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Cardioembolism is the Most Frequent Etiology of an Acute Ischemic Stroke in Patients Admitted within 12 Hours from Symp­tom Onset –  Results of the HISTORY Study


Authors: M. Král 1;  D. Šaňák 1;  D. Školoudík 2;  History Study Group *
Authors‘ workplace: HISTORY Study Group: T. Veverka, A. Bárt-ková, A. Kunčarová, T. Dorňák, P. Kaňovský (Neurologická klinika LF UP a FN Olomouc), M. Hutyra, D. Vindiš, M. Táborský (Kardiologická klinika LF UP a FN Olomouc), E. Čecháková, Z. Tüdös, M. Černá, M. Köcher (Radio *;  Komplexní cerebrovaskulární centrum, Neurologická klinika LF UP a FN Olomouc 1;  Ústav ošetřovatelství, FZV UP v Olomouci 2
Published in: Cesk Slov Neurol N 2016; 79/112(1): 61-67
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn201661

* HISTORY Study Group: T. Veverka, A. Bártková, A. Kunčarová, T. Dorňák, P. Kaňovský (Neurologická klinika LF UP a FN Olomouc), M. Hutyra, D. Vindiš, M. Táborský (Kardiologická klinika LF UP a FN Olomouc), E. Čecháková, Z. Tüdös, M. Černá, M. Köcher (Radiologická klinika LF UP a FN Olomouc), L. Roubalová, D. Novotný, T. Adam (Oddělení klinické biochemie, FN Olomouc), J. Úlehlová, L. Slavík (Hemato-onkologická klinika LF UP a FN Olomouc), R. Herzig (Neurologická klinika LF UP a FN Hradec Králové), K. Langová (Katedra biofyziky, LF UP v Olomouci)

Overview

Aim:
The aims of the study were to compare stroke classifications TOAST and ASCOD in acute ischemic stroke (AIS) patients, age, gender, day-time of stroke symptoms onset, time to hospital admission, usage or recanalization methods and prognosis of patients admitted to the hospital within 12 hours after stroke onset with different AIS subtypes.

Materials and methods:
In total, 519 AIS patients admitted to a hospital within 12 hours after stroke onset were consecutively enrolled to the study. Demographic, epidemiologic, anamnestic data, neurological, physical examinations, brain imaging, laboratory tests, vascular and cardiac examinations were performed in all patients. Etiology of AIS was evaluated using the TOAST and ASCOD criteria.

Results:
Agreement in stroke classification between the TOAST and ASCOD systems was 78.2%. The most frequent etiology of AIS was cardioembolism, detected in 43.2% patients using the TOAST. Using the ASCOD, 46.1% patients had cardioembolism as potential, 9.2% patients as uncertain and 16.2% as unlikely cause of AIS. Patients with cardioembolic stroke according to the TOAST were significantly older than patients with large-artery atherosclerosis (p = 0.003), lacunar stroke (p < 0.001), other determined (p = 0.026) or undetermined AIS etiology (p < 0.001). Patients with lacunar stroke or other determined AIS etiology had significantly better prognosis of survival than patients with cardioembolic stroke or large-artery atherosclerosis (p < 0.05).

Conclusions:
Cardioembolism is the most frequent etiology of AIS in patients admitted to a Comprehensive Stroke Center within 12 hours after onset. These patients were significantly older and had significantly worse prognosis than patients with lacunar stroke or other determined AIS etiology.

Key words:
ischemic stroke – etiology – classification – cardioembolism – ASCOD – TOAST

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


Sources

1. Powers WJ, Derdeyn CP, Bil­ler J, Cof­fey CS, Hoh BL, Jauch EC et al. American Heart As­sociation Stroke Council 2015 AHA/ ASA Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regard­ing Endovascular Treatment: a Guideline for Healthcare Profes­sionals From the American Heart As­sociation/ American Stroke As­sociation. Stroke 2015; in press.

2. Jauch EC, Saver JL, Adams HP jr, Bruno A, Con­nors JJ, Demaerschalk BM et al. American Heart As­sociation Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare profes­sionals from the American Heart As­sociation/ American Stroke As­sociation. Stroke 2013; 44(3): 870– 947. doi: 10.1161/ STR.0b013e318284056a.

3. Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 2007; 38(3): 967– 973.

4. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359(13): 1317– 1329. doi: 10.1056/ NEJMoa0804656.

5. Berkhemer OA, Fransen PS, Beumer D, van den Berg LA, Lingsma HF, Yoo AJ et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372(1): 11– 20. doi: 10.1056/ NEJMoa1411587.

6. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J et al. Randomized as­ses­sment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372(11): 1019– 1030. doi: 10.1056/ NEJMoa1414905.

7. Soize S, Barbe C, Kadziolka K, Estrade L, Ser­re I, Pierot L. Predictive factors of outcome and hemor­rhage after acute ischemic stroke treated by mechanical thrombectomy with a stent-retriever. Neuroradiology 2013; 55(8): 977– 987. doi: 10.1007/ s00234-013-1191-4.

8. Linfante I, Starosciak AK, Walker GR, Dabus G, Castonguay AC, Gupta R et al. Predictors of poor outcome despite recanalization: a multiple regres­sion analysis of the NASA registry. J Neurointerv Surg 2015; pii: neurintsurg-2014-011525. doi: 10.1136/ neurintsurg-2014-011525.

9. Chung CP, Yong CS, Chang FC, Sheng WY, Huang HC, Tsai JY et al. Stroke etiology is as­sociated with outcome in posterior circulation stroke. Ann Clin Transl Neurol 2015; 2(5): 510– 517. doi: 10.1002/ acn3.188.

10. Ueda T, Sakaki S, Kumon Y, Ohta S. Multivariable anal­ysis of predictive factors related to outcome at 6 months after intra-arterial thrombolysis for acute ischemic stroke. Stroke 1999; 30(11): 2360– 2365.

11. Adams HP, Bendixen BH, Kappel­le LJ, Bil­ler J, Love BB, Gordon DL et al. Clas­sification of subtype of acute ischemic stroke definitions for use in a multicenter clinical trial. Stroke 1993; 24(1): 35– 41.

12. Han SW, Kim SH, Lee JY, Chu CK, Yang JH, Shin HY et al. A new subtype clas­sification of ischemic stroke based on treatment and etiologic. Eur Neurol 2007; 57(2): 96– 102.

13. Scul­len TA, Monlezun DJ, Siegler JE, George AJ, Schwickrath M, El Khoury R et al. Cryptogenic stroke: clinical consideration of a heterogeneous ischemic subtype. J Stroke Cerebrovasc Dis 2015; 24(5): 993– 999. doi: 10.1016/ j.jstrokecerebrovasdis.2014.12.024.

14. Amarenco P, Bogous­slavsky J, Caplan LR, Don­nan GA, Wolf ME, Hen­nerici MG. The ASCOD Phenotyp­ing of Ischemic Stroke (Updated ASCO Phenotyping). Cerebrovasc Dis 2013; 36(1): 1– 5. doi: 10.1159/ 000352050.

15. Amarenco P, Bogous­slavsky J, Caplan LR, Don­nan GA, Hen­nerici MG. New approach to stroke subtyping: the A-S-C-O (phenotypic) clas­sification of stroke. Cerebrovasc Dis 2009; 27(5): 502– 508. doi: 10.1159/ 000210433.

16. Marnane M, Duggan CA, Sheehan OC, Merwick A, Han­non N, Curtin D et al. Stroke subtype clas­sification to mechanism-specific and undetermined categories by TOAST, A-S-C-O, and causative clas­sification system. Stroke 2010; 41(8): 1579– 1586. doi: 10.1161/ STROKEAHA.109.575373.

17. Shang Wy, Liu Jy. Stroke subtype clas­sification: a comparative study of ASCO and modified TOAST. J Neurol Sci 2012; 314(1– 2): 66– 70. doi: 10.1016/ j.jns.2011.10.029.

18. Kral M, Skoloudik D, Sanak D, Veverka T, Bartkova A, Dornak T et al. As­ses­sment of relationship between acute ischemic stroke and heart disease –  protocol of a prospective observational trial. Biomed Pap 2012; 156(6): 284– 289. doi: 10.5507/ bp.2012.094.

19. Yancy CW, Jes­sup M, Bozkurt B, Butler J, Casey DE jr, Drazner MH; American Col­lege of Cardiology Foundation; American Heart As­sociation Task Force on Practice Guidelines. 2013 ACCF/ AHA guideline for the management of heart failure: executive sum­mary: a report of the American Col­lege of Cardiology Foundation/ American Heart As­sociation Task Force on practice guidelines. Circulation 2013; 128(16): 1810– 1852. doi: 10.1161/ CIR.0b013e31829e8807.

20. National Kidney Foundation. K/ DOQI, clinical practice guidelines for chronic kidney disease: evaluation, clas­sification, and stratification. Am J Kidney Dis 2002; 39 (Suppl 1): S1– S266.

21. Herzig R, Urbánek K, Vlachová I, Krupka B, Gabrys M, Mares J et al. The role of chronic alcohol intake in patients with spontaneous intracranial hemor­rhage: a carbohydrate-deficient transfer­rin study. Cerebrovasc Dis 2003; 15(1– 2): 22– 28.

22. Kernan WN, Ovbiagele B, Black HR, Bravata DM,Chimowitz MI, Ezekowitz MD et al; American HeartAs­sociation Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Peripheral Vascular Disease. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare profes­sionals from the American Heart As­sociation/ American Stroke As­sociation. Stroke 2014; 45(7): 2160– 2236. doi: 10.1161/ STR.0000000000000024.

23. Cotter PE, Belham M, Martin PJ. Towards understand­ing the cause of stroke in young adults utilis­ing a new stroke clas­sification system (A-S-C-O). Cerebrovasc Dis 2012; 33(2): 123– 127. doi: 10.1159/ 000334183.

24. Kolominsky-Rabas PL, Weber M, Gefel­ler O, Neundoerfer B, Heuschmann PU. Epidemiology of ischemic stroke subtypes accord­ing to TOAST criteria: incidence, recur­rence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke 2001; 32(12): 2735– 2740.

25. Sirimarco G, Laval­lée PC, Labreuche J, Meseguer E, Cabrejo L, Guidoux C et al. Overlap of diseases underly­ing ischemic stroke: the ASCOD phenotyping. Stroke 2013; 44(9): 2427– 2433. doi: 10.1161/ STROKEAHA.113.001363.

26. Tsai CF, Thomas B, Sudlow CL. Epidemiology of stroke and its subtypes in Chinese vs white populations: a systematic review. Neurology 2013; 81(3): 264– 272. doi: 10.1212/ WNL.0b013e31829bfde3.

27. Král M, Herzig R, Šaňák D, Školoudík D, Bártková A, Veverka T et al. Underuse of oral anticoagulation in primary prevention of cardioembolic stroke. Cesk Slov Neurol N 2014; 77/ 110(1): 59– 63.

28. Wong CX, Lee SW, Gan SW, Mahajan R, Rangnekar G, Pathak RK et al. Underuse and overuse of anticoagulation for atrial fibril­lation: a study in indigenous and non-indigenous Australians. Int J Cardiol 2015; 191: 20– 24. doi: 10.1016/ j.ijcard.2015.03.064.

29. Bahri O, Roca F, Lechani T, Druesne L, Jouan­ny P, Serot JM et al. Underuse of oral anticoagulation for individuals with atrial fibril­lation in a nurs­ing home sett­ing in France: comparisons of resident characteristics and physician attitude. J Am Geriatr Soc 2015; 63(1): 71– 76. doi: 10.1111/ jgs.13200.

30. Arboix A, Alió J. Acute cardioembolic stroke: an update. Expert Rev Cardiovasc Ther 2011; 9(3): 367– 379. doi: 10.1586/ erc.10.192.

31. Wolf PA, Abbott RD, Kan­nel WB. Atrial fibril­lation as an independent risk factor for stroke: the framingham study. Stroke 1991; 22(8): 983– 988.

32. Chao TF, Liu CJ, Tuan TC, Chen SJ, Wang KL, Lin YJ et al. Rate-Control Treatment and Mortality in Atrial Fibril­lation. Circulation 2015; 132(17): 1604– 1612. doi: 10.1161/ CIRCULATIONAHA.114.013709.

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