Divišová Petra, Šaňák Daniel, Král Michal, Bártková Andrea, Hutyra Martin, Zapletalová Jana, Dorňák Tomáš, Špaček Miloslav, Franc David, Polidar Petr, Veverka Tomáš, Kaňovský Petr
Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic.
Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, I. P. Pavlova 6, 77520 Olomouc, Czech Republic.
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105046. doi: 10.1016/j.jstrokecerebrovasdis.2020.105046. Epub 2020 Jun 23.
Ischemic strokes (IS) occur also in young adults and despite an extensive work-up the cause of IS remains very often cryptogenic. Thus, effectiveness of secondary prevention may be unclear. We aimed to analyze a relationship among vascular risk factors (VRF), clinical and laboratory parameters, outcomes and recurrent IS (RIS) in young cryptogenic IS (CIS) patients.
The study set consisted of young acute IS patients < 50 years enrolled in the prospective HISTORY (Heart and Ischemic STrOke Relationship studY) study registered on ClinicalTrials.gov (NCT01541163). All analyzed patients underwent transesophageal echocardiography, 24-h and 3-week ECG-Holter to assess cause of IS according to the ASCOD classification. Recurrent IS (RIS) was recorded during a follow-up (FUP).
Out of 294 young enrolled patients, 208 (70.7%, 113 males, mean age 41.6 ± 7.2 years) were identified as cryptogenic. Hyperlipidemia (43.3%), smoking (40.6%) and arterial hypertension (37.0%) were the most frequent VRF. RIS occurred in 7 (3.4%) patients during a mean time of FUP 19 ± 23 months. One-year risk of RIS was 3.4% (95%CI: 1.4-6.8%). Patients with RIS were older (47.4 vs. 41.1 years, p = 0.007) and more often obese (71.4 vs. 19.7%, p = 0.006), and did not differ in any of other analyzed parameters and VRF. Multivariate logistic regression analysis showed obesity (OR: 9.527; 95%CI: 1.777-51.1) and the previous use of antiplatelets (OR: 15.68; 95%CI: 2.430-101.2) as predictors of recurrent IS.
Despite a higher presence of VRF in young CIS patients, the risk of RIS was very low. Obesity and previous use of antiplatelet therapy were found the only predictors of RIS.
缺血性卒中（IS）也会发生在年轻人中，尽管进行了全面检查，但IS的病因往往仍不明。因此，二级预防的有效性可能不明确。我们旨在分析年轻不明原因缺血性卒中（CIS）患者的血管危险因素（VRF）、临床和实验室参数、结局与复发性IS（RIS）之间的关系。
研究对象包括纳入前瞻性HISTORY（心脏与缺血性卒中关系研究）研究的年龄<50岁的年轻急性IS患者，该研究已在ClinicalTrials.gov（NCT01541163）注册。所有分析的患者均接受经食管超声心动图、24小时和3周动态心电图检查，以根据ASCOD分类评估IS的病因。随访（FUP）期间记录复发性IS（RIS）。
在294名纳入研究的年轻患者中，208名（70.7%，男性113名，平均年龄41.6±7.2岁）被确定为不明原因。高脂血症（43.3%）、吸烟（40.6%）和动脉高血压（37.0%）是最常见的VRF。在平均19±23个月的随访期间，7名（3.4%）患者发生了RIS。RIS的1年风险为3.4%（95%CI：1.4-6.8%）。发生RIS的患者年龄较大（47.4岁对41.1岁，p=0.007），肥胖者更多（71.4%对19.7%，p=0.006），在其他任何分析参数和VRF方面无差异。多因素逻辑回归分析显示肥胖（OR：9.527；95%CI：1.777-51.1）和既往使用抗血小板药物（OR：15.68；95%CI：2.430-101.2）是复发性IS的预测因素。
尽管年轻CIS患者中VRF的存在率较高，但RIS的风险非常低。肥胖和既往使用抗血小板治疗是RIS的唯一预测因素。
