In:
Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. Suppl_1 ( 2021-03)
Abstract:
Introduction: Acute Ischemic Stroke (AIS) in the young is increasing in prevalence and the largest sub-type within this cohort is cryptogenic. The risk factors and etiologies for these strokes likely differ by socioeconomic, racial, and ethnic background. To curb this trend, new ways of defining cryptogenic stroke and its risk factors are needed that can be applied to different populations. We aimed to create such a framework using patients in one of the poorest and most diverse urban counties in the country: Bronx, NY. Methods: We conducted a retrospective cohort study of AIS patients aged 18-49 who presented to an urban tertiary care center. Stroke risk factor phenotypes were determined by multivariate analysis and resultant models were applied to cryptogenic stroke cases. Results: A total 449 patients met inclusion criteria. The mean age was 41, 49% were women, 39% were Black, and 32% were Hispanic. 133 patients had strokes due to small and large vessel disease (vascular phenotype); these patients had higher rates of hypertension, intracranial atherosclerosis, and diabetes mellitus, and higher admission glucose, HbA1c, admission blood pressure, and cholesterol compared to the patients with cardioembolic AIS. The 69 patients with strokes due to cardioembolism (cardiac phenotype) had significantly higher rates of congestive heart failure (CHF), rheumatic heart disease, atrial fibrillation, clotting disorders, left ventricular hypertrophy, larger left atrial sizes, lower ejection fractions, and higher B-type natriuretic peptide and troponin levels. There were no differences in stroke subtype by race or ethnicity. Adjusted multivariate analysis produced 6 variables independently associated with the vascular phenotype (age, male sex, hemoglobin A1c, EF, LDL cholesterol, and family history of AIS) and 5 independently associated with the cardiac phenotype (age, female sex, decreased EF, CHF, and absence of intracranial atherosclerosis). Applying these models to 97 cryptogenic stroke cases yielded that 51.5% fit the vascular phenotype and 3.1% fit the cardiac phenotype. Conclusion: In our cohort of young patients in a low-resource, diverse urban community, half of cryptogenic cases fit the risk factor phenotype of small and large vessel strokes.
Type of Medium:
Online Resource
ISSN:
0039-2499
,
1524-4628
DOI:
10.1161/str.52.suppl_1.P890
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2021
detail.hit.zdb_id:
1467823-8
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