Long‐term risk of recurrent vascular events and mortality in young stroke patients: Insights from a multicenter study

Abstract

Background Although the incidence of stroke in the young is rising, data on long‐term outcomes in these patients are scarce. We thus aimed to investigate the long‐term risk of recurrent vascular events and mortality in a multicenter study. Methods We followed 396 consecutive patients aged 18–55 years with ischemic stroke (IS) or transient ischemic attack (TIA) enrolled in three European centers during the period 2007–2010. A detailed outpatient clinical follow‐up assessment was performed between 2018 and 2020. When an in‐person follow‐up visit was not possible, outcome events were assessed using electronic records and registry data. Results During a median follow‐up of 11.8 (IQR 10.4–12.7) years, 89 (22.5%) patients experienced any recurrent vascular event, 62 (15.7%) had any cerebrovascular event, 34 (8.6%) had other vascular events, and 27 (6.8%) patients died. Cumulative 10‐year incidence rate per 1000 person‐years was 21.6 (95% CI 17.1–26.9) for any recurrent vascular event and 14.9 (95% CI 11.3–19.3) for any cerebrovascular event. The prevalence of cardiovascular risk factors increased over time, and 22 (13.5%) patients lacked any secondary preventive medication at the in‐person follow‐up. After adjustment for demographics and comorbidities, atrial fibrillation at baseline was found to be significantly associated with recurrent vascular events. Conclusions This multicenter study shows a considerable risk of recurrent vascular events in young IS and TIA patients. Further studies should investigate whether detailed individual risk assessment, modern secondary preventive strategies, and better patient adherence may reduce recurrence risk.

Long‐term follow‐up after minor ischaemic strokes or transient ischaemic attacks: not as good as previously thought

“…In this issue of the European Journal of Neurology Broman et al [5] included 396 consecutive patients aged 18−55 years who were admitted in three European centres between 2007 and 2010 for ischaemic strokes or TIAs and were followed up over 11.8 years (interquartile range 10.4-12.7 years). They found that 27 (6.8%) of them had died at the end of the follow-up and 89 (22.5%) had a new recurrent vascular event of any type (any type of cerebrovascular event in 62, 15.7%; any other type of vascular event in 34, 8.6%; both in 5).…”

“…The authors conclude that risks of recurrent vascular events are high in young patients after ischaemic strokes or TIAs. They suggest also that these risks might be reduced by a better adherence of patients to modern strategies of secondary prevention [5]. In this study, patients were recruited up to 55 years, meaning that they could be 65 years old at the end of the follow-up, an age where atrial fibrillation becomes a frequent cause of cerebral ischaemia.…”