Mortality and long-term recurrence of ischaemic stroke in young adults of a northern Spanish region (Aragón)

Abstract

Introduction

The incidence of ischemic stroke in young adults is increasing worldwide, and it is not uncommon in our region. It is associated with the presence of traditional vascular risk factors. However, there is little information about its prognosis, unlike other age groups. The objective of this study is to determine mortality, both in the short and long term follow-up, and the long-term follow-up recurrence of ischemic stroke in young adult patients in Aragon, making up the first study of this kind in Spain, and one of the few that addresses this issue in Europe.

Methods

Multicenter, observational, retrospective study of all patients between 18 and 50 years old who were admitted for an ischemic stroke in any hospital in Aragon between 2005−2015. The follow-up was carried out until March 31, 2021. Mortality, causes of death and recurrence of cerebrovascular events were collected, stratifying the sample based on the sex and age group of the patients. Logistic and Cox regression models were used to determine the factors associated with mortality and recurrence.

Results

721 patients were included (697 with long-term follow-up). Mortality was 3.3% in the first 30 days. Long-term mortality and recurrence was 9.2% and 11.9% at a median of 10.1 years of follow-up. The most frequent cause of death in the short term was of Neurovascular origin and in the long term was cancer. Having a NIHSS > 15 was associated with higher short-term mortality. Arterial hypertension, diabetes mellitus, excessive alcohol consumption, atrial fibrillation and peripheral vascular disease were associated with long-term mortality. A history of previous stroke, diabetes mellitus, and atherothrombotic aetiology were associated with a higher cumulative risk of stroke recurrence.

Conclusions

Mortality and recurrence of ischaemic stroke in young adults in Aragon, although lower than that described by other studies, is by no means negligible and is associated with the presence of traditional vascular risk factors.