Abstract WP172: Stroke Incidence and Outcomes in Northeastern Greece: the Evros Stroke Registry

Abstract

Introduction: Data are scarce on both stroke incidence rates and outcomes in Greece and in rural areas in particular. We performed a prospective population-based study evaluating the incidence of first-ever stroke in the Evros perfecture, a region of a total 147,947 residents located in North Eastern Greece. Methods: Adult patients with first ever stroke were registered during a 24-month period (2010-2012) and followed up for 12 months. To compare our stroke incidence with that observed in other studies, we standardized our incidence rate data according to the European Standard Population (ESP) of 2013 and applied criteria of data quality, as proposed by the Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) project. Stroke diagnosis and classification was performed using WHO criteria on the basis of neuroimaging and/or autopsy data. Results: We prospectively documented 703 stroke cases (mean age: 75±12 years; 52.8% males; ischemic stroke (IS): 80.8%, intracerebral hemorrhage (ICH): 11.8%, subarachnoid hemorrhage (SAH): 4.4%, undefined: 3.0%) with a total follow-up time of 119,805 person-years. The unadjusted and ESP adjusted incidences of all strokes were 586.8 (95%CI: 543.4-630.2) and 534.3 (95%CI: 532.3-536.3) per 100,000 person-years, respectively. The unadjusted incidence rates for IS, ICH and SAH were 474.1 (95%CI: 435-513), 69.3 (95%CI: 54-84) and 25.8 (95%CI: 25.7-25.9) per 100,000 person-years, respectively. The corresponding ESP-adjusted incidence rates per 100,000 person-years were 425.9 (95%CI: 424-427), 63.3 (95%CI: 63-63.5) and 25.8 (95%CI: 25.7-25.9) for IS, ICH and SAH, respectively. The overall 30-day case fatality rate was 21.3% (95%: 18.3-24.4%) for all strokes, and was higher in hemorrhagic strokes than IS (40.4%, 95%CI: 31.3-49.4% vs 16.2%, 95%CI: 13.2%-19.2%). Conclusion: This is the largest to date population-based study in Greece documenting one of the highest stroke incidences in South-Eastern Europe.

Clinical and Neuroimaging Characteristics in Embolic Stroke of Undetermined versus Cardioembolic Origin: A Population‐Based Study

“…We identified 21 ESUS (3.7% of the IS cohort) and 211 CE patients (37.1% of the IS cohort). Baseline characteristics and outcomes between ESUS patients and CE patients are presented in Table 1 [5][6][7][8][9][10][11][12][13][14][15][16][17]; P < .001), had higher prevalence of smoking (57.1 vs 15.6%, P < .001), had less often positive family history for cardiovascular disease (38.1 vs 73%, P < .001). Male sex was less common in ESUS (28.6 vs 59.2%; P = .007).…”

“…The ESR collected data from consecutive patients with first-ever IS during a 24-month period (2010-2012). 13 The unadjusted incidence rate for ischemic stroke in the region was 474.1 (95% CI: 435-513). 13 IS cases were consequently classified according to the TOAST criteria.…”

“…13 The unadjusted incidence rate for ischemic stroke in the region was 474.1 (95% CI: 435-513). 13 IS cases were consequently classified according to the TOAST criteria. 14 ESUS cases were derived from patients with IS of undetermined cause fulfilling the recently proposed ESUS criteria, 1 as previously described in ESR.…”

“…16,17 Functional outcome assessments, using the modified Rankin Scale (mRS) score, were performed either by visit at the stroke outpatient clinic of Alexandroupolis University Hospital or by structured telephone interview by certified investigators as previously described. 13,15 Patients were followed-up for 1 year and outcome assessments were performed at 28, 90, and 365 days following stroke onset. Details regarding the follow-up evaluations in ESR have been previously described.…”

The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

“…Atrial fibrillation causes up to one-third of ischemic strokes, frequently involving multiple vascular territories, and is associated, in ischemic stroke patients, with increased odds of early ischemic recurrence or hemorrhagic transformation. [84][85][86] Parental heparin administration is not formally recommended due to increased hemorrhagic risk, whereas aspirin, typically prescribed within the hyperacute phase, is associated with a 5% recurrence within the first 2 weeks. 87,88 TCD monitoring captures MES in both symptomatic and asymptomatic individuals with nonvalvular atrial fibrillation (NVAF).…”