Embolic strokes of undetermined source: Prevalence and patient features in the ESUS Global Registry

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  • Kanjana S Perera
    Department of Medicine (Neurology), McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
  • Thomas Vanassche
    Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
  • Jackie Bosch
    Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
  • Mohana Giruparajah
    Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
  • Balakumar Swaminathan
    Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
  • Katie R Mattina
    Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
  • Scott D Berkowitz
    Bayer Healthcare Pharmaceuticals, Whippany, NJ, USA
  • Antonio Arauz
    Instituto Nacional de Neurologia y Neurocirugia, Mexico DF, Mexico
  • Martin J O’Donnell
    University of Galway, Galway, Ireland
  • Sebastian F Ameriso
    Institute for Neurological Research, Fundacion para la Lucha contra las Enfermedades Neurologicas de la Infancia (FLENI), Buenos Aires, Argentina
  • Graeme J Hankey
    School of Medicine and Pharmacology, University of Western Australia, Sir Charles Gairdner Hospital, Perth, Australia
  • Byung-Woo Yoon
    Department of Neurology, Seoul National University Hospital, Seoul, Korea
  • Philippa Lavallee
    Department of Neurology, Bichat Hospital, Paris, France
  • Luis Cunha
    Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • Nikolay Shamalov
    Pirogov Russian National Research Medical University, Moscow, Russia
  • Raf Brouns
    Universitair Ziekenhuis Brussel, Brussels, Belgium
  • Rubens J Gagliardi
    Irmandade da Santa Casa de Misericórdia de São Paulo, Sao Paulo, Brazil
  • Scott E Kasner
    Department of Neurology, Hospital of the University of Pennsylvania, Philadephia, United States
  • Alessio Pieroni
    Department of Neurology and Psychiatry, “Sapienza” University of Rome, Rome, Italy
  • Philipp Vermehren
    Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
  • Kazuo Kitagawa
    Department of Neurology, Tokyo Women’s Medical University, Tokyo, Japan
  • Yongjun Wang
    Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  • Keith Muir
    Institute of Neuroscience and Physiology, University of Glasgow, Queen Elizabeth Hospital, Glasgow, United Kingdom
  • Jonathan Coutinho
    Academic Medical Center, Amsterdam, Netherlands
  • Ildiko Vastagh
    Department of Neurology, Semmelweis University, Budapest, Hungary
  • Stuart J Connolly
    Department of Medicine (Cardiology), Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada
  • Robert G Hart
    Department of Medicine (Neurology), McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada

説明

<jats:sec><jats:title>Background</jats:title><jats:p> Recent evidence supports that most non-lacunar cryptogenic strokes are embolic. Accordingly, these strokes have been designated as embolic strokes of undetermined source (ESUS). </jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p> We undertook an international survey to characterize the frequency and clinical features of ESUS patients across global regions. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Consecutive patients hospitalized for ischemic stroke were retrospectively surveyed from 19 stroke research centers in 19 different countries to collect patients meeting criteria for ESUS. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Of 2144 patients with recent ischemic stroke, 351 (16%, 95% CI 15% to 18%) met ESUS criteria, similar across global regions (range 16% to 21%), and an additional 308 (14%) patients had incomplete evaluation required for ESUS diagnosis. The mean age of ESUS patients (62 years; SD = 15) was significantly lower than the 1793 non-ESUS ischemic stroke patients (68 years, p ≤ 0.001). Excluding patients with atrial fibrillation ( n = 590, mean age = 75 years), the mean age of the remaining 1203 non-ESUS ischemic stroke patients was 64 years ( p = 0.02 vs. ESUS patients). Among ESUS patients, hypertension, diabetes, and prior stroke were present in 64%, 25%, and 17%, respectively. Median NIHSS score was 4 (interquartile range 2–8). At discharge, 90% of ESUS patients received antiplatelet therapy and 7% received anticoagulation. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> This cross-sectional global sample of patients with recent ischemic stroke shows that one-sixth met criteria for ESUS, with additional ESUS patients likely among those with incomplete diagnostic investigation. ESUS patients were relatively young with mild strokes. Antiplatelet therapy was the standard antithrombotic therapy for secondary stroke prevention in all global regions. </jats:p></jats:sec>

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