title: Long-term mortality in patients with coexisting potential causes of ischemic stroke.
abstract: BACKGROUND
  Multiple potential causes of stroke may coexist in ischemic stroke patients, which may affect long-term outcome.
  
  
  OBJECTIVE
  We investigated whether there are differences in long-term mortality among stroke patients with coexisting potential causes.
  
  
  METHODS
  We evaluated the long-term all-cause mortality and stroke or cardiovascular mortality of ischemic stroke patients with multiple potential stroke mechanisms, large artery atherosclerosis, cardioembolism, small vessel occlusion, and negative evaluation admitted to a single center between January 1996 and December 2008. Mortality data were obtained from a National Death Certificate system.
  
  
  RESULTS
  Total 3533 patients were included in this study: 286 multiple potential mechanisms (138 large artery atherosclerosis + cardioembolism, 105 small vessel occlusion + large artery atherosclerosis, 43 small vessel occlusion + cardioembolism), 1045 large artery atherosclerosis, 701 cardioembolism, 606 small vessel occlusion, and 895 negative evaluation. During a mean follow-up of 3.9 years, as referenced to small vessel occlusion mortality rate, the adjusted mortality hazard ratio was 4.387 (95% confidence interval 3.157-6.096) for large artery atherosclerosis + cardioembolism group, 3.903 (95% confidence interval 3.032-5.024) for cardioembolism group, and 2.121 (95% confidence interval 1.655-2.717) for large artery atherosclerosis. The risk of long-term ischemic stroke mortality or cardiovascular mortality also showed comparable findings: highest in the large artery atherosclerosis + cardioembolism, followed by cardioembolism, and large artery atherosclerosis groups. However, the outcome of small vessel occlusion + large artery atherosclerosis or small vessel occlusion + cardioembolism group was not significantly different from that of small vessel occlusion.
  
  
  CONCLUSIONS
  Coexisting potential causes of ischemic stroke impact on long-term mortality. Identification of coexisting potential causes may help to predict stroke outcomes and to guide planning secondary prevention strategies.
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Young Dae
authors.initials: YD
authors.lastname: Kim
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.|Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
authors.forename: Myoung-Jin
authors.initials: MJ
authors.lastname: Cha
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jinkwon
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.|Department of Neurology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Chung Mo
authors.initials: CM
authors.lastname: Nam
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hyo Suk
authors.initials: HS
authors.lastname: Nam
authors.affiliation: Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ji Hoe
authors.initials: JH
authors.lastname: Heo
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000150:complications / Q000453:epidemiology / Q000473:pathology / Q000503:physiopathology; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D002545:Brain Ischemia / Q000209:etiology / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology; D002533:Cerebral Angiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007723:Korea / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D020521:Stroke / Q000209:etiology / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed
keywords: cerebral infarction; etiology; outcomes