Abstract WP193: Secular Trends in Ischemic Stroke Subtypes
Background: In the past it was thought that ~ 20-25% of ischemic strokes were cardioembolic, ~ 20% from large artery disease and ~ 20% from small vessel disease. With the aging of the population, and with increasing prevalence of therapy for hypertension and hyperlipidemia, it might be expected that stroke subtypes would be changing over time.
Purpose and Methods: We studied the change over time of ischemic stroke subtypes from 2000-2012, among 2300 patients referred to the Urgent TIA Clinic at University Hospital, London, Canada. We divided the patients into 3 eras that were approximately equal in numbers: Era 1 (2000-2004), Era
2 (2005-2007) and Era 3 (since 2008). Ischemic stroke subtypes were defined by clinical and imaging criteria into evident, probable and possible causes.
Results: Mean age + SD was 63.39 + 17.47 years; 50% were women, 17.7% were diabetic, 19.6% current smokers. The proportion of patients with known atrial fibrillation increased from 4.2% in Era 1 to
6.6% in Era 2, to 9.6% in Era 3 (p-0.001). Among patients thought to have cardioembolic stroke, atrial fibrillation accounted for 95.8% in Era 1,
93.4% in Era 2 and 90.4% in Era 3 (p=0.001). Among patients whose stroke subtype was regarded as evident or probable (n=1699), stroke subtypes changed over time, as shown in Table 1:
Similar trends were observed If all patients (evident, probable, possible) were included. Stroke subtypes have changed significantly since 2000 (Chi-Square 2p=0.0001), with a marked increase in cardioembolic stroke, and a decline in large artery stroke.
Conclusion: In recent years, the proportion of patients with cardioembolic stroke has increased significantly. This has important implications for treatment to reduce the risk of recurrent stroke
- © 2012 by American Heart Association, Inc.