Incidence, characteristics and outcomes in patients with embolic stroke of undetermined source

A population-based study

Georgios Tsivgoulis, Odysseas Kargiotis, Aristeidis H. Katsanos, Athanasia Patousi, Dimitris Mavridis, Sofia Tsokani, Maria Pikilidou, Theodosis Birbilis, Michael Mantatzis, Christina Zompola, Sokratis Triantafyllou, Nikolaos Papanas, Panagiotis Skendros, Aikaterini Terzoudi, George S. Georgiadis, Efstratios Maltezos, Charitomeni Piperidou, Konstantinos Tsioufis, Ioannis Heliopoulos, Konstantinos Vadikolias

Research output: Contribution to journalArticle

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Abstract

Embolic stroke of undetermined source (ESUS) represents a subgroup of cryptogenic ischemic stroke (CS) distinguished by high probability of an underlying embolic mechanism. There are scarce population-based data regarding the incidence, characteristics and outcomes of ESUS. Consecutive patients included with first-ever ischemic stroke of undetermined cause in the previously published population-based Evros Stroke Registry were further subdivided into ESUS and non-ESUS CS. Crude and adjusted [according to the European Standard Population (ESP), WHO and Segi population] incidence rates (IR) for ESUS and non-ESUS CS were calculated. Baseline characteristics, admission stroke severity (assessed using NIHSS-score), stroke recurrence and functional outcomes [determined by modified Rankin Scale (mRS) scores], were recorded during the 1-year follow-up period. We identified 21 and 242 cases with ESUS (8% of CS) and non-ESUS CS. The crude and ESP-adjusted IR for ESUS were 17.5 (95%CI: 10–25) and 16.6 (95%CI: 10–24) per 100,000 person-years. Patients with ESUS were younger (p <.001) and had lower median admission NIHSS-scores (p <.001). Functional outcomes were more favorable in ESUS at 28, 90 and 365 days. ESUS was independently (p =.033) associated with lower admission NIHSS-scores (unstandardized linear regression coefficient: -13.34;95%CI: -23.34, −3.35) on multiple linear regression models. ESUS was not related to 1-year stroke recurrence, mortality and functional improvement on multivariable analyses. In conclusion we found that ESUS cases represented 8% of CS patients in this population-based study. Despite the fact that ESUS was independently related to lower admission stroke severity, there was no association of ESUS with long-term outcomes.

Original languageEnglish (US)
Pages (from-to)5-11
Number of pages7
JournalJournal of the Neurological Sciences
Volume401
DOIs
StatePublished - Jun 15 2019

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Stroke
Incidence
Population
Linear Models
Recurrence

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology

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Incidence, characteristics and outcomes in patients with embolic stroke of undetermined source : A population-based study. / Tsivgoulis, Georgios; Kargiotis, Odysseas; Katsanos, Aristeidis H.; Patousi, Athanasia; Mavridis, Dimitris; Tsokani, Sofia; Pikilidou, Maria; Birbilis, Theodosis; Mantatzis, Michael; Zompola, Christina; Triantafyllou, Sokratis; Papanas, Nikolaos; Skendros, Panagiotis; Terzoudi, Aikaterini; Georgiadis, George S.; Maltezos, Efstratios; Piperidou, Charitomeni; Tsioufis, Konstantinos; Heliopoulos, Ioannis; Vadikolias, Konstantinos.

In: Journal of the Neurological Sciences, Vol. 401, 15.06.2019, p. 5-11.

Research output: Contribution to journalArticle

Tsivgoulis, G, Kargiotis, O, Katsanos, AH, Patousi, A, Mavridis, D, Tsokani, S, Pikilidou, M, Birbilis, T, Mantatzis, M, Zompola, C, Triantafyllou, S, Papanas, N, Skendros, P, Terzoudi, A, Georgiadis, GS, Maltezos, E, Piperidou, C, Tsioufis, K, Heliopoulos, I & Vadikolias, K 2019, 'Incidence, characteristics and outcomes in patients with embolic stroke of undetermined source: A population-based study', Journal of the Neurological Sciences, vol. 401, pp. 5-11. https://doi.org/10.1016/j.jns.2019.04.008
Tsivgoulis, Georgios ; Kargiotis, Odysseas ; Katsanos, Aristeidis H. ; Patousi, Athanasia ; Mavridis, Dimitris ; Tsokani, Sofia ; Pikilidou, Maria ; Birbilis, Theodosis ; Mantatzis, Michael ; Zompola, Christina ; Triantafyllou, Sokratis ; Papanas, Nikolaos ; Skendros, Panagiotis ; Terzoudi, Aikaterini ; Georgiadis, George S. ; Maltezos, Efstratios ; Piperidou, Charitomeni ; Tsioufis, Konstantinos ; Heliopoulos, Ioannis ; Vadikolias, Konstantinos. / Incidence, characteristics and outcomes in patients with embolic stroke of undetermined source : A population-based study. In: Journal of the Neurological Sciences. 2019 ; Vol. 401. pp. 5-11.
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abstract = "Embolic stroke of undetermined source (ESUS) represents a subgroup of cryptogenic ischemic stroke (CS) distinguished by high probability of an underlying embolic mechanism. There are scarce population-based data regarding the incidence, characteristics and outcomes of ESUS. Consecutive patients included with first-ever ischemic stroke of undetermined cause in the previously published population-based Evros Stroke Registry were further subdivided into ESUS and non-ESUS CS. Crude and adjusted [according to the European Standard Population (ESP), WHO and Segi population] incidence rates (IR) for ESUS and non-ESUS CS were calculated. Baseline characteristics, admission stroke severity (assessed using NIHSS-score), stroke recurrence and functional outcomes [determined by modified Rankin Scale (mRS) scores], were recorded during the 1-year follow-up period. We identified 21 and 242 cases with ESUS (8{\%} of CS) and non-ESUS CS. The crude and ESP-adjusted IR for ESUS were 17.5 (95{\%}CI: 10–25) and 16.6 (95{\%}CI: 10–24) per 100,000 person-years. Patients with ESUS were younger (p <.001) and had lower median admission NIHSS-scores (p <.001). Functional outcomes were more favorable in ESUS at 28, 90 and 365 days. ESUS was independently (p =.033) associated with lower admission NIHSS-scores (unstandardized linear regression coefficient: -13.34;95{\%}CI: -23.34, −3.35) on multiple linear regression models. ESUS was not related to 1-year stroke recurrence, mortality and functional improvement on multivariable analyses. In conclusion we found that ESUS cases represented 8{\%} of CS patients in this population-based study. Despite the fact that ESUS was independently related to lower admission stroke severity, there was no association of ESUS with long-term outcomes.",
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T2 - A population-based study

AU - Tsivgoulis, Georgios

AU - Kargiotis, Odysseas

AU - Katsanos, Aristeidis H.

AU - Patousi, Athanasia

AU - Mavridis, Dimitris

AU - Tsokani, Sofia

AU - Pikilidou, Maria

AU - Birbilis, Theodosis

AU - Mantatzis, Michael

AU - Zompola, Christina

AU - Triantafyllou, Sokratis

AU - Papanas, Nikolaos

AU - Skendros, Panagiotis

AU - Terzoudi, Aikaterini

AU - Georgiadis, George S.

AU - Maltezos, Efstratios

AU - Piperidou, Charitomeni

AU - Tsioufis, Konstantinos

AU - Heliopoulos, Ioannis

AU - Vadikolias, Konstantinos

PY - 2019/6/15

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