Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
Stroke. 2012 Nov;43(11):2948-56. doi: 10.1161/STROKEAHA.112.661074. Epub 2012 Aug 28.
The determination of stroke etiology is essential for planning treatment for stroke prevention. However, the etiology of stroke is undetermined in many patients.
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.
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.
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.
确定中风病因对于预防中风的治疗计划至关重要。然而，许多患者的中风病因仍未确定。
在 10 年期间，连续纳入急性缺血性中风患者。根据急性中风治疗试验的 ORG 10172 分类，确定中风病因。使用死亡证明确定长期死亡率和死亡原因。计算标准化死亡率以比较中风患者和普通韩国人群的死亡率。
共纳入 3278 例患者，并随访中位数为 3.4 年（四分位距 1.5-5.7）。由于评估阴性（21.2%）、多种原因（10.6%）和评估不完整（4.8%），37%的中风亚型无法确定。3 个月时功能预后不良（改良 Rankin 量表评分>2）在评估不完整的患者中比在其他中风亚型患者中更为常见（49.6% vs 24.5%；P<0.001）。随访期间，781 例患者（23.8%）死亡。评估不完整患者的总体累积死亡率最高（30 天内 12.7%，1 年内 25.5%，3 年内 35.7%），其次是心源性栓塞。调整包括初始中风严重程度在内的混杂因素后进行多变量分析，评估不完整患者的死亡率仅次于心源性栓塞，而评估阴性患者的死亡率较低。
评估不完整患者的长期死亡率相当高。病因学研究有助于更好地确定中风亚型并确定预后。
