Recurrence after first cerebral infarction in young adults

Camerlingo, M.; Casto, L.; Censori, B.; Ferraro, B.; Caverni, L.; Manara, Ornella; Finazzi, Guido; Radice, E.; Drago, G; Tommasi, S M De; Gotti, Eliana; Barbui, T; Mamoli, A

doi:10.1034/j.1600-0404.2000.102002087.x

Cited by 33 publications

(23 citation statements)

References 20 publications

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“…Furthermore, the low prevalence of migraine and the lack of characterization of migraine subtypes in some of the previous studies prompt the speculation that several possible biases in the assessment of individual migraine history were also operant. [28][29][30][31][32][33][34][35] As an indirect support to our findings, Gioia and coworkers 36 recently found a higher prevalence of MA in young patients with stroke with silent ischemic lesions on brain MRI, an independent predictor of recurrence, in comparison with those with no evidence of brain abnormalities. This reinforces the hypothesis that MA might also predict clinical recurrent events.…”

Section: Discussionsupporting

confidence: 73%

“…This is not surprising when considering the well-known prothrombotic effects of these molecules, and it is even more likely if we take into account the controversy on the most adequate treatment approach in these cases. 30,40 The assessment of factors we identified as predictors of arterial thrombotic recurrence is part of the routine clinical investigation of patients with ischemic stroke at a young age. Therefore, the risk score we developed based on such factors is a simple prediction algorithm for the estimation of the individual long-term risk in this age category in a clinical setting.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Long-Term Recurrent Vascular Events After Ischemic Stroke at Young Age

et al. 2014

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Background-Data on long-term risk and predictors of recurrent thrombotic events after ischemic stroke at a young age are limited. Methods and Results-We followed 1867 patients with first-ever ischemic stroke who were 18 to 45 years of age (mean age, 36.8±7.1 years; women, 49.0%), as part of the Italian Project on Stroke in Young Adults (IPSYS). Median follow-up was 40 months (25th to 75th percentile, 53). The primary end point was a composite of ischemic stroke, transient ischemic attack, myocardial infarction, or other arterial events. One hundred sixty-three patients had recurrent thrombotic events (average rate, 2.26 per 100 person-years at risk). At 10 years, cumulative risk was 14.7% (95% confidence interval, 12.2%-17.9%) for primary end point, 14.0% (95% confidence interval, 11.4%-17.1%) for brain ischemia, and 0.7% (95% confidence interval, 0.4%-1.3%) for myocardial infarction or other arterial events. Familial history of stroke, migraine with aura, circulating antiphospholipid antibodies, discontinuation of antiplatelet and antihypertensive medications, and any increase of 1 traditional vascular risk factor were independent predictors of the composite end point in multivariable Cox proportional hazards analysis. A point-scoring system for each variable was generated by their β-coefficients, and a predictive score (IPSYS score) was calculated as the sum of the weighted scores. The area under the receiver operating characteristic curve of the 0-to 5-year score was 0.66 (95% confidence interval, 0.61-0.71; mean, 10-fold internally cross-validated area under the receiver operating characteristic curve, 0.65).© 2014 American Heart Association, Inc. 1 Although it is well documented that such a risk is much lower in young patients with stroke than in elderly patients, information on what specific factors may predict recurrent events in younger age groups are limited. Most data derive from single-center studies enrolling several hundred patients or less, 2 using different thresholds of age to define young, and sometimes being biased by the inadequate capture of cases, the inclusion of different ethnic groups, and the high number of patients lost to follow-up.3 This makes such studies somewhat heterogeneous and their findings poorly comparable. In addition, the influential effect of some specific factors is missing in most previous studies. This is the case, for example, of patients' adherence to secondary prevention therapies, which is likely to impact the recurrence of potentially avoidable vascular events. The Italian Project on Stroke in Young Adults (IPSYS) provides the opportunity to investigate these issues owing to its large sample size, the homogeneous demographic characteristics and clinical phenotype of the subjects included, and the standard diagnostic workup. Therefore, in the present study we aimed at (1) elucidating the predictors of long-term recurrent vascular events after first-ever IS, and the extent to which these factors can be modified, which implicates the potential of reducing this risk,...

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Predictors of Long-Term Recurrent Vascular Events After Ischemic Stroke at Young Age

et al. 2014

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“…Ischemic stroke in the young originates limitations in the quality of life and occupational status [9,12,20,21,40,44]. Series have reported that between 50%-70% of young adults with stroke return to work, with a time period ranging from several days after stroke to 40 months, with a mean of 8 months.…”

Section: Occupational Statusmentioning

confidence: 99%

“…Thus, prognosis of stroke in young as a whole has been described as favorable in most of the series [12,[17][18][19][20][21], but the long-term prognosis is notably worse when compared with the general population of the same age, with higher death rate, higher risk of cardiovascular events, and significant limitations in quality of life [12]. Moreover, in our series (with a mean followup of almost 12 years and mean age of 36 years old), only 57% of the patients followed for more than 3 years are alive, free of significant disability, stroke recurrence or other vascular event [12].…”

Section: Introductionmentioning

confidence: 99%

Long-term prognosis of ischemic stroke in young adults

et al. 2004

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There is limited information about long-term prognosis of ischemic stroke in young adults. Giving the potentially negative impact in physical, social, and emotional aspects of an ischemic stroke in young people, providing early accurate long-term prognostic information is very important in this clinical setting. Moreover, detection of factors associated with bad outcomes (death, recurrence, moderate-to-severe disability) help physicians in optimizing secondary prevention strategies. The present paper reviews the most relevant published information concerning long-term prognosis and predictors of unfavorable outcomes of ischemic stroke affecting young adults. As a summary, we can conclude that, in the long term, stroke in the young adult increases slightly the risk of mortality, implies higher risk of future cardiovascular events, and determines functional limitations in a significant percentage of patients. Nevertheless, in every individual case the prognosis has to be considered depending on several factors (stroke subtype, initial severity, cardiovascular risk factors) that determine the long-term outcomes.

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“…In studies evaluating stroke in young patients, a relatively low rate of annual recurrence of between 1.4 and 2.6% has been found [16,17,18,19]. However, stroke in the young carries an excess mortality compared to those of the same age in the general population [19] and its repercussion in terms of years-of-life-lost and/or economic costs due to resultant disabilities are of great importance.…”

Section: Recurrence and Agementioning

confidence: 99%

Benefits of Modifying the Predictive Factors of Stroke Recurrence

Egido

2005

Cerebrovasc Dis

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The risk of stroke recurrence is high. With annual rates of around 4%, accumulative rates of 40% are reached within 10 years. Despite being underestimated, the risk is highest in the early stages; around 12% in the first year. The most important etiological subtypes have different levels of risk; the highest being for atherothrombotic infarction and the lowest for lacunar infarction. Each etiology has its own risk factors. For example, in carotid stenosis, the grade of stenosis, ulceration, and plaque morphology, silent infarction on neuroimaging, coexistence of intracranial disease, or microemboli detected on transcranial Doppler, all have predictive value for stroke recurrence. There is a paucity of data on the risk factors for intracranial stenosis. In cardioembolism due to atrial fibrillation age, coexistence of hypertension or diabetes, and echocardiographic data predict recurrence. Risk factors for recurrence do not parallel those for first stroke. Diabetes is the most consistent risk factor for recurrence in different studies, while control of hypertension has been shown to be effective in the prevention of recurrences. Among the inflammatory markers, C-reactive protein is the most effective in prediction of recurrence. Elevated levels of homocysteine also predict recurrence, but attempts to improve risk by the modification of these levels have, to date, been unsuccessful. To be effective, the modification of predictive factors needs to be multifactorial and should be taken into account corresponding to each etiological type. More research is needed on biological markers to establish their clinical relevance and the benefit of targeting them for therapeutic modification.

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Recurrence after first cerebral infarction in young adults

Abstract: Our data suggest that recurrence of stroke is a major clinical problem also for the patients aged less than 45 years and that it might be more frequent with specific clinical syndromes and etiologic subtypes of first stroke.

Cited by 33 publications

References 20 publications

Predictors of Long-Term Recurrent Vascular Events After Ischemic Stroke at Young Age

Predictors of Long-Term Recurrent Vascular Events After Ischemic Stroke at Young Age

Long-term prognosis of ischemic stroke in young adults

Benefits of Modifying the Predictive Factors of Stroke Recurrence

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