Dohoung Kim1,†, Seung-Hoon Lee1,†, Beom Joon Kim1, Keun-Hwa Jung1, Kyung-Ho Yu2, Byung-Chul Lee2,*, Jae-Kyu Roh1,*, for Korean Stroke Registry investigators
1Department of Neurology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
2Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
†These authors contributed equally.
*Corresponding author : Jae-Kyu Roh, Byung-Chul Lee
Aims Although use of antithrombotic agents is recommended after ischaemic stroke or transient ischaemic attack (TIA), long-term outcome of secondary prevention between stroke subtypes has not yet been explored.
Methods and results We used data from the Korean Stroke Registry (KSR), a nationwide, multicentre, prospective registry for acute stroke patients. Patients with acute ischaemic stroke or TIA within 7 days of onset were consecutively enrolled between January 2002 and September 2010. A total of 46 108 patients with ischaemic stroke and TIA were included in this study. Among the major stroke subtypes, stroke due to small vessel occlusion (SVO) showed the lowest mortality, whereas cardioembolic stroke (CE) was associated with the fatal prognosis during the follow-up [for SVO: hazard ratio (HR) 0.66, 95% CI 0.62-0.71; for CE: HR 1.41, 95% CI 1.30-1.53; large artery atherosclerosis (LAA) group as a reference]. Regarding secondary prevention, antiplatelet polytherapy was better than monotherapy in the patients with LAA-related stroke in prognosis [HR 0.89, 95% CI 0.80-0.98]. Anticoagulant therapy was associated with better outcome than antiplatelet monotherapy in CE-related stroke [HR 0.66, 95% CI 0.59-0.74]. In SVO-related stroke group, antiplatelet polytherapy failed to show benefits over monotherapy. Additionally, the risk of death was higher with anticoagulant therapy in the patients with SVO-related stroke [HR 1.44, CI 95% 1.06-1.97].
Conclusions Our study demonstrated that stroke subtype affects prognosis and also determines the effectiveness of secondary prevention.
Key words : Ischaemic stroke, Stroke prevention, Antiplatelet