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Evaluating Rates of Recurrent Ischemic Stroke Among Young Adults With Embolic Stroke of Undetermined Source: The Young ESUS Longitudinal Cohort Study

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dc.contributor.author Perera, Kanjana S.
dc.contributor.author De Sa Boasquevisque, Danielle
dc.contributor.author Rao-Melacini, Purnima
dc.contributor.author Taylor, Amanda
dc.contributor.author Cheng, Anna
dc.contributor.author Hankey, Graeme J.
dc.contributor.author Lee, Sarah
dc.contributor.author Marti Fabregas, Joan
dc.contributor.author Ameriso, Sebastián Francisco
dc.contributor.author Field, Thalia S.
dc.contributor.author Arauz-Gongora, Antonio
dc.contributor.author Coutts, Shelagh B.
dc.contributor.author Arnold, Marcel
dc.contributor.author Mikulik, Robert
dc.contributor.author Toni, Danilo
dc.contributor.author Mandzia, Jennifer
dc.contributor.author Veltkamp, Roland C.
dc.contributor.author Meseguer, Elena
dc.contributor.author Haeusler, Karl Georg
dc.contributor.author Young ESUS Investigators
dc.date.accessioned 2023-01-16T13:30:22Z
dc.date.available 2023-01-16T13:30:22Z
dc.date.issued 2022-05-01
dc.identifier.citation Perera KS, de Sa Boasquevisque D, Rao-Melacini P, Taylor A, Cheng A, Hankey GJ, Lee S, Fabregas JM, Ameriso SF, Field TS, Arauz-Gongora A, Coutts SB, Arnold M, Mikulik R, Toni D, Mandzia J, Veltkamp RC, Meseguer E, Haeusler KG, Hart RG; Young ESUS Investigators. Evaluating Rates of Recurrent Ischemic Stroke Among Young Adults With Embolic Stroke of Undetermined Source: The Young ESUS Longitudinal Cohort Study. JAMA Neurol. 2022 May 1;79(5):450-458. doi: 10.1001/jamaneurol.2022.0048. es_ES
dc.identifier.uri https://doi.org/10.1001/jamaneurol.2022.0048
dc.identifier.uri https://repositorio.fleni.org.ar/xmlui/handle/123456789/781
dc.description.abstract Importance: Cryptogenic strokes constitute approximately 40% of ischemic strokes in young adults, and most meet criteria for the embolic stroke of undetermined source (ESUS). Two randomized clinical trials, NAVIGATE ESUS and RESPECT ESUS, showed a high rate of stroke recurrence in older adults with ESUS but the prognosis and prognostic factors among younger individuals with ESUS is uncertain. Objective: To determine rates of and factors associated with recurrent ischemic stroke and death and new-onset atrial fibrillation (AF) among young adults. Design, setting, and participants: This multicenter longitudinal cohort study with enrollment from October 2017 to October 2019 and a mean follow-up period of 12 months ending in October 2020 included 41 stroke research centers in 13 countries. Consecutive patients 50 years and younger with a diagnosis of ESUS were included. Of 576 screened, 535 participants were enrolled after 1 withdrew consent, 41 were found to be ineligible, and 2 were excluded for other reasons. The final follow-up visit was completed by 520 patients. Main outcomes and measures: Recurrent ischemic stroke and/or death, recurrent ischemic stroke, and prevalence of patent foramen ovale (PFO). Results: The mean (SD) age of participants was 40.4 (7.3) years, and 297 (56%) participants were male. The most frequent vascular risk factors were tobacco use (240 patients [45%]), hypertension (118 patients [22%]), and dyslipidemia (109 patients [20%]). PFO was detected in 177 participants (50%) who had transthoracic echocardiograms with bubble studies. Following initial ESUS, 468 participants (88%) were receiving antiplatelet therapy, and 52 (10%) received anticoagulation. The recurrent ischemic stroke and death rate was 2.19 per 100 patient-years, and the ischemic stroke recurrence rate was 1.9 per 100 patient-years. Of the recurrent strokes, 9 (64%) were ESUS, 2 (14%) were cardioembolic, and 3 (21%) were of other determined cause. AF was detected in 15 participants (2.8%; 95% CI, 1.6-4.6). In multivariate analysis, the following were associated with recurrent ischemic stroke: history of stroke or transient ischemic attack (hazard ratio, 5.3; 95% CI, 1.8-15), presence of diabetes (hazard ratio, 4.4; 95% CI, 1.5-13), and history of coronary artery disease (hazard ratio, 10; 95% CI, 4.8-22). Conclusions and relevance: In this large cohort of young adult patients with ESUS, there was a relatively low rate of subsequent ischemic stroke and a low frequency of new-onset AF. Most recurrent strokes also met the criteria for ESUS, suggesting the need for future studies to improve our understanding of the underlying stroke mechanism in this population. es_ES
dc.language.iso eng es_ES
dc.publisher American Medical Association es_ES
dc.rights info:eu-repo/semantics/openAccess
dc.rights.uri https://creativecommons.org/licenses/by/2.5/ar/
dc.subject Stroke es_ES
dc.subject Accidente Cerebrovascular es_ES
dc.title Evaluating Rates of Recurrent Ischemic Stroke Among Young Adults With Embolic Stroke of Undetermined Source: The Young ESUS Longitudinal Cohort Study es_ES
dc.type info:eu-repo/semantics/article es_ES
dc.type info:eu-repo/semantics/publishedVersion
dc.description.fil Fil: Ameriso, Sebastian Francisco. Fleni. Departamento de Neurología. Servicio de Neurología Vascular; Argentina.
dc.description.fil Fil: Perera, Kanjana S. McMaster University; Canadá. Hamilton Health Sciences; Canadá.
dc.description.fil Fil: De Sa Boasquevisque, Danielle. McMaster University; Canadá. Hamilton Health Sciences; Canadá.
dc.description.fil Fil: Rao-Melacini, Purnima. McMaster University; Canadá. Hamilton Health Sciences; Canadá.
dc.description.fil Fil: Taylor, Amanda. Hamilton Health Sciences; Canadá.
dc.description.fil Fil: Cheng, Anna. Hamilton Health Sciences; Canadá.
dc.description.fil Fil: Hankey, Graeme J. University of Western Australia; Australia. Sir Charles Gairdner Hospital; Canadá.
dc.description.fil Fil: Lee, Sarah. Stanford Stroke Center; Estados Unidos. Stanford Children's Health; Estados Unidos.
dc.description.fil Fil: Marti Fabregas, Joan. Hospital de la Santa Creu i Sant Pau; España.
dc.description.fil Fil: Field, Thalia S. University of British Columbia; Canadá.
dc.description.fil Fil: Arauz-Gongora, Antonio. National Institute of Neurology; México.
dc.description.fil Fil: Coutts, Shelagh B. University of Calgary; Canadá.
dc.description.fil Fil: Arnold, Marcel. University Hospital Bern; Suiza.
dc.description.fil Fil: Mikulik, Robert. St Anne's University Hospital; República Checa. Masaryk University; República Checa.
dc.description.fil Fil: Toni, Danilo. Sapienza University of Rome; Italia.
dc.description.fil Fil: Mandzia, Jennifer. Western University; Canadá.
dc.description.fil Fil: Veltkamp, Roland C. The Hammersmith Hospital; Reino Unido.
dc.description.fil Fil: Meseguer, Elena. Bichat Hospital; Francia.
dc.description.fil Fil: Haeusler, Karl Georg. Universitätsklinikum Würzburg; Alemania.
dc.relation.ispartofVOLUME 79
dc.relation.ispartofNUMBER 5
dc.relation.ispartofPAGINATION 450-458.
dc.relation.ispartofCOUNTRY Estados Unidos
dc.relation.ispartofCITY Chicago
dc.relation.ispartofTITLE JAMA neurology
dc.relation.ispartofTITLE JAMA neurology
dc.relation.ispartofISSN 2168-6157
dc.type.snrd info:ar-repo/semantics/artículo es_ES


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