title: Small-vessel disease relates to poor poststroke survival in a 12-year follow-up.
abstract: OBJECTIVE
  We sought to compare ultra-long-term poststroke survival in small-vessel disease (SVD) vs non-SVD subtype of stroke.
  
  
  METHODS
  We followed patients hospitalized with acute ischemic stroke (age 55-85) for 12 years. The diagnosis of SVD was based on the criteria of Trial of Org 10172 in Acute Stroke Treatment. A detailed medical history regarding the relevant risk factors was obtained. Stroke severity was assessed with the modified Rankin Scale (mRS) at 3 months. Influence of the SVD subtype of stroke was analyzed using Kaplan-Meier log-rank analysis with endpoint all-cause death, and Cox regression proportional hazards model was constructed for multivariate analysis. The association between SVD and causes of death (cardiac, brain-related, all other) was analyzed using Kaplan-Meier log-rank analysis.
  
  
  RESULTS
  Of the 486 patients, stroke etiology was SVD in 63 patients (13.0%). Median survival was 4.3 years for SVD and 7.9 years for non-SVD (p ≤ 0.001). In the stepwise Cox regression analysis adjusted for relevant confounders, independent predictors of death were SVD (hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.06-2.41), advanced age (HR 1.07, 95% CI 1.05-1.09), stroke severity (mRS 3-5 vs 1-2; HR 2.02, 95% CI 1.58-2.58), smoking (HR 1.44, 95% CI 1.10-1.88), and cardiac failure (HR 1.53, 95% CI 1.14-2.06). SVD was associated with cardiac cause of death (p = 0.021).
  
  
  CONCLUSIONS
  In this well-characterized ischemic stroke cohort of patients aged 55-85 years with a 12-year follow-up, acute index stroke attributable to SVD was associated with poorer long-term survival and higher risk for cardiac death than other stroke subtypes.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland. susanna.melkas@hus.fi
authors.forename: S
authors.initials: S
authors.lastname: Melkas
authors.forename: J
authors.initials: J
authors.lastname: Putaala
authors.forename: N K J
authors.initials: NK
authors.lastname: Oksala
authors.forename: T
authors.initials: T
authors.lastname: Pohjasvaara
authors.forename: A
authors.initials: A
authors.lastname: Oksala
authors.forename: M
authors.initials: M
authors.lastname: Kaste
authors.forename: P J
authors.initials: PJ
authors.lastname: Karhunen
authors.forename: T
authors.initials: T
authors.lastname: Erkinjuntti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D004522:Educational Status; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000150:complications* / Q000401:mortality*; D016019:Survival Analysis; D020293:Vasculitis, Central Nervous System / Q000145:classification / Q000175:diagnosis / Q000209:etiology*