Recurrent ischemic events in young adults after first‐ever ischemic stroke

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Abstract
Objective:: Data on recurrence of vascular events and their prognostic factors in young (<50 years of age) stroke patients are not well defined.Methods:: We assessed the occurrence of arterial thrombotic events in consecutive first‐ever ischemic stroke patients aged 15 to 49 years entered into the Helsinki Young Stroke Registry (January 1994–October 2004) within 5‐year follow‐up. Follow‐up was conducted with a structured telephone interview or letter, and review of all patient records; mortality data came from Statistics Finland. Primary outcomes were (1) nonfatal or fatal recurrent ischemic stroke; (2) nonfatal or fatal myocardial infarct, other arterial thrombotic event, or revascularization procedure; and (3) any combination of these, whichever occurred first (composite endpoint). We used Kaplan‐Meier analysis to estimate cumulative risks and Cox proportional hazard model—adjusted for age, gender, relevant risk factors, and stroke subtype—for identifying predictors of recurrence.Results:: In the 807 patients followed (mean age, 41.5 ± 7.4 years; 62.9% male), cumulative 5‐year recurrence rate was 9.4% (95% confidence interval [CI], 7.3–11.5%) for nonfatal or fatal ischemic stroke, 2.4% (95% CI, 1.3‐3.5%) for nonfatal or fatal myocardial infarct or other arterial endpoint, and 11.5% (95% CI, 9.2‐13.7%) for the composite endpoint. Independent predictors of the composite endpoint were type 1 diabetes mellitus (hazard ratio [HR], 4.39; 95% CI, 2.28‐8.45), large‐artery atherosclerosis underlying the index stroke (HR, 2.82; 95% CI, 1.36‐5.83), heart failure (HR, 2.96; 95% CI, 1.17‐7.50), previous transient ischemic attack (HR, 2.33; 95% CI, 1.40‐3.88), and increasing age (HR, 1.05; 95% CI, 1.01‐1.10).Interpretation:: Despite their young age, these individuals were at marked risk of recurrent arterial events, predicted by mostly modifiable baseline factors.ANN NEUROL 2010;68:661–671