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Observational Study
. 2014 Apr 22;129(16):1668-76.
doi: 10.1161/CIRCULATIONAHA.113.005663. Epub 2014 Feb 7.

Predictors of long-term recurrent vascular events after ischemic stroke at young age: the Italian Project on Stroke in Young Adults

Alessandro Pezzini  1 , Mario Grassi, Corrado Lodigiani, Rosalba Patella, Carlo Gandolfo, Andrea Zini, Maria Luisa Delodovici, Maurizio Paciaroni, Massimo Del Sette, Antonella Toriello, Rossella Musolino, Rocco Salvatore Calabrò, Paolo Bovi, Alessandro Adami, Giorgio Silvestrelli, Maria Sessa, Anna Cavallini, Simona Marcheselli, Domenico Marco Bonifati, Nicoletta Checcarelli, Lucia Tancredi, Alberto Chiti, Elisabetta Del Zotto, Alessandra Spalloni, Alessia Giossi, Irene Volonghi, Paolo Costa, Giacomo Giacalone, Paola Ferrazzi, Loris Poli, Andrea Morotti, Maurizia Rasura, Anna Maria Simone, Massimo Gamba, Paolo Cerrato, Giuseppe Micieli, Maurizio Melis, Davide Massucco, Valeria De Giuli, Licia Iacoviello, Alessandro Padovani; Italian Project on Stroke in Young Adults (IPSYS) Investigators
Collaborators, Affiliations
Observational Study

Predictors of long-term recurrent vascular events after ischemic stroke at young age: the Italian Project on Stroke in Young Adults

Alessandro Pezzini et al. Circulation. .

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.

Keywords: brain ischemia; prognosis; stroke.

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