Risk factors profile and clinical outcome of ischemic stroke patients admitted in a Department of Internal Medicine and classified by TOAST classification.

Full Abstract

AIM:
A classification of ischemic stroke subtypes tailored for individual patients is hard to achieve. In 1993, the Trial of Org 10172 in Acute Stroke Treatment (TOAST) group developed a new system to classify the subtypes of ischemic stroke. In our study we applied the TOAST classification to a group of consecutive patients affected by ischemic stroke, to evaluate outcome and factors associated to each stroke subtype.

METHODS:
To evaluate the prognosis and the associated factors of ischemic stroke subtypes, we classified according to the TOAST classification a cohort of 159 consecutive patients affected by an acute ischemic stroke. We evaluated neurological deficit at admission by Scandinavian Stroke Scale and scored disability at discharge and 6 months after discharge using the Rankin disability scale. We determined 30 days survival and anamnestically evaluated major vascular risk factors.

RESULTS:
Patients with cardioembolic stroke and stroke of undetermined etiology had a greater neurological deficit on admission and the worst prognosis either in terms of disability or mortality. Lacunar stroke had the least neurological deficit at admission and the best prognosis. Hypercholesterolemia and smoking were more frequent among patients with large artery atherosclerotic stroke. Hypertension, a history of transient ischemic attack and diabetes were more frequent among patients with lacunar stroke. A weak association with hypertension and smoking was observed for cardioembolic stroke.

CONCLUSIONS:
The TOAST classification is useful in the clinical setting because it identifies ischemic stroke subtypes with different prognosis and with a different profile of associated factors.

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Author information

Author/s: Pinto, A (A); Tuttolomondo, A (A); Di Raimondo, D (D); Fernandez, P (P); Licata, G (G);

Affiliation: Biomedical Department of Internal and Specialistic Medicine, University of Palermo, Palermo, Italy. pinto(-atsign-)neomedia.it

Journal and publication information

Publication Type: Journal Article

Journal: International angiology : a journal of the International Union of Angiology (Int Angiol), published in Italy. (Language: eng)

Reference: 2006-Sep; vol 25 (issue 3) : pp 261-7

Dates: Created 2006/07/31; Completed 2007/06/22; Revised 2007/11/15;

PMID: 16878074, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Acute Disease
Adult
Aged
Aged, 80 and over
Analysis of Variance
Brain Ischemia - complications; diagnosis; epidemiology; etiology; pathology
Diabetes Complications - epidemiology
Female
Hospital Departments
Humans
Hypercholesterolemia - complications
Hypertension - complications

Hypertension - complications
Internal Medicine
Ischemic Attack, Transient - complications
Italy - epidemiology
Logistic Models
Male
Middle Aged
Patient Admission
Prognosis
Risk Factors
Smoking - adverse effects
Stroke - diagnosis; epidemiology; etiology; pathology

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