Long-Term Prognosis of Ischemic Stroke in Young Adults—A Single-Center Chinese Cohort Study

IF 2.6 3区心理学 Q2 BEHAVIORAL SCIENCES

Brain and Behavior Pub Date : 2025-04-18 DOI:10.1002/brb3.70479

Yuhui Sha, Qiqi Wang, Mingyu Tang, Ming Yao, Yicheng Zhu, Lixin Zhou, Jun Ni

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Abstract

Introduction

Young patients with ischemic stroke often present with more complex etiologies and risk factors, making their long-term prognosis particularly challenging. This study aims to investigate the long-term prognosis and identify factors associated with recurrent ischemic cerebrovascular events and unfavorable functional outcome in a prospective, single-center cohort.

Methods

We consecutively enrolled young adults (aged 18–49) with ischemic stroke in the single-center cohort at Peking Union Medical College Hospital (PUMCH) from March 2017 to March 2023. Follow-up was conducted through face-to-face visits or telephone interviews. Main outcomes were recurrent ischemic cerebrovascular events and unfavorable functional outcome (an mRS score ≥ 2). Kaplan–Meier analysis was used to estimate the 5-year cumulative recurrence risk, and multivariate logistic analysis was used to identify predictors of recurrent ischemic cerebrovascular events and unfavorable functional outcome.

Results

A total of 226 patients (median (IQR) age, 35 (30–41) years; 148 male (65.5%)) were included to the final analysis. According to the TOAST classification, large-artery atherosclerosis was identified as the most common subtype (38.1%). The 5-year cumulative recurrence rate for ischemic cerebrovascular events was 13.5% (95% CI: 6.7%–19.9%), with no significant difference between patients with different etiologies. Low education level (OR 12.016, 95% CI: 2.805–51.469, p < 0.001), previous TIA (OR 9.594, 95% CI: 2.500–36.824, p < 0.001), previous ischemic stroke (OR 3.177, 95% CI: 1.128–8.946, p = 0.029), and mRS score at follow-up (OR 3.339, 95% CI: 1.714–6.502, p < 0.001) were independent risk factors of ischemic cerebrovascular event recurrence after adjusting for sex and age. Baseline mRS scores was identified as an independent predictor of long-term poor functional outcome (OR 2.264, 95%CI: 1.207–4.246, p = 0.011) after adjusting for sex, age, receiving antiplatelet treatment and having recurrent ischemic stroke or TIA.

Conclusions

Young patients with ischemic stroke were at risk of recurrent ischemic cerebrovascular events, enhancing the need to enhance stroke prevention and treatment, particularly among young Chinese individuals with low education levels.

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青壮年缺血性脑卒中的长期预后——一项单中心中国队列研究

年轻缺血性脑卒中患者往往具有更复杂的病因和危险因素，使其长期预后尤其具有挑战性。本研究旨在通过前瞻性单中心队列研究长期预后，并确定与复发性缺血性脑血管事件和不良功能结局相关的因素。方法我们于2017年3月至2023年3月在北京协和医院（PUMCH）的单中心队列中连续招募18-49岁的缺血性脑卒中年轻成人。通过面对面访问或电话访谈进行随访。主要结局为复发性缺血性脑血管事件和不良功能结局（mRS评分≥2）。采用Kaplan-Meier分析估计5年累积复发风险，并采用多因素logistic分析确定复发性缺血性脑血管事件和不良功能结局的预测因素。结果226例患者(中位（IQR）年龄：35（30-41）岁；148例男性（65.5%）纳入最终分析。根据TOAST分类，大动脉粥样硬化是最常见的亚型（38.1%）。缺血性脑血管事件5年累计复发率为13.5% (95% CI: 6.7%-19.9%)，不同病因患者间无显著差异。教育程度低(OR 12.016, 95% CI: 2.805-51.469, p <；0.001)，既往TIA (OR 9.594, 95% CI: 2500 - 36.824, p <；0.001)、既往缺血性卒中（OR 3.177, 95% CI: 1.128-8.946, p = 0.029）和随访时mRS评分(OR 3.339, 95% CI: 1.714-6.502, p <；0.001)是校正性别和年龄后缺血性脑血管事件复发的独立危险因素。在调整性别、年龄、接受抗血小板治疗和复发性缺血性卒中或TIA后，基线mRS评分被确定为长期功能不良预后的独立预测因子（OR 2.264, 95%CI: 1.207-4.246, p = 0.011）。结论年轻缺血性脑卒中患者有复发性缺血性脑血管事件的危险，加强脑卒中预防和治疗的必要性，特别是在受教育程度较低的中国年轻人中。

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来源期刊

Brain and Behavior BEHAVIORAL SCIENCES-NEUROSCIENCES

CiteScore

5.30

自引率

0.00%

发文量

352

审稿时长

14 weeks

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