Has the aetiology of ischaemic stroke changed in the past decades? Analysis and comparison of data from current and historical stroke databases

Á Sánchez-Larsen; J García-García; O Ayo-Martín; F Hernández-Fernández; I Díaz-Maroto; E Fernández-Díaz; M Monteagudo; T Segura

doi:10.1016/j.nrl.2016.07.003

Has the aetiology of ischaemic stroke changed in the past decades? Analysis and comparison of data from current and historical stroke databases

Neurologia (Engl Ed). 2016 Sep 16:S0213-4853(16)30168-2. doi: 10.1016/j.nrl.2016.07.003. Online ahead of print.

[Article in English, Spanish]

Authors

Á Sánchez-Larsen¹, J García-García², O Ayo-Martín², F Hernández-Fernández², I Díaz-Maroto², E Fernández-Díaz², M Monteagudo², T Segura²

Affiliations

¹ Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España. Electronic address: aa.sanchezlarsen@gmail.com.
² Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España.

PMID: 27645775
DOI: 10.1016/j.nrl.2016.07.003

Abstract

Objectives: We aimed to determine whether the aetiology of ischaemic stroke has changed in recent years and, if so, to ascertain the possible reasons for these changes.

Patients and methods: We analysed the epidemiological history and vascular risk factors of all patients diagnosed with ischaemic stroke at Complejo Hospitalario Universitario de Albacete (CHUA) from 2009 to 2014. Ischaemic stroke subtypes were established using the TOAST criteria. Our results were compared to data from the classic Stroke Data Bank (SDB); in addition, both series were compared to those of other hospital databases covering the period between the two.

Results: We analysed 1664 patients (58% were men) with a mean age of 74 years. Stroke aetiology in both series (CHUA, SDB) was as follows: atherosclerosis (12%, 9%), small-vessel occlusion (13%, 25%), cardioembolism (32%, 19%), stroke of other determined aetiology (3%, 4%), and stroke of undetermined aetiology (40%, 44%). Sixty-three percent of the patients from the CHUA and 42% of the patients from the SDB were older than 70 years. Cardioembolic strokes were more prevalent in patients older than 70 years in both series. Untreated hypertension was more frequent in the SDB (SDB = 31% vs CHUA = 10%). The analysis of other databases shows that the prevalence of cardioembolic stroke is increasing worldwide.

Conclusions: Our data show that the prevalence of lacunar strokes is decreasing worldwide whereas cardioembolic strokes are increasingly more frequent in both our hospital and other series compared to the SDB. These differences may be explained by population ageing and the improvements in management of hypertension and detection of cardioembolic arrhythmias in stroke units.

Keywords: Atrial fibrillation; Base de Datos de Ictus; Etiología del ictus; Factores de riesgo vascular; Fibrilación auricular; Stroke Data Bank; Stroke aetiology; Stroke subtypes; Subtipos de ictus; TOAST; Vascular risk factors.