Key result
Complex aortic plaque ESUS linked to ~147% higher MACE risk versus minor cardioembolic ESUS.
Why the study?
Prognosis in patients with embolic stroke of undetermined source may vary according to the underlying cause.
Does the complex aortic plaque (CAP) subtype of embolic stroke of undetermined source (ESUS) predict higher rates of major adverse cardiovascular events compared to other ESUS subtypes?
Cohort (n=775)
No
Does the complex aortic plaque (CAP) subtype of embolic stroke of undetermined source (ESUS) predict higher rates of major adverse cardiovascular events compared to other ESUS subtypes?
Effect estimate: HR 2.466 (95% CI 1.305-4.660)
Absolute Event Rate: 9.7% vs 2.8%
p-value: p=0.005
Categorizing embolic stroke of undetermined source (ESUS) into subtypes reveals that complex aortic plaque (CAP) ESUS is associated with a significantly higher risk of long-term major adverse cardiovascular events and stroke recurrence.
CAP ESUS signals higher MACE risk warranting vigilance; leaves open whether subtype-specific strategies improve outcomes.
Abstract Background and Aims: The prognosis of patients with embolic stroke of undetermined source (ESUS) may vary according to the underlying cause. Therefore, we aimed to divide ESUS into subtypes and assess the long-term outcomes. Methods: Consecutive patients with acute ischemic stroke who underwent a comprehensive workup, including transesophageal echocardiography and prolonged electrocardiography monitoring, were enrolled. We classified ESUS into minor cardioembolic (CE) ESUS, arteriogenic ESUS, two or more causes ESUS, and no cause ESUS. Arteriogenic ESUS was sub-classified into complex aortic plaque (CAP) ESUS and non-stenotic (<50%) relevant artery plaque (NAP) ESUS. Results: A total of 775 patients were enrolled. During 1286 ± 748 days follow-up, 116 major adverse cardiovascular events (MACE) occurred (4.2 events/100 patient-years). Among the ESUS subtypes, CAP ESUS was associated with the highest MACE frequency (9.7/100 patient-years, p=0.021). Cox regression analyses showed that CAP ESUS was an independent predictor of MACE (hazard ratio 2.466, 95% confidence interval 1.305–4.660) and any stroke recurrence (hazard ratio 2.470, 95% confidence interval, 1.108–5.508). Conclusions:The prognosis of ESUS varies according to the subtype, with CAP ESUS having the worst prognosis. Categorizing ESUS into subtypes could improve patient care and refine clinical trials.
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Lee et al. (2023) conducted a cohort in Embolic stroke of undetermined source (ESUS) (n=775). Complex aortic plaque (CAP) ESUS vs. Minor cardioembolic (CE) ESUS was evaluated on Major adverse cardiovascular events (MACE) (HR 2.466, 95% CI 1.305-4.660, p=0.005). Complex aortic plaque (CAP) ESUS was independently associated with a higher risk of major adverse cardiovascular events compared to minor cardioembolic ESUS (HR 2.466).
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