Stroke: in young adults increased mortality

Clinical bottom line (level 1b)

  1. One in thirteen patients aged 15 to 44 with a first stroke or TIA died within the next 8 years.
  2. One in thirty had another stroke, and one in forty had a myocardial infarction.
Marini et al: Stroke 1999; 30 : 2320-2325
Expires December 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: 7 neurology departments, Italy

330 patients (aged 15 to 44; ?mean, ?% male) with a first-ever TIA (42%) or ischaemic stroke (58%)

Excluded if
  • stroke or TIA > 8 weeks previously
  • aged < 15, > 44



Multivariate Cox regression analysis used to adjust for confounding factors.

99% followed for 5 to 10 years: mean 8 years
Outcomes studied:
  • death
  • further stroke
  • myocardial infarction

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    death 5 to 10 years: mean 8 years 26/330 7.9%
    (5.0% to 10.8%)    		 13
    (9 to 20)
    further stroke 5 to 10 years: mean 8 years 10/330 3.0%
    (1.2% to 4.9%)    		 33
    (20 to 85)
    myocardial infarction 5 to 10 years: mean 8 years 8/330 2.4%
    (0.8% to 4.1%)    		 41
    (24 to 130)

    • Death, recurrent stroke or a myocardial infarction were independently associated with
      • male sex
      • aged > 35
      • stroke on enrollment
      • cardiac diseases
    • Survival was worse than the age and sex-matched Italian population: SMR: 10.8 (p < 0.001)
    • Death was highest in the first year after the stroke or TIA.

    Citation

    1. Marini C, Totaro R, Carolei A, et al: long-term prognosis of cerebral ischaemia in young adults. Stroke 1999; 30 : 2320-2325
    Contributor: Chris Ball, December 2001
    Reviewer:

    Clinical Question.
    Patient young adult
    Intervention or Exposure first stroke
    Outcome death, recurrent stroke, myocardial infarction
    		•