What is the clinical evidence from this study?

Study design: Observational. Population: Non-cardioembolic ischemic stroke (n=180021). Intervention: TOAST subtypes. Primary outcome: Recurrent ischemic stroke at 1 year.

May 8, 2026European Stroke JournalOpen Access

Abstract Number: Esoc2026a528 Real-World Patient Characteristics and Clinical Outcomes Across Stroke Toast Subtypes: Analysis of a Large Representative Us Electronic Health Record Database

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Key result

Most TOAST subtypes share consistent 1-year recurrent ischemic stroke rates except small vessel occlusion at ~10%.

n=180,021

Why the study?

Stroke subtypes per TOAST classification predict prognosis and treatment response, but limited real-world data exist across subtypes.

Population

180,021 adults hospitalised with a first NCIS (29,816 with documented TOAST subtype)

Comparison

Outcomes and treatment patterns compared across TOAST subtypes

Design

Retrospective observational EHR-based study

Follow-up

1 year

Authors

ASAshkan ShoamaneshPopulation Health Research Institute TNThanh N NguyenBoston Medical Center MRMathew ReevesMichigan State University

Discussion

Member takes

Implication

Should not yet change practice for TOAST subtype-guided NCIS care; leaves open targeted prevention trials to optimize real-world outcomes.

Key Points

This study aims to assess real-world patient characteristics and clinical outcomes across various stroke TOAST subtypes.
Retrospective observational study using EHRs from the US Truveta database between 01/2017 and 12/2023.
Included adults hospitalized with a first non-cardioembolic ischemic stroke (NCIS).
Excluded patients with a baseline diagnosis suggesting cardioembolic etiology and analyzed outcomes by TOAST subtype.
Among 180,021 NCIS patients, 29,816 (17%) had documented TOAST subtypes, with SVO being the most common (30%).
LAA strokes had the highest rates of dual antiplatelet therapy (DAPT) treatment at discharge (59.4%).
Recurrent ischemic stroke incidence rates at 1 year ranged from 12.5 to 15.67 per 100 patients for all subtypes except SVO, which had a rate of 9.91.

Study Design

Type

Observational (n=180,021)

Multicenter

Yes

Structured PICO

Population

180,021 adults hospitalised with a first NCIS (n=29,816 with a documented TOAST subtype) between 01/2017–12/2023 in the US Truveta database. Patients with baseline diagnoses suggesting cardioembolic aetiology were excluded.

Outcome

Recurrent IS (ischemic stroke) at 1 yearhard clinical

Real-world analysis of a large US EHR database demonstrates that 1-year recurrent ischemic stroke rates are consistent across most TOAST subtypes (12.5-15.67) except for small vessel occlusion (9.91).

Cite This Study

Shoamanesh et al. (2026) conducted an observational in Non-cardioembolic ischemic stroke (n=180,021). TOAST subtypes was evaluated on Recurrent ischemic stroke at 1 year. Real-world 1-year incidence rates for recurrent ischemic stroke were consistent across most TOAST subtypes (12.5 to 15.67), except for small vessel occlusion which had a lower rate (9.91).

synapsesocial.com/papers/69fd7f3abfa21ec5bbf07b03 https://doi.org/10.1093/esj/aakag023.1343

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Implication

Should not yet change practice for TOAST subtype-guided NCIS care; leaves open targeted prevention trials to optimize real-world outcomes.

Abstract Number: Esoc2026a528 Real-World Patient Characteristics and Clinical Outcomes Across Stroke Toast Subtypes: Analysis of a Large Representative Us Electronic Health Record Database

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Abstract Number: Esoc2026a528 Real-World Patient Characteristics and Clinical Outcomes Across Stroke Toast Subtypes: Analysis of a Large Representative Us Electronic Health Record Database

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

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