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Long-term mortality in patients with coexisting potential causes of ischemic stroke

 Young Dae Kim  ;  Myoung-Jin Cha  ;  Jinkwon Kim  ;  Dong Hyun Lee  ;  Hye Sun Lee  ;  Chung Mo Nam  ;  Hyo Suk Nam  ;  Ji Hoe Heo 
 INTERNATIONAL JOURNAL OF STROKE, Vol.10(4) : 541-546, 2015 
Journal Title
Issue Date
Aged ; Atherosclerosis/complications ; Atherosclerosis/epidemiology ; Atherosclerosis/pathology ; Atherosclerosis/physiopathology ; Brain/pathology ; Brain/physiopathology ; Brain Ischemia/etiology ; Brain Ischemia/mortality* ; Brain Ischemia/pathology ; Brain Ischemia/physiopathology ; Cerebral Angiography ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Korea/epidemiology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Regression Analysis ; Stroke/etiology ; Stroke/mortality* ; Stroke/pathology ; Stroke/physiopathology ; Tomography, X-Ray Computed
cerebral infarction ; etiology ; outcomes
BACKGROUND: Multiple potential causes of stroke may coexist in ischemic stroke patients, which may affect long-term outcome. AIM: We investigated whether there are differences in long-term mortality among stroke patients with coexisting potential causes. METHODS: We evaluated the long-term all-cause mortality and stroke or cardiovascular mortality of ischemic stroke patients with multiple potential stroke mechanisms, large artery atherosclerosis, cardioembolism, small vessel occlusion, and negative evaluation admitted to a single center between January 1996 and December 2008. Mortality data were obtained from a National Death Certificate system. RESULTS: Total 3533 patients were included in this study: 286 multiple potential mechanisms (138 large artery atherosclerosis + cardioembolism, 105 small vessel occlusion + large artery atherosclerosis, 43 small vessel occlusion + cardioembolism), 1045 large artery atherosclerosis, 701 cardioembolism, 606 small vessel occlusion, and 895 negative evaluation. During a mean follow-up of 3.9 years, as referenced to small vessel occlusion mortality rate, the adjusted mortality hazard ratio was 4.387 (95% confidence interval 3.157-6.096) for large artery atherosclerosis + cardioembolism group, 3.903 (95% confidence interval 3.032-5.024) for cardioembolism group, and 2.121 (95% confidence interval 1.655-2.717) for large artery atherosclerosis. The risk of long-term ischemic stroke mortality or cardiovascular mortality also showed comparable findings: highest in the large artery atherosclerosis + cardioembolism, followed by cardioembolism, and large artery atherosclerosis groups. However, the outcome of small vessel occlusion + large artery atherosclerosis or small vessel occlusion + cardioembolism group was not significantly different from that of small vessel occlusion. CONCLUSIONS: Coexisting potential causes of ischemic stroke impact on long-term mortality. Identification of coexisting potential causes may help to predict stroke outcomes and to guide planning secondary prevention strategies.
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1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Kim, Jinkwon(김진권) ORCID logo https://orcid.org/0000-0003-0156-9736
Nam, Jung Mo(남정모) ORCID logo https://orcid.org/0000-0003-0985-0928
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Lee, Dong Hyun(이동현)
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Cha, Myoung Jin(차명진)
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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