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

Perera, K. S. et al. (2016) Embolic strokes of undetermined source: prevalence and patient features in the ESUS Global Registry. International Journal of Stroke, 11(5), pp. 526-533. (doi:10.1177/1747493016641967) (PMID:27256472)

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Abstract

Background: Recent evidence supports that most non-lacunar cryptogenic strokes are embolic. Accordingly, these strokes have been designated as embolic strokes of undetermined source (ESUS). Aims: We undertook an international survey to characterize the frequency and clinical features of ESUS patients across global regions. Methods: 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. Results: 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. Conclusions: 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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Muir, Professor Keith
Authors: Perera, K. S., Vanassche, T., Bosch, J., Giruparajah, M., Swaminathan, B., Mattina, K. R., Berkowitz, S. D., Arauz, A., O’Donnell, M. J., Ameriso, S. F., Hankey, G. J., Yoon, B.-W., Lavallee, P., Cunha, L., Shamalov, N., Brouns, R., Gagliardi, R. J., Kasner, S. E., Pieroni, A., Vermehren, P., Kitagawa, K., Wang, Y., Muir, K., Coutinho, J., Vastagh, I., Connolly, S. J., and Hart, R. G.
College/School:College of Medical Veterinary and Life Sciences > Institute of Neuroscience and Psychology
Journal Name:International Journal of Stroke
Publisher:SAGE Publications
ISSN:1747-4930
ISSN (Online):1747-4949
Published Online:11 April 2016
Copyright Holders:Copyright © 2016 World Stroke Organization
First Published:First published in International Journal of Stroke 11(5): 526-533
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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