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Long-term mortality in patients with stroke of undetermined etiology

 Hyo Suk Nam  ;  Hyeon Chang Kim  ;  Young Dae Kim  ;  Hye Sun Lee  ;  Jinkwon Kim  ;  Dong Hyun Lee  ;  Ji Hoe Heo 
 Stroke, Vol.43(11) : 2948-2956, 2012 
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BACKGROUND AND PURPOSE: The determination of stroke etiology is essential for planning treatment for stroke prevention. However, the etiology of stroke is undetermined in many patients. METHODS: During a 10-year period, consecutive patients with acute ischemic stroke were enrolled. The stroke etiology was determined based on the Trial of ORG 10172 in Acute Stroke Treatment classification. Long-term mortality and causes of death were identified using death certificates. The standardized mortality ratio was calculated to compare the mortality in patients with stroke and that in the general Korean population. RESULTS: In total, 3278 patients were enrolled and followed-up for a median of 3.4 years (interquartile range, 1.5-5.7). The stroke subtype was undetermined in 37% because of negative evaluation (21.2%), multiple causes (10.6%), and incomplete evaluation (4.8%). Poor functional outcome at 3 months (modified Rankin scale score >2) was more frequent in patients with an incomplete evaluation than in those with the other stroke subtypes (49.6% vs 24.5%; P<0.001). During follow-up, 781 patients (23.8%) died. The overall cumulative death rate was highest in patients with an incomplete evaluation (12.7% within 30 days, 25.5% within 1 year, and 35.7% within 3 years), followed by those with cardioembolism. Multivariate analysis after adjusting for covariates including initial stroke severity, the mortality of patients with an incomplete evaluation was second lowest after cardioembolism, whereas that in patients with a negative evaluation was low. CONCLUSIONS: Long-term mortality in patients with an incomplete evaluation was quite high. Etiologic work-up helps to better define the stroke subtype and determine the prognosis.
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실)
Yonsei Authors
김영대(Kim, Young Dae) ; 김진권(Kim, Jin Kwon) ; 김현창(Kim, Hyeon Chang) ; 남효석(Nam, Hyo Suk) ; 이동현(Lee, Dong Hyun) ; 허지회(Heo, Ji Hoe)
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