Predictors for the prognosis and recurrence of ischaemic stroke among young Chinese patients: a cohort study

Abstract

Objective: To identify predictors of young Chinese patients with ischaemic stroke outcome and recurrence of stroke.

Design: Through considered the risk factors, neuroimaging findings, distribution, vascular stenosis, and the post-stroke treatment of young Chinese patients with ischemic stroke.

Setting: The First Hospital of Jilin University.

Participants: We enrolled 579 patients (median age 45 years, range 15-49, men 81.0%) treated for the first occurrence of ischaemic stroke between January 2014 and December 2017.

Main outcome measures: We assessed stroke outcome based on the modified Rankin Scale (mRS) scores and recurrence of cerebrovascular events at 12 months. Multivariate logistic regression was used to identify the independent predictors of unfavourable outcomes (mRS score ≥2) and recurrence.

Results: We observed stenosis in 295 patients (50.9%)-middle cerebral artery stenosis was the most common (18.1%). Of all 579 included patients, normal or mild, moderate and severe stenoses or occlusions were observed in 51.8%, 6.0% and 42.1% of patients, respectively. Unfavourable outcomes were observed in 91 patients (15.7%), including 10 patients (1.7%) who died. The rate of stroke recurrence was 7.9%. Independent predictors of unfavourable outcomes included a high National Institutes of Health Stroke Scale score (OR 1.151, 95% CI 1.094 to 1.210; p<0.001) and severe vascular stenosis or occlusion (OR 1.867, 95% CI 1.181 to 2.952; p=0.008). Predictors of recurrence included age of ≥45 years (OR 2.072, 95% CI 1.066 to 4.025; p=0.032) and atrial fibrillation (OR 15.207, 95% CI 4.273 to 54.120; p<0.001).

Conclusions: Our research shows that when developing prevention strategies for young people, measures that focus on mitigating risk factors should be considered. In addition, vascular screening of young populations is also of vital importance for stroke prevention and poor prognosis prediction.

Keywords: stroke; stroke medicine.

Figure 1

Flowchart of the study.

Figure 2

TOASTand OCSP findings according to unfavourable outcomes and recurrence. (A) Comparison of TOAST classification between favourable and unfavourable outcomes. (B) Comparison of OCSP classification between favourable and unfavourable outcomes. (C) Comparison of TOAST classification between recurrence and non-recurrence. (D) Comparison of OCSP classification between recurrence and non-recurrence. CE, cardioembolism; LAA, large-artery atherosclerosis; LACS, lacunar syndrome; OCSP, Oxfordshire Community Stroke Project; PACS, partial anterior circulation syndrome; POCS, posterior circulation syndrome; SVD, small-vessel disease; TACS, total anterior circulation syndrome; TOAST, Trial of Org 10172 in Acute Stroke Treatment; UDE, undetermined aetiology.

Figure 3

mRS score at the 12-month follow-up. mRS, modified Rankin Scale.

Figure 4

Distribution of artery stenosis according to unfavourable outcomes and recurrence. (A) Distribution of artery stenosis with favourable outcomes and unfavourable outcomes. (B) Distribution of artery stenosis with recurrence and non-recurrence. ACA, anterior cerebral artery; BA, basilar artery; CCA, common carotid artery; ICA, internal carotid artery; MAS, multiple artery stenosis; MCA, middle cerebral artery; PCA, posterior cerebral artery; SUBA, subclavian artery; VA, vertebral artery.