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

Czech version

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.

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