2021-04&rft.volume=28&rft.issue=4&rft.spage=1275&rft.epage=1283&rft.pages=1275-1283&rft.issn=1351-5101&rft.eissn=1468-1331&rft_id=info:doi/10.1111/ene.14667&rft_dat=%3Cproquest_cross%3E2497979295%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2497979295&rft_id=info:pmid/33284528&rfr_iscdi=true |