BACKGROUND-: Data on long-term risk and predictors of recurrent thrombotic events after ischemic stroke at a young age are limited. METHODS AND RESULTS-: We followed 1867 patients with first-ever ischemic stroke who were 18 to 45 years of age (mean age, 36.8±7.1 years; women, 49.0%), as part of the Italian Project on Stroke in Young Adults (IPSYS). Median follow-up was 40 months (25th to 75th percentile, 53). The primary end point was a composite of ischemic stroke, transient ischemic attack, myocardial infarction, or other arterial events. One hundred sixty-three patients had recurrent thrombotic events (average rate, 2.26 per 100 person-years at risk). At 10 years, cumulative risk was 14.7% (95% confidence interval, 12.2%-17.9%) for primary end point, 14.0% (95% confidence interval, 11.4%-17.1%) for brain ischemia, and 0.7% (95% confidence interval, 0.4%-1.3%) for myocardial infarction or other arterial events. Familial history of stroke, migraine with aura, circulating antiphospholipid antibodies, discontinuation of antiplatelet and antihypertensive medications, and any increase of 1 traditional vascular risk factor were independent predictors of the composite end point in multivariable Cox proportional hazards analysis. A point-scoring system for each variable was generated by their β-coefficients, and a predictive score (IPSYS score) was calculated as the sum of the weighted scores. The area under the receiver operating characteristic curve of the 0-to 5-year score was 0.66 (95% confidence interval, 0.61-0.71; mean, 10-fold internally cross-validated area under the receiver operating characteristic curve, 0.65). CONCLUSIONS-: Among patients with ischemic stroke aged 18 to 45 years, the long-term risk of recurrent thrombotic events is associated with modifiable, age-specific risk factors. The IPSYS score may serve as a simple tool for risk estimation. © 2014 American Heart Associtian, Inc.
Predictors of long-term recurrent vascular events after ischemic stroke at young age: The Italian project on stroke in young adults / A., Pezzini; M., Grassi; C., Lodigiani; Patella, Rosalba; C., Gandolfo; A., Zini; M. L., Delodovici; M., Paciaroni; M., Del Sette; A., Toriello; R., Musolino; R. S., Calabro; P., Bovi; A., Adami; G., Silvestrelli; M., Sessa; A., Cavallini; S., Marcheselli; D. M., Bonifati; N., Checcarelli; L., Tancredi; A., Chiti; E., Del Zotto; A., Spalloni; A., Giossi; I., Volonghi; P., Costa; G., Giacalone; P., Ferrazzi; L., Poli; A., Morotti; Rasura, Maurizia; A. M., Simone; M., Gamba; P., Cerrato; G., Micieli; M., Melis; D., Massucco; V., De Giuli; L., Iacoviello; A., Padovani; O. N., Behalf Of The Italian Project On Stroke In Young Adults Investigators. - In: CIRCULATION. - ISSN 0009-7322. - 129:16(2014), pp. 1668-1676. [10.1161/circulationaha.113.005663]
Predictors of long-term recurrent vascular events after ischemic stroke at young age: The Italian project on stroke in young adults
PATELLA, ROSALBA;RASURA, Maurizia;
2014
Abstract
BACKGROUND-: Data on long-term risk and predictors of recurrent thrombotic events after ischemic stroke at a young age are limited. METHODS AND RESULTS-: We followed 1867 patients with first-ever ischemic stroke who were 18 to 45 years of age (mean age, 36.8±7.1 years; women, 49.0%), as part of the Italian Project on Stroke in Young Adults (IPSYS). Median follow-up was 40 months (25th to 75th percentile, 53). The primary end point was a composite of ischemic stroke, transient ischemic attack, myocardial infarction, or other arterial events. One hundred sixty-three patients had recurrent thrombotic events (average rate, 2.26 per 100 person-years at risk). At 10 years, cumulative risk was 14.7% (95% confidence interval, 12.2%-17.9%) for primary end point, 14.0% (95% confidence interval, 11.4%-17.1%) for brain ischemia, and 0.7% (95% confidence interval, 0.4%-1.3%) for myocardial infarction or other arterial events. Familial history of stroke, migraine with aura, circulating antiphospholipid antibodies, discontinuation of antiplatelet and antihypertensive medications, and any increase of 1 traditional vascular risk factor were independent predictors of the composite end point in multivariable Cox proportional hazards analysis. A point-scoring system for each variable was generated by their β-coefficients, and a predictive score (IPSYS score) was calculated as the sum of the weighted scores. The area under the receiver operating characteristic curve of the 0-to 5-year score was 0.66 (95% confidence interval, 0.61-0.71; mean, 10-fold internally cross-validated area under the receiver operating characteristic curve, 0.65). CONCLUSIONS-: Among patients with ischemic stroke aged 18 to 45 years, the long-term risk of recurrent thrombotic events is associated with modifiable, age-specific risk factors. The IPSYS score may serve as a simple tool for risk estimation. © 2014 American Heart Associtian, Inc.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
