Department of Neurology, Helsinki University Central Hospital, Haartmaninkatu 4, FIN-00290, Helsinki, Finland.
Stroke. 2012 Feb;43(2):356-61. doi: 10.1161/STROKEAHA.111.635276. Epub 2011 Nov 3.
We aimed to explore clinical features of young patients with ischemic stroke with no traditional vascular risk factors and to assess the impact of risk factor counts on outcomes.
We included 990 patients aged 15 to 49 years with first-ever ischemic stroke followed for a mean of 9.0 ± 3.8 years (survivors). Risk factors were categorized as well-documented and less well-documented. Outcome measures were unfavorable functional outcome (3-month modified Rankin Scale 2-6); recurrent ischemic stroke; myocardial infarction or other arterial noncerebrovascular event; and death from any cause.
Compared with those with at least 1 well-documented risk factor, the 127 (12.8%) patients without risk factors were younger (median age, 37 versus 44 years; P<0.001), likely to be females (54.3% versus 34.9%; P<0.001), and they had more frequently a low-risk source of cardioembolism (21.3% versus 8.1%; P<0.001), internal carotid artery dissection (12.6% versus 6.4%; P=0.011), or vertebral artery dissection (17.3% versus 7.2%; P<0.001). The groups had similar 3-month functional outcomes. Patients without well-documented risk factors had less frequently recurrent ischemic strokes (4.7% versus 13.6%; log rank P=0.014), noncerebrovascular arterial events (0% versus 6.1%; P=0.008), and lower long-term mortality (3.4% versus 14.3%; P=0.003) than did those with at least 1 risk factor. Adjusted for demographics and stroke etiology, the number of well-documented risk factors was associated with higher risk for noncerebrovascular events. Increasing count of less well-documented risk factors was, in turn, independently associated with higher long-term mortality.
In young adults with first-ever ischemic stroke, risk factor counts added independent prognostic information regarding noncerebrovascular events and mortality.
本研究旨在探讨无传统血管危险因素的青年缺血性脑卒中患者的临床特征，并评估危险因素数量对结局的影响。
我们纳入了 990 例年龄在 15 至 49 岁之间的首发缺血性脑卒中患者，平均随访 9.0±3.8 年（幸存者）。危险因素分为有充分记录和记录不足两类。结局指标包括不良功能结局（3 个月改良 Rankin 量表 2-6 分）、复发性缺血性脑卒中、心肌梗死或其他动脉非脑血管事件、以及任何原因导致的死亡。
与至少有 1 个充分记录的危险因素的患者相比，127 例（12.8%）无危险因素的患者年龄更小（中位数年龄，37 岁 vs. 44 岁；P＜0.001），更可能为女性（54.3% vs. 34.9%；P＜0.001），且更常存在低危心源性栓塞源（21.3% vs. 8.1%；P＜0.001）、颈内动脉夹层（12.6% vs. 6.4%；P=0.011）或椎动脉夹层（17.3% vs. 7.2%；P＜0.001）。两组患者 3 个月时的功能结局相似。无充分记录的危险因素的患者复发性缺血性脑卒中发生率较低（4.7% vs. 13.6%；对数秩检验 P=0.014）、非脑血管动脉事件发生率较低（0% vs. 6.1%；P=0.008）、长期死亡率较低（3.4% vs. 14.3%；P=0.003）。与至少有 1 个危险因素的患者相比，经人口统计学和脑卒中病因校正后，充分记录的危险因素数量与非脑血管事件风险增加相关。记录不足的危险因素数量增加则与长期死亡率升高独立相关。
在首次发生缺血性脑卒中的年轻成年人中，危险因素数量增加可提供关于非脑血管事件和死亡率的独立预后信息。
