TY - JOUR
T1 - Characteristics and outcomes of unknown onset stroke
T2 - The Japan Stroke Data Bank
AU - Japan Stroke Data Bank Investigators
AU - Wada, Shinichi
AU - Yoshimura, Sohei
AU - Toyoda, Kazunori
AU - Nakai, Michikazu
AU - Sasahara, Yusuke
AU - Miwa, Kaori
AU - Koge, Junpei
AU - Ishigami, Akiko
AU - Shiozawa, Masayuki
AU - Ogasawara, Kuniaki
AU - Kitazono, Takanari
AU - Nogawa, Shigeru
AU - Iwanaga, Yoshitaka
AU - Miyamoto, Yoshihiro
AU - Minematsu, Kazuo
AU - Koga, Masatoshi
N1 - Publisher Copyright:
© 2023
PY - 2023/10/15
Y1 - 2023/10/15
N2 - Background: Clinical outcomes of unknown onset stroke (UOS) are influenced by the enlargement of the therapeutic time window for reperfusion therapy. This study aimed to investigate and describe the characteristics and clinical outcomes of patients with UOS. Methods: Patients with acute ischemic stroke (AIS) who were admitted within 24 h of their last known well time, from January 2017 to December 2020, were included. Data were obtained from a long-lasting nationwide hospital-based multicenter prospective registry: the Japan Stroke Data Bank. The co-primary outcomes were the National Institutes of Stroke Scale (NIHSS) scores on admission and unfavorable outcomes at discharge, corresponding to modified Rankin Scale (mRS) scores of 3–6. Results: Overall, 26,976 patients with AIS were investigated. Patients with UOS (N = 5783, 78 ± 12 years of age) were older than patients with known onset stroke (KOS) (N = 21,193, 75 ± 13 years of age). Age, female sex, higher premorbid mRS scores, atrial fibrillation, and congestive heart failure were associated with UOS in multivariate analysis. UOS was associated with higher NIHSS scores (median = 8 [interquartile range [IQR]: 3–19] vs. 4 [1–10], adjusted incidence rate ratio = 1.37 [95% CI: 1.35–1.38]) and unfavorable outcomes (52.1 vs. 33.6%, adjusted odds ratio = 1.27 [1.14–1.40]). Intergroup differences in unfavorable outcomes were attenuated among females (1.12 [0.95–1.32] vs. males 1.38 [1.21–1.56], P = 0.040) and in the subgroup that received reperfusion therapy (1.10 [0.92–1.33] vs. those who did not receive therapy 1.23 [1.08–1.39], P = 0.012). Conclusions: UOS was associated with unfavorable outcomes but to a lesser degree among females and patients receiving reperfusion therapy.
AB - Background: Clinical outcomes of unknown onset stroke (UOS) are influenced by the enlargement of the therapeutic time window for reperfusion therapy. This study aimed to investigate and describe the characteristics and clinical outcomes of patients with UOS. Methods: Patients with acute ischemic stroke (AIS) who were admitted within 24 h of their last known well time, from January 2017 to December 2020, were included. Data were obtained from a long-lasting nationwide hospital-based multicenter prospective registry: the Japan Stroke Data Bank. The co-primary outcomes were the National Institutes of Stroke Scale (NIHSS) scores on admission and unfavorable outcomes at discharge, corresponding to modified Rankin Scale (mRS) scores of 3–6. Results: Overall, 26,976 patients with AIS were investigated. Patients with UOS (N = 5783, 78 ± 12 years of age) were older than patients with known onset stroke (KOS) (N = 21,193, 75 ± 13 years of age). Age, female sex, higher premorbid mRS scores, atrial fibrillation, and congestive heart failure were associated with UOS in multivariate analysis. UOS was associated with higher NIHSS scores (median = 8 [interquartile range [IQR]: 3–19] vs. 4 [1–10], adjusted incidence rate ratio = 1.37 [95% CI: 1.35–1.38]) and unfavorable outcomes (52.1 vs. 33.6%, adjusted odds ratio = 1.27 [1.14–1.40]). Intergroup differences in unfavorable outcomes were attenuated among females (1.12 [0.95–1.32] vs. males 1.38 [1.21–1.56], P = 0.040) and in the subgroup that received reperfusion therapy (1.10 [0.92–1.33] vs. those who did not receive therapy 1.23 [1.08–1.39], P = 0.012). Conclusions: UOS was associated with unfavorable outcomes but to a lesser degree among females and patients receiving reperfusion therapy.
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U2 - 10.1016/j.jns.2023.120798
DO - 10.1016/j.jns.2023.120798
M3 - Article
C2 - 37729754
AN - SCOPUS:85171389586
SN - 0022-510X
VL - 453
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
M1 - 120798
ER -