Long-term mortality in patients with coexisting potential causes of ischemic stroke

Multiple potential causes of stroke may coexist in ischemic stroke patients, which may affect long-term outcome. Aim: We investigated whether there are differences in long-term mortality among stroke patients with coexisting potential causes. Methods: We evaluated the long-term all-cause mortality and stroke or cardiovascular mortality of ischemic stroke patients with multiple potential stroke mechanisms, large artery atherosclerosis, cardioembolism, small vessel occlusion, and negative evaluation admitted to a single center between January 1996 and December 2008. Mortality data were obtained from a National Death Certificate system. Results: Total 3533 patients were included in this study: 286 multiple potential mechanisms (138 large artery atherosclerosis+cardioembolism, 105 small vessel occlusion+large artery atherosclerosis, 43 small vessel occlusion+cardioembolism), 1045 large artery atherosclerosis, 701 cardioembolism, 606 small vessel occlusion, and 895 negative evaluation. During a mean follow-up of 3·9 years, as referenced to small vessel occlusion mortality rate, the adjusted mortality hazard ratio was 4·387 (95% confidence interval 3·157-6·096) for large artery atherosclerosis+cardioembolism group, 3·903 (95% confidence interval 3·032-5·024) for cardioembolism group, and 2·121 (95% confidence interval 1·655-2·717) for large artery atherosclerosis. The risk of long-term ischemic stroke mortality or cardiovascular mortality also showed comparable findings: highest in the large artery atherosclerosis+cardioembolism, followed by cardioembolism, and large artery atherosclerosis groups. However, the outcome of small vessel occlusion+large artery atherosclerosis or small vessel occlusion+cardioembolism group was not significantly different from that of small vessel occlusion. Conclusions: Coexisting potential causes of ischemic stroke impact on long-term mortality. Identification of coexisting potential causes may help to predict stroke outcomes and to guide planning secondary prevention strategies.