Abstract MP89: Epidemiology of Ischemic Stroke Subtypes within the Mashhad Stroke Incidence Study (MSIS): A Population-Based Study of Stroke in the Middle East
BACKGROUND: Incidence and case fatality rates of ischemic stroke subtypes are unknown in the Middle-East due to the lack of community-based incidence stroke studies in this region.
AIM: To characterize ischemic stroke subtypes in a Middle Eastern population.
Methods: MSIS is a community-based study, that prospectively ascertained all cases of stroke among the 450 229 inhabitants of Mashhad, Iran between 2006-2007. Within this population, we identified 560 cases of first-ever ischemic stroke. Ischemic stroke subtypes were classified according to the modified-TOAST criteria. Incidence rates were age standardized to the European population. The primary outcome of interest was all cause mortality at 1-year follow-up.
Results: The proportion of stroke subtypes were distributed as follows: 53% large-artery disease (LAD), 14% cardioembolic, 23% small vessel disease (SVD), 6% undetermined and 5% other. The incidence rates (per 100 000) were 157 for LAD, 34 for cardioembolism, 66 for SVD, 16 for undetermined and 7 for other types category. In comparison to individuals with the other stroke subtypes, those with LAD stroke were older and had overrepresentation of diabetes (P<0.001), hyperlipidemia (p=0.047) and prior TIA (p=0.005), whereas those with SVD had overrepresentation of hypertension (p<0.001). Overall, there were 163 deaths (30%) during the 1-year of follow-up. The highest 1-year mortality was observed in cases of cardioembolism (59%) and the lowest in SVD (8%). Ischemic stroke subtype was a significant predictor of one-year mortality (Log-rank P<0.0001).
Conclusions: We observed markedly higher incidence rates of ischemic stroke within the MSIS, particularly in the LAD subtype. Our findings should be considered when planning prevention and stroke-care services in this region.
Author Disclosures: H. Saber: None. A. Shoamanesh: None. M. Azarpazhooh: None.
- © 2015 by American Heart Association, Inc.