Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
Characteristics and prognosis of patients with embolic stroke of undetermined source in China
First author：Xiaomeng Yang,Jing Jing
Corresponding author：Yongjun Wang
essential_information
- Person in charge：Xiaomeng Yang,Jing Jing
- Data Sources： CNSR-Ⅲ
- Number of papers：CNSR-Ⅲ20190241
- Published time：2021-07-02
2021-07-02
Published articles
Journal：International journal of stroke
Publication type: Original Contributions
IF(IF): 5.266
PMID: 34125633 Link To Pubmed Full text Download
Background And Purpose
Embolic strokes of undetermined source (ESUS) have in common thromboembolic mechanisms that may be more responsive to anticoagulants than antiplatelet therapy for secondary stroke prevention. However, the two large international randomized trials had failed to illustrate the superiority of anticoagulants to aspirin in preventing recurrent stroke. We aimed to describe the baseline characteristics and prognosis at 1 year of this large ESUS cohort to characterize the frequency、clinical features , stroke recurrence and cardiovascular death at 1 year. Meanwhile, we will compare the characteristics and prognosis between ESUS and different TOAST stroke types.
Method
Between August 2015 and March 2018, the Third China National Stroke Registry recruited consecutive patients with ischemic stroke or transient ischemic attack in China. The baseline characteristics, risks of stroke, and prognosis in patients with embolic stroke of undetermined source were described and compared with that in patients with other causative subtypes.
Conclusion
Embolic stroke of undetermined source is a common cause of ischemic stroke in Chinese population with a higher stroke recurrence than previously reported. It was more likely to have nonstenosing large artery atherosclerosis in patients with embolic stroke of undetermined source than with cardioembolic strokes and small vessel disease.
Main results
A total of 15,166 transient ischemic attack and ischemic stroke patients were enrolled in the Third China National Stroke Registry. Among 8528 ischemic stroke with standard diagnostic work-up, 2415 (28.3%) patients were diagnosed with embolic stroke of undetermined source. The mean age was 61 years and 70% of them were male. Compared to patients with cardioembolic strokes and small vessel disease, patients with embolic stroke of undetermined source had higher prevalence of nonstenosing large artery atherosclerosis (37.93% vs. 31.26%, P¼0.008 and 37.93% vs.34.40%, P¼0.044 respectively). The cumulative probability of stroke recurrence in patients with embolic stroke of undetermined source at three months and one year was 5.59% and 8.74%. Compared with embolic stroke of undetermined source patients (0.70% and 1.99%), patients with the large artery atherosclerosis and cardioembolic strokes had higher cumulative probability of death at three months (1.94% and 3.22%) and one year (4.17% and 7.39%).