title: Predictors of long-term recurrent vascular events after ischemic stroke at young age: the Italian Project on Stroke in Young Adults.
abstract: BACKGROUND
  Data on long-term risk and predictors of recurrent thrombotic events after ischemic stroke at a young age are limited.
  
  
  RESULTS
  We followed 1867 patients with first-ever ischemic stroke who were 18 to 45 years of age (mean age, 36.8±7.1 years; women, 49.0%), as part of the Italian Project on Stroke in Young Adults (IPSYS). Median follow-up was 40 months (25th to 75th percentile, 53). The primary end point was a composite of ischemic stroke, transient ischemic attack, myocardial infarction, or other arterial events. One hundred sixty-three patients had recurrent thrombotic events (average rate, 2.26 per 100 person-years at risk). At 10 years, cumulative risk was 14.7% (95% confidence interval, 12.2%-17.9%) for primary end point, 14.0% (95% confidence interval, 11.4%-17.1%) for brain ischemia, and 0.7% (95% confidence interval, 0.4%-1.3%) for myocardial infarction or other arterial events. Familial history of stroke, migraine with aura, circulating antiphospholipid antibodies, discontinuation of antiplatelet and antihypertensive medications, and any increase of 1 traditional vascular risk factor were independent predictors of the composite end point in multivariable Cox proportional hazards analysis. A point-scoring system for each variable was generated by their β-coefficients, and a predictive score (IPSYS score) was calculated as the sum of the weighted scores. The area under the receiver operating characteristic curve of the 0- to 5-year score was 0.66 (95% confidence interval, 0.61-0.71; mean, 10-fold internally cross-validated area under the receiver operating characteristic curve, 0.65).
  
  
  CONCLUSIONS
  Among patients with ischemic stroke aged 18 to 45 years, the long-term risk of recurrent thrombotic events is associated with modifiable, age-specific risk factors. The IPSYS score may serve as a simple tool for risk estimation.
authors: Dipartimento di Scienze Mediche e Chirurgiche, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia (A. Pezzini, P.C., L.P., A.M., V.D.G., A. Padovani; Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, Università di Pavia, Pavia, Italia (M.G.); Centro Trombosi, IRCCS Istituto Clinico Humanitas, Rozzano-Milano, Italia (C.L., P.F.); Stroke Unit, Azienda Ospedaliera Sant'Andrea, Roma, Italia (R.P., A.S., M.R.); Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, Genova, Italia (C.G., D.M.); Stroke Unit, Clinica Neurologica, Nuovo Ospedale Civile "S. Agostino Estense", AUSL Modena, Italia (A.Z., A.M.S.); Unità di Neurologia, Ospedale di Circolo, Università dell'Insubria, Varese, Italia (M.L.D.); Stroke Unit, Divisione di Medicina Cardiovascolare, Università di Perugia, Perugia, Italia (M.P.); Unità di Neurologia, Ospedale S. Andrea, La Spezia, Italia (M.D.S.); U.O.C. Neurologia, A.O Universitaria "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italia (A.T.); Dipartimento di Neuroscienze, Scienze Psichiatriche e Anestesiologiche, Clinica Neurologica, Università di Messina, Messina, Italia (R.M.); Istituto di Ricovero e Cura a Carattere Scientifico, Centro Neurolesi Bonino-Pulejo, Messina, Italia (R.S.C.); UO Neurologia, Azienda Ospedaliera-Universitaria Borgo Trento, Verona, Italia (P.B.); Stroke Center, Dipartimento di Neurologia, Ospedale Sacro Cuore Negrar, Verona, Italia (A.A.); Stroke Unit, U.O Neurologia, Azienda Ospedaliera "C. Poma", Mantova, Italia (G.S.); Stroke Unit, U.O Neurologia, IRCCS Ospedale S. Raffaele, Milano, Italia (M.S., G.G.); U.C Malattie Cerebrovascolari e Stroke Unit (A.C.) and U.C Neurologia d'Urgenza (G.M.), IRCCS Fondazione Istituto Neurologico Nazionale "C. Mondino," Pavia, Italia; Neurologia d'Urgenza and Stroke Unit, IRCCS Istituto Clinico Humanitas, Rozzano-Milano, Italia (S.M.); Stroke Un
authors: Alessandro
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authors: Pezzini
authors: Mario
authors: M
authors: Grassi
authors: Corrado
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authors: Lodigiani
authors: Rosalba
authors: R
authors: Patella
authors: Carlo
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authors: Gandolfo
authors: Andrea
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authors: Zini
authors: Maria Luisa
authors: ML
authors: Delodovici
authors: Maurizio
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authors: Paciaroni
authors: Massimo
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authors: Del Sette
authors: Antonella
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authors: Toriello
authors: Rossella
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authors: Musolino
authors: Rocco Salvatore
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authors: Calabrò
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authors: Alessandro
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authors: Adami
authors: Giorgio
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authors: Silvestrelli
authors: Maria
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authors: Sessa
authors: Anna
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authors: Cavallini
authors: Simona
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authors: Marcheselli
authors: Domenico Marco
authors: DM
authors: Bonifati
authors: Nicoletta
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authors: Checcarelli
authors: Lucia
authors: L
authors: Tancredi
authors: Alberto
authors: A
authors: Chiti
authors: Elisabetta
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authors: Del Zotto
authors: Alessandra
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authors: Spalloni
authors: Alessia
authors: A
authors: Giossi
authors: Irene
authors: I
authors: Volonghi
authors: Paolo
authors: P
authors: Costa
authors: Giacomo
authors: G
authors: Giacalone
authors: Paola
authors: P
authors: Ferrazzi
authors: Loris
authors: L
authors: Poli
authors: Andrea
authors: A
authors: Morotti
authors: Maurizia
authors: M
authors: Rasura
authors: Anna Maria
authors: AM
authors: Simone
authors: Massimo
authors: M
authors: Gamba
authors: Paolo
authors: P
authors: Cerrato
authors: Giuseppe
authors: G
authors: Micieli
authors: Maurizio
authors: M
authors: Melis
authors: Davide
authors: D
authors: Massucco
authors: Valeria
authors: V
authors: De Giuli
authors: Licia
authors: L
authors: Iacoviello
authors: Alessandro
authors: A
authors: Padovani
mesh_terms: D000328:Adult; D000367:Age Factors; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*; D013997:Time Factors; D055815:Young Adult
keywords: brain ischemia; prognosis; stroke