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Stroke subtype predicts outcome in young and middle-aged stroke sufferers

Artikel i vetenskaplig tidskrift
Författare Petra Redfors
Katarina Jood
Lukas Holmegaard
Annika Rosengren
Christian Blomstrand
Christina Jern
Publicerad i Acta neurologica Scandinavica
Volym 126
Nummer/häfte 5
Sidor 329–335
ISSN 1600-0404
Publiceringsår 2012
Publicerad vid Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap och rehabilitering
Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 329–335
Språk en
Länkar dx.doi.org/10.1111/j.1600-0404.2012...
https://gup.ub.gu.se/file/190224
Ämnesord cerebral infarct; prognosis; stroke recovery; neurological impairment; TOAST subtype
Ämneskategorier Klinisk medicin

Sammanfattning

OBJECTIVES: There are few studies on long-term outcome after ischemic stroke (IS) for young and middle-aged stroke sufferers in relation to etiologic subtypes. Here, we report 2-year outcome in the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS). MATERIALS AND METHODS: SAHLSIS comprises 600 patients with IS before the age of 70 years. Etiologic subtype of IS was classified according to Trial of Org 10172 in Acute Stroke Treatment (TOAST). Recurrent vascular events and death were registered using several overlapping methods. Functional outcome was assessed according to the modified Rankin Scale (mRS). RESULTS: After 2 years, 55 (9.2%) patients had suffered a recurrent stroke, 15 (2.5%) had a transient ischemic attack (TIA), 4 (0.7%) had a coronary event, and 24 (4.0%) had died. The number of recurrent stroke, TIA, and death differed significantly between etiologic stroke subtypes. The highest rates were observed in large-vessel disease (LVD), whereas small-vessel disease and cryptogenic stroke showed the lowest recurrence and mortality rates. LVD was a significant predictor of the composite outcome (recurrent stroke, TIA, coronary event and/or death) independently of cardiovascular risk factors and stroke severity. Stroke subtype also predicted functional outcome 2 years after index stroke, but this association was not retained after adjustment for stroke severity. CONCLUSIONS: In young and middle-aged stroke patients, stroke subtype predicts recurrent vascular events and/or death 2 years after index stroke independently of cardiovascular risk factors and stroke severity. Thus, it is important to take the etiologic subtype of IS in account when assessing the risk of recurrence both in the clinical setting and in future studies.

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