Risk Factors, Treatments, and Outcomes of Adults Aged <55 Years With Acute Ischemic Stroke With Undetermined Versus Determined Pathogenesis: A Nationwide Swiss Cohort Study
Background The rising prevalence of acute ischemic stroke (AIS) in young adults, particularly with undetermined pathogenesis, is a growing concern. This study assessed risk factors, treatments, and outcomes between young AIS patients with undetermined and determined pathogeneses. Methods and Results...
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2024-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.036761 |
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| author | Tolga D. Dittrich Thomas Schneider Mira Katan Andreas R. Luft Marie‐Luise Mono Manuel Bolognese Krassen Nedeltchev Timo Kahles Marcel Arnold Mirjam Heldner Patrik Michel Emmanuel Carrera Biljana Rodic Carlo W. Cereda Nils Peters Leo H. Bonati Susanne Renaud Andrea M. Humm Friedrich Medlin Sylvan Albert Rolf Sturzenegger Alexander A. Tarnutzer Philip Siebel Markus Baumgärtner Christian Berger Pasquale Mordasini Jochen Vehoff Gian Marco De Marchis |
| author_facet | Tolga D. Dittrich Thomas Schneider Mira Katan Andreas R. Luft Marie‐Luise Mono Manuel Bolognese Krassen Nedeltchev Timo Kahles Marcel Arnold Mirjam Heldner Patrik Michel Emmanuel Carrera Biljana Rodic Carlo W. Cereda Nils Peters Leo H. Bonati Susanne Renaud Andrea M. Humm Friedrich Medlin Sylvan Albert Rolf Sturzenegger Alexander A. Tarnutzer Philip Siebel Markus Baumgärtner Christian Berger Pasquale Mordasini Jochen Vehoff Gian Marco De Marchis |
| author_sort | Tolga D. Dittrich |
| collection | DOAJ |
| description | Background The rising prevalence of acute ischemic stroke (AIS) in young adults, particularly with undetermined pathogenesis, is a growing concern. This study assessed risk factors, treatments, and outcomes between young AIS patients with undetermined and determined pathogeneses. Methods and Results This was a retrospective cohort study including AIS patients aged 18 to 55 years in Switzerland, treated between 2014 and 2022. Stroke pathogeneses were classified using a modified TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification, with undetermined pathogenesis defined as no identified cause (including patent foramen ovale and cervical artery dissection). We examined vascular risk factors, acute treatments, 3‐month functional outcomes, and AIS recurrence within 3 months using logistic regression and Fine–Gray proportional hazards models. Of 3995 patients, 863 (22%) had undetermined pathogenesis. Compared with patients with determined pathogenesis, those with undetermined pathogenesis had a higher prevalence of dyslipidemia (54% versus 59%, P=0.007) and smoking (37% versus 43%, P=0.001), and were more likely to receive intravenous thrombolysis (27% versus 31%, P=0.046). Despite higher 3‐month AIS recurrence risk for the undetermined group (adjusted hazard ratio, 1.72 [95% CI, 1.01–2.94]), favorable functional outcomes at 3 months were more frequent (modified Rankin Scale score, 0–2: 90% versus 87%, P=0.033). Patients aged 46 to 55 years with undetermined pathogenesis had better outcomes than those with determined pathogenesis (modified Rankin Scale score, 0–1: 70% versus 64%, P=0.013; modified Rankin Scale score, 0–2: 89% versus 85%, P=0.023), while those aged 18 to 45 years showed higher recurrence rates (4.5% versus 1.8%, P<0.05) but similar functional outcomes. Conclusions Young adults with AIS exhibit a considerable vascular risk burden. Those with undetermined pathogenesis displayed age‐related outcome disparities, with better short‐term outcomes in older and higher recurrence rates in younger patients. |
| format | Article |
| id | doaj-art-dbc4a8ec54a14f05b0a82019a0cbde63 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-dbc4a8ec54a14f05b0a82019a0cbde632024-12-03T10:06:25ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-12-01132310.1161/JAHA.124.036761Risk Factors, Treatments, and Outcomes of Adults Aged <55 Years With Acute Ischemic Stroke With Undetermined Versus Determined Pathogenesis: A Nationwide Swiss Cohort StudyTolga D. Dittrich0Thomas Schneider1Mira Katan2Andreas R. Luft3Marie‐Luise Mono4Manuel Bolognese5Krassen Nedeltchev6Timo Kahles7Marcel Arnold8Mirjam Heldner9Patrik Michel10Emmanuel Carrera11Biljana Rodic12Carlo W. Cereda13Nils Peters14Leo H. Bonati15Susanne Renaud16Andrea M. Humm17Friedrich Medlin18Sylvan Albert19Rolf Sturzenegger20Alexander A. Tarnutzer21Philip Siebel22Markus Baumgärtner23Christian Berger24Pasquale Mordasini25Jochen Vehoff26Gian Marco De Marchis27Department of Neurology University Teaching and Research Hospital St. Gallen St. Gallen SwitzerlandDepartment of Neurology University Teaching and Research Hospital St. Gallen St. Gallen SwitzerlandDepartment of Neurology University Hospital Basel and University of Basel Basel SwitzerlandDepartment of Neurology University Hospital Zurich Zurich SwitzerlandDepartment of Neurology Municipal Hospital Waid und Triemli Zurich SwitzerlandDepartment of Neurology Cantonal Hospital of Lucerne Lucerne SwitzerlandDepartment of Neurology Cantonal Hospital Aarau Aarau SwitzerlandDepartment of Neurology Cantonal Hospital Aarau Aarau SwitzerlandDepartment of Neurology University Hospital Bern and University of Bern Bern SwitzerlandDepartment of Neurology University Hospital Bern and University of Bern Bern SwitzerlandDepartment of Neurology University Hospital Lausanne Lausanne SwitzerlandDepartment of Neurology University Hospital Geneva Geneva SwitzerlandDepartment of Neurology Cantonal Hospital Winterthur Winterthur SwitzerlandDepartment of Neurology EOC Neurocenter of Southern Switzerland Lugano SwitzerlandDepartment of Neurology Hirslanden Hospital Zurich Zurich SwitzerlandNeurorehabilitation Rheinfelden Rehabilitation Clinic Rheinfelden SwitzerlandDepartment of Neurology Cantonal Hospital Neuchâtel Neuchâtel SwitzerlandDepartment of Internal Medicine, Neurological Unit HFR Fribourg – Cantonal Hospital Fribourg SwitzerlandDepartment of Internal Medicine, Neurological Unit HFR Fribourg – Cantonal Hospital Fribourg SwitzerlandDepartment of Neurology Cantonal Hospital Graubünden Chur SwitzerlandDepartment of Neurology Cantonal Hospital Graubünden Chur SwitzerlandDepartment of Neurology Cantonal Hospital of Baden Baden SwitzerlandDepartment of Neurology Cantonal Hospital Frauenfeld Frauenfeld SwitzerlandDepartment of Neurology Cantonal Hospital Münsterlingen Münsterlingen SwitzerlandDepartment of Neurology Cantonal Hospital Grabs Grabs SwitzerlandDepartment of Neuroradiology Cantonal Hospital Aarau Aarau SwitzerlandDepartment of Neurology University Teaching and Research Hospital St. Gallen St. Gallen SwitzerlandDepartment of Neurology University Teaching and Research Hospital St. Gallen St. Gallen SwitzerlandBackground The rising prevalence of acute ischemic stroke (AIS) in young adults, particularly with undetermined pathogenesis, is a growing concern. This study assessed risk factors, treatments, and outcomes between young AIS patients with undetermined and determined pathogeneses. Methods and Results This was a retrospective cohort study including AIS patients aged 18 to 55 years in Switzerland, treated between 2014 and 2022. Stroke pathogeneses were classified using a modified TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification, with undetermined pathogenesis defined as no identified cause (including patent foramen ovale and cervical artery dissection). We examined vascular risk factors, acute treatments, 3‐month functional outcomes, and AIS recurrence within 3 months using logistic regression and Fine–Gray proportional hazards models. Of 3995 patients, 863 (22%) had undetermined pathogenesis. Compared with patients with determined pathogenesis, those with undetermined pathogenesis had a higher prevalence of dyslipidemia (54% versus 59%, P=0.007) and smoking (37% versus 43%, P=0.001), and were more likely to receive intravenous thrombolysis (27% versus 31%, P=0.046). Despite higher 3‐month AIS recurrence risk for the undetermined group (adjusted hazard ratio, 1.72 [95% CI, 1.01–2.94]), favorable functional outcomes at 3 months were more frequent (modified Rankin Scale score, 0–2: 90% versus 87%, P=0.033). Patients aged 46 to 55 years with undetermined pathogenesis had better outcomes than those with determined pathogenesis (modified Rankin Scale score, 0–1: 70% versus 64%, P=0.013; modified Rankin Scale score, 0–2: 89% versus 85%, P=0.023), while those aged 18 to 45 years showed higher recurrence rates (4.5% versus 1.8%, P<0.05) but similar functional outcomes. Conclusions Young adults with AIS exhibit a considerable vascular risk burden. Those with undetermined pathogenesis displayed age‐related outcome disparities, with better short‐term outcomes in older and higher recurrence rates in younger patients.https://www.ahajournals.org/doi/10.1161/JAHA.124.036761ischemic strokeundetermined pathogenesisvascular risk factorsyoung |
| spellingShingle | Tolga D. Dittrich Thomas Schneider Mira Katan Andreas R. Luft Marie‐Luise Mono Manuel Bolognese Krassen Nedeltchev Timo Kahles Marcel Arnold Mirjam Heldner Patrik Michel Emmanuel Carrera Biljana Rodic Carlo W. Cereda Nils Peters Leo H. Bonati Susanne Renaud Andrea M. Humm Friedrich Medlin Sylvan Albert Rolf Sturzenegger Alexander A. Tarnutzer Philip Siebel Markus Baumgärtner Christian Berger Pasquale Mordasini Jochen Vehoff Gian Marco De Marchis Risk Factors, Treatments, and Outcomes of Adults Aged <55 Years With Acute Ischemic Stroke With Undetermined Versus Determined Pathogenesis: A Nationwide Swiss Cohort Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease ischemic stroke undetermined pathogenesis vascular risk factors young |
| title | Risk Factors, Treatments, and Outcomes of Adults Aged <55 Years With Acute Ischemic Stroke With Undetermined Versus Determined Pathogenesis: A Nationwide Swiss Cohort Study |
| title_full | Risk Factors, Treatments, and Outcomes of Adults Aged <55 Years With Acute Ischemic Stroke With Undetermined Versus Determined Pathogenesis: A Nationwide Swiss Cohort Study |
| title_fullStr | Risk Factors, Treatments, and Outcomes of Adults Aged <55 Years With Acute Ischemic Stroke With Undetermined Versus Determined Pathogenesis: A Nationwide Swiss Cohort Study |
| title_full_unstemmed | Risk Factors, Treatments, and Outcomes of Adults Aged <55 Years With Acute Ischemic Stroke With Undetermined Versus Determined Pathogenesis: A Nationwide Swiss Cohort Study |
| title_short | Risk Factors, Treatments, and Outcomes of Adults Aged <55 Years With Acute Ischemic Stroke With Undetermined Versus Determined Pathogenesis: A Nationwide Swiss Cohort Study |
| title_sort | risk factors treatments and outcomes of adults aged 55 years with acute ischemic stroke with undetermined versus determined pathogenesis a nationwide swiss cohort study |
| topic | ischemic stroke undetermined pathogenesis vascular risk factors young |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.036761 |
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