Background and Aims

There is scarce clinical information about the frequency, patient profile and stroke mechanisms in patients with acute ischaemic stroke (AIS) with previously undiagnosed major vascular risk factors (UMRF).

Methods

In a retrospective analysis from the ASTRAL-registry from 2003-2018, we analysed demographic, clinical, therapeutic and prognostic variables. Univariate comparisons were performed and results of logistic regression analysis will be presented at the congress.

Results

After excluding 763 (14.9%) patients for lack of consent and 3 for missing information, we analysed 4354 patients [median age 70 years (IQR 15.2), 44.7% female]. In the 1125 (25.8%) UMRF patients, 342 (7.9%) had no UMRF, and 783 (18.0%) had at least one UMRF. The newly detected major risk factors were dyslipidaemia (61.4%), hypertension (23.7%), atrial fibrillation (10.2%), diabetes mellitus (5.2%), ejection fraction <35% (2.0%) and coronary disease (1.0%).

Patients with UMRF had significantly lower age (OR=0.9, 0.9-0.9), lower BMI (OR=0.9, 0.9-0.9), less valvular disease (OR=0.5, 0.4-0.5), renal failure (OR=0.2, 0.1-0.3), sleep apnea (OR=0.9, 0.9-1) and prestroke antiplatelet intake (OR=0.1, 0.1-0.2). They were more often smokers (OR=2.0, 1.8-2.4), contraceptive users (OR=7.7, 5.1-12.1) and more often had PFO (OR=2.6, 2.1-3.3). Regarding stroke mechanism, they had more rare (OR=2.5, 1.8-3.3) and less cardioembolic (OR=0.2, 0.2-0.3) etiologies.

Conclusions

In this large single center AIS cohort, 25.8% of patients with UMRF were newly diagnosed with it, the most common being dyslipidaemia, hypertension and atrial fibrillation. Patients with UMRF were younger and more often had rare stroke mechanisms, PFOs, contraceptive and tobacco use.