Risk factors and outcome of subtypes of ischemic stroke. Data from a multicenter multinational hospital-based registry. The European Community Stroke Project
Introduction
Stroke is a highly heterogeneous disorder with distinct subtypes, each presenting specific clinical and epidemiological aspects [1]. In developed countries, cerebral infarction represents the most common type of stroke and may be further differentiated in subtypes. Subtype characterization of ischemic stroke may improve knowledge of risk factors and pathogenesis, with a positive impact on prevention, acute-phase treatment and, possibly, outcome [2].
The Oxfordshire Community Stroke Project (OCSP) classification defined four clinically identifiable subgroups of cerebral infarction: total anterior circulation infarction (TACI), partial anterior circulation infarction (PACI), posterior circulation infarction (POCI) and lacunar infarction (LACI) [3]. This classification showed a moderate to good interobserver reliability [4], [5], could predict size and site of infarction seen on computed tomography or magnetic resonance imaging in about 75% of cases [6], and was proposed for clinical–epidemiological purposes, but little is known about possible determinants and prognosis of the single subtypes.
The objective of the present study was to evaluate differences in risk factors, resource use and 3-month outcome of different ischemic stroke subtypes, defined according to the OCSP classification, in a large European setting of patients hospitalized for acute stroke.
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Patients and methods
A European Union Concerted Action was initiated to establish the relationships between resource use, costs and outcome of packages of care for stroke in Europe. The specific objectives have been outlined previously [7]. The study was prospective and involved 12 centers (22 hospitals) in 7 countries: England, France, Germany, Hungary, Italy, Portugal and Spain. The hospitals were chosen because they contained staff interested in stroke research. They provide general acute care to the local
Results
During the 12-month study period, cerebral infarction was diagnosed in 2740 patients with first-in-a-lifetime stroke (mean age 70.5 ± 12.4 years, range 13.7–100.4). Overall, 1463 patients were males (53.4%, mean age 68.2 ± 11.9 years) and 1277 females (46.6%, mean age 73.1 ± 12.4 years). A definition of OCSP subtypes was achieved in 2472 (90.2%) of the 2740 events diagnosed as ischemic strokes. A total of 659 events (26.7%) were TACI, 740 (29.9%) PACI, 413 (16.7%) POCI and 660 (26.7%) LACI.
Table 1
Discussion
This study evaluated differences in risk factors, management and outcome of subtypes of ischemic stroke, defined according to the OCSP classification, in a large sample of European patients. There were differences in baseline living conditions, risk factor profile and stroke outcome. Different subtypes required different use of in-hospital rehabilitation services and diagnostic tools. Also, separate patterns were observed for in-hospital stay, 28-day case-fatality rate and 3-month mortality.
Acknowledgments
This study was supported by European Union BIOMED I Program. The authors thank Ms. Maria Elena Della Santa for her support in preparing the manuscript.
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2019, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :About 20% of the cerebral blood flow is directed to the posterior circulation (PC), explaining the approximate 20% rate of PC strokes observed in several case series.1-5 Current data comparing PC and AC strokes with regards to clinical, etiological, radiological, and outcome factors are scarce and multivariate analyses were not applied6,7-9 or are limited to large PC-only case series.2,10,11 The arterial anatomy and the site of obstruction in PC and AC strokes show notable differences.10,12