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Severity and outcomes according to stroke etiology in patients under 50 years of age with ischemic stroke

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Abstract

To analyze the association of stroke etiological subtypes with severity and outcomes at 3 and 12 months in patients ≤50 years. Observational study of patients admitted to a stroke unit (2007–2013). Variables: demographic data, vascular risk factors, comorbidities, severity on admission (NIHSS), and good functional outcome (mRS ≤ 1) at 3 and 12 months. We used multivariate analyses to evaluate the influence of stroke etiology on severity and outcomes. We included 214 patients, 58.3 % men, mean age 41.4 years. General linear models showed all etiologies were more severe than lacunar strokes (P < 0.05). Atherothrombotic strokes showed greater severity than those of undetermined and uncommon etiology, whereas cardioembolic strokes were more severe than cryptogenic. Taking into account specific etiologies, atherothrombotic strokes (B = 5.860; 95 % CI 2.979–8.751), cervical artery dissection (CAD) [B = 7.485; 95 % confidence interval (CI) 4.734–10.237], and atrial fibrillation (AF) strokes (B = 5.773; 95 % CI 2.704–8.132) were more severe than other etiologies. Logistic regression models showed that strokes of uncommon etiology, especially those not related to CAD, had a lower probability of good outcome at 3 months [odds ratio (OR) = 0.197; CI 95 % 0.044–0.873], whereas atherothrombotic strokes were associated with this probability at 12 months (OR = 0.187; 95 % CI 0.037–0.951; P = 0.007). In patients ≤50 years of age, strokes of atherothrombotic, cardioembolic (particularly those due to AF), and uncommon etiology had a greater severity than the rest. Furthermore, strokes of uncommon etiology, especially those different from CAD, decreased the probability of a good outcome at 3 months, as did atherothrombotic strokes at 1 year.

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Author contribution

All authors contributed equally to this study in terms of the research, database performance, statistical analysis, and the writing of this paper.

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Authors and Affiliations

  1. Department of Neurology and Stroke Center, La Paz University Hospital, IdiPAZ Health Research Institute, Autonomous University of Madrid, Paseo de la Castellana 261, 28046, Madrid, Spain

    Daniel Prefasi, Patricia Martínez-Sánchez, Blanca Fuentes & Exuperio Díez-Tejedor

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  1. Daniel Prefasi
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  2. Patricia Martínez-Sánchez
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  3. Blanca Fuentes
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  4. Exuperio Díez-Tejedor
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Correspondence to Patricia Martínez-Sánchez or Exuperio Díez-Tejedor.

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Dr Prefasi, Dr. Martínez-Sánchez, Dr. Blanca Fuentes, and Prof. Díez-Tejedor declare no conflicts of interest related to this manuscript.

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Prefasi, D., Martínez-Sánchez, P., Fuentes, B. et al. Severity and outcomes according to stroke etiology in patients under 50 years of age with ischemic stroke. J Thromb Thrombolysis 42, 272–282 (2016). https://doi.org/10.1007/s11239-016-1336-5

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