Prabhakaran Shyam, Messé Steven R, Kleindorfer Dawn, Smith Eric E, Fonarow Gregg C, Xu Haolin, Zhao Xin, Lytle Barbara, Cigarroa Joaquin, Schwamm Lee H
University of Chicago (SP), Pritzker School of Medicine; University of Pennsylvania (SRM); University of Cincinnati (DK); Hotchkiss Brain Institute (EES), University of Calgary, Calgary, Alberta, Canada; Ahmanson Cardiomyopathy Center (GCF), UCLA, Los Angeles, CA; Duke Clinical Research Institute (HX, XZ, BL), Durham, NC; Knight Cardiovascular Institute (JC), Oregon Health and Sciences University; and Department of Neurology (LHS), Massachusetts General Hospital.
Neurol Clin Pract. 2020 Oct;10(5):396-405. doi: 10.1212/CPJ.0000000000000736.
Nationwide data on patients with cryptogenic stroke (CS) are lacking. We evaluated patient and hospital characteristics, in-hospital treatments, and discharge outcomes among patients with CS compared with other subtypes in the Get With The Guidelines (GWTG)-Stroke registry.
We identified patients with ischemic stroke (IS) admitted to GWTG-Stroke participating hospitals between January 1, 2016, and September 30, 2017, with documented National Institutes of Health Stroke Scale (NIHSS) scale and stroke etiology (cardioembolic [CE], large artery atherosclerosis [LAA], small vessel occlusion [SVO], other determined etiology [OTH], or CS). Using multivariable logistic regression, we compared hospital treatments and discharge outcomes by subtype, adjusted for patient and hospital characteristics.
Among 316,623 patients from 1,687 hospitals, there were 63,301 (20.0%) patients with CS. In multivariable analysis, patients with CS received IV thrombolysis more often than other subtypes and had lower mortality than CE, LAA, and OTH but higher mortality than SVO. They were more likely to be discharged home than all other subtypes and be independent at discharge than LAA, OTH, or SVO.
In a large contemporary nationwide registry, CS accounted for 20% of ISs among patients with a documented stroke etiology. Patients with CS had a distinct profile of treatments and outcomes relative to other subtypes. Improved subtype documentation and further research into CS are warranted to improve care and outcomes for patients with stroke.
目前缺乏关于隐源性卒中（CS）患者的全国性数据。我们在“遵循指南（GWTG）-卒中”注册研究中，评估了CS患者与其他亚型患者的个体及医院特征、住院治疗情况和出院结局。
我们确定了2016年1月1日至2017年9月30日期间入住参与GWTG-卒中研究医院的缺血性卒中（IS）患者，这些患者有记录的美国国立卫生研究院卒中量表（NIHSS）评分及卒中病因（心源性栓塞[CE]、大动脉粥样硬化[LAA]、小血管闭塞[SVO]、其他确定病因[OTH]或CS）。使用多变量逻辑回归分析，我们比较了各亚型的医院治疗情况和出院结局，并根据患者和医院特征进行了调整。
在来自1687家医院的316,623例患者中，有63,301例（20.0%）为CS患者。在多变量分析中，CS患者接受静脉溶栓治疗的频率高于其他亚型，死亡率低于CE、LAA和OTH，但高于SVO。与所有其他亚型相比，他们更有可能出院回家，且出院时比LAA、OTH或SVO患者更独立。
在一个大型当代全国性注册研究中，在有记录卒中病因的患者中，CS占IS的20%。与其他亚型相比，CS患者有独特的治疗情况和结局。有必要改进亚型记录并对CS进行进一步研究，以改善卒中患者的护理和结局。
