Long-term outcomes after first-ever posterior circulation stroke and the prognostic significance of the New England Medical Center Posterior Circulation Registry stroke classification: A prospective study from the Athens Stroke Registry.

IF 5.8 3区医学 Q1 CLINICAL NEUROLOGY European Stroke Journal Pub Date : 2024-12-03 DOI:10.1177/23969873241302657

Nikolaos Karvelas, Leonidas Palaiodimos, Dimitrios Karamanis, Dimitrios Sagris, Anna-Maria Louka, Panagiotis Papanagiotou, Eleni Korompoki, George Ntaios, Konstantinos Vemmos

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Abstract

Background: There is paucity of data on the long-term outcomes after acute ischemic posterior circulation stroke (PCS). Additionally, the long-term prognostic value of the New England Medical Center-Posterior Circulation Registry (NEMC-PCR) classification of PCS has not been studied.

Patients and methods: All consecutive patients with PCS registered in the Athens Stroke Registry between 01/1993 and 12/2012 were prospectively followed for up to 10 years and included in the analysis. The NEMC-PCR criteria were applied to classify them in relation to topography. The main studied outcomes were all cause mortality, stroke recurrence and major adverse cardiovascular events (MACEs).

Results: A total of 653 patients with PCS (455 men, mean age 68.06 years) were followed up for 52.8 ± 44.0 months. Seventy-four (11.3%), 219 (33.5%), 335 (51.3%), and 25 (3.8%) patients had proximal, middle, distal, and multiple territories PCS, respectively. During the 10-year follow-up period, 217 patients died (7.6 per 100 patient years), 127 developed recurrent stroke (4.2 per 100 patient years), and 209 had a MACE (7.3 per 100 patient years). The cumulative 10-year mortality was higher in distal and multiple territories PCS compared to middle and proximal PCS (55.6%, 58.8%, 40.0%, 35.5%, respectively, p < 0.001 by log-rank test). Patients with distal location PCS had almost twofold increased 10-year risk of mortality compared to proximal location patients after adjusting for all confounding variables (HR 1.99, 95% CI 1.05-3.77). Per TOAST classification, large artery atherosclerosis was associated with almost two-fold increase in risk of mortality, stroke recurrence and MACEs.

Discussion and conclusion: A large proportion of PCS patients experienced 10-year death, stroke and MACE occurrence after PCS. NEMC-PCR topographic classification was found to have significant prognostic value, with distal and middle PCS having worse long-term outcomes than proximal PCS.

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首次后循环卒中后的长期预后和新英格兰医学中心后循环卒中分类的预后意义：一项来自雅典卒中登记处的前瞻性研究。

背景：缺乏关于急性缺血性后循环卒中（PCS）后长期预后的数据。此外，新英格兰医学中心-后循环登记（NEMC-PCR）分类对PCS的长期预后价值尚未研究。患者和方法：所有在1993年1月1日至2012年12月期间在雅典卒中登记处登记的连续PCS患者均被前瞻性随访长达10年，并纳入分析。应用NEMC-PCR标准对它们进行地形分类。主要研究结果为全因死亡率、卒中复发率和主要不良心血管事件（mace）。结果：653例PCS患者（男性455例，平均年龄68.06岁），随访时间52.8±44.0个月。74例（11.3%）、219例（33.5%）、335例（51.3%）和25例（3.8%）患者分别发生近端、中端、远端和多部位PCS。在10年随访期间，217例患者死亡（每100患者年7.6例），127例发生复发性卒中（每100患者年4.2例），209例发生MACE（每100患者年7.3例）。远端和多区域PCS的累积10年死亡率高于中端和近端PCS（分别为55.6%、58.8%、40.0%和35.5%）。p讨论和结论：PCS术后10年死亡、卒中和MACE发生率较高。NEMC-PCR地形分类发现具有显著的预后价值，远端和中端PCS的长期预后比近端PCS差。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.