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Long-term outcomes of patients with embolic stroke of undetermined source according to subtype

Authors
 Il Hyung Lee  ;  JoonNyung Heo  ;  Hyungwoo Lee  ;  JaeWook Jeong  ;  Joonho Kim  ;  Minho Han  ;  Joonsang Yoo  ;  Jinkwon Kim  ;  Minyoul Baik  ;  Hyungjong Park  ;  Jae Wook Jung  ;  Young Dae Kim  ;  Hyo Suk Nam 
Citation
 SCIENTIFIC REPORTS, Vol.14(1) : 9295, 2024-04 
Journal Title
SCIENTIFIC REPORTS
Issue Date
2024-04
MeSH
Aged ; Echocardiography, Transesophageal ; Embolic Stroke* / etiology ; Female ; Follow-Up Studies ; Humans ; Ischemic Stroke / etiology ; Male ; Middle Aged ; Plaque, Atherosclerotic / complications ; Plaque, Atherosclerotic / diagnostic imaging ; Prognosis ; Risk Factors
Abstract
The prognosis of patients with embolic stroke of undetermined source (ESUS) may vary according to the underlying cause. Therefore, we aimed to divide ESUS into subtypes and assess the long-term outcomes. Consecutive patients with acute ischemic stroke who underwent a comprehensive workup, including transesophageal echocardiography and prolonged electrocardiography monitoring, were enrolled. We classified ESUS into minor cardioembolic (CE) ESUS, arteriogenic ESUS, two or more causes ESUS, and no cause ESUS. Arteriogenic ESUS was sub-classified into complex aortic plaque (CAP) ESUS and non-stenotic (< 50%) relevant artery plaque (NAP) ESUS. A total of 775 patients were enrolled. During 1286 ± 748 days follow-up, 116 major adverse cardiovascular events (MACE) occurred (4.2 events/100 patient-years). Among the ESUS subtypes, CAP ESUS was associated with the highest MACE frequency (9.7/100 patient-years, p = 0.021). Cox regression analyses showed that CAP ESUS was associated with MACE (hazard ratio 2.466, 95% confidence interval 1.305–4.660) and any stroke recurrence (hazard ratio 2.470, 95% confidence interval, 1.108–5.508). The prognosis of ESUS varies according to the subtype, with CAP ESUS having the worst prognosis. Categorizing ESUS into subtypes could improve patient care and refine clinical trials.
Files in This Item:
T202402600.pdf Download
DOI
10.1038/s41598-024-58292-4
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 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, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Baik, Minyoul(백민렬)
Yoo, Joon Sang(유준상) ORCID logo https://orcid.org/0000-0003-1169-6798
Lee, Ilhyung(이일형)
Jung, Jae Wook(정재욱)
Heo, JoonNyung(허준녕)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/199173
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