Ischemic stroke subtypes: risk factors, treatments, and 1-month prognosis - The Lille, France Stroke Registry

Léonie Langanay; Roberto Gonzalez Sanchez; Aghiles Hamroun; Luc Dauchet; Philippe Amouyel; Jean Dallongeville; Aline Meirhaeghe; Victoria Gauthier

doi:10.1016/j.jstrokecerebrovasdis.2024.107761

Ischemic stroke subtypes: risk factors, treatments, and 1-month prognosis - The Lille, France Stroke Registry

J Stroke Cerebrovasc Dis. 2024 May 7;33(8):107761. doi: 10.1016/j.jstrokecerebrovasdis.2024.107761. Online ahead of print.

Authors

Léonie Langanay¹, Roberto Gonzalez Sanchez¹, Aghiles Hamroun¹, Luc Dauchet¹, Philippe Amouyel¹, Jean Dallongeville¹, Aline Meirhaeghe², Victoria Gauthier¹

Affiliations

¹ Lille University, Lille University Hospital, INSERM U1167 - RID-AGE, Institut Pasteur de Lille, U1167, 1 rue du Pr Calmette, Lille 59019, France.
² Lille University, Lille University Hospital, INSERM U1167 - RID-AGE, Institut Pasteur de Lille, U1167, 1 rue du Pr Calmette, Lille 59019, France. Electronic address: aline.meirhaeghe@pasteur-lille.fr.

PMID: 38723923
DOI: 10.1016/j.jstrokecerebrovasdis.2024.107761

Abstract

Objectives: First, this registry-based study aimed to comprehensively analyze patients' medical histories and treatments based on ischemic strokes' etiology. We focused on the management of atrial fibrillation among patients diagnosed with cardioembolic stroke. Then, our objective was to identify prognostic factors associated with 28-day mortality.

Materials and methods: All ischemic strokes occurring in adults between 2014 and 2021 in Lille, France, were categorized using the TOAST classification. Comparative analyses of patients' medical characteristics were conducted across subtypes. Survival rates within 28 days post-stroke were assessed, and factors influencing mortality were identified using a multivariate Cox model.

Results: 1912 ischemic strokes were recorded, due to cardioembolism (36%), large-artery atherosclerosis (9%), small-artery occlusion (9%), other determined causes (6%), or undetermined causes (39%). The median NIHSS score after cardioembolic stroke (6, IQR: 3-13) was twice that after small-artery occlusion (3, IQR: 2-5). Among patients with cardioembolic stroke, 26% were diagnosed post-admission with atrial fibrillation. For the 42% diagnosed pre-admission, only 54% had prior prescriptions for oral anticoagulants. Reperfusion therapies were administered in 21% of cases, with significant variations across subtypes. Mortality rates were higher after cardioembolic strokes (17%) than after small-artery occlusions (3%). Prognostic factors included etiology, high NIHSS score, atrial fibrillation, and previous heparin prescription.

Conclusions: While atrial fibrillation was underdiagnosed and undertreated, patients with cardioembolic stroke exhibited high severity and elevated mortality rates. Etiology emerged as an independent predictor of early mortality, regardless of NIHSS score upon admission. These findings underscore the importance of targeted prevention to improve patient outcomes after ischemic stroke.

Keywords: Atrial fibrillation; Cardioembolic stroke; Ischemic stroke subtype; Mortality; Prognosis; Registry; Treatment.