EXPRESS: Characteristics and Prognosis of Patients with Embolic Stroke of Undetermined Source in China

Abstract

Background and purpose: We aimed to explore the frequencies, risk factors, and natural history of ESUS through a national prospective registry in China. Methods: Between August 2015 and March 2018, the Third China National Stroke Registry (CNSR-III) recruited consecutive patients with ischemic stroke or transient ischemic attack (TIA) in China. The baseline characteristics, risks of stroke, and mortality in patients with ESUS were described and compared with that in patients with other causative subtypes. Results: A total of 15166 TIA and ischemic stroke patients were enrolled in CNSR-III. Among 8528 ischemic stroke with standard diagnostic work-up, 2415 (28.3%) patients were diagnosed with ESUS. The mean age was 61 years and 70% of them were male. Compared to patients with cardioembolic strokes and small vessel disease, patients with ESUS had higher prevalence of nonstenosing large artery atherosclerosis (37.93% vs 31.26%, P=0.008 and 37.93% vs 34.40%, P=0.044 respectively). The cumulative probability of stroke recurrence in patients with ESUS at 3 month and 1 year was 5.59% and 8.74%. Compared with ESUS patients (0.70% and 1.99%), patients with the large artery atherosclerosis and cardioembolic strokes had higher cumulative probability of death at 3 month (1.94% and 3.22%) and 1 year (4.17% and 7.39%). Conclusions: ESUS is a common cause of ischemic stroke in Chinese population with a higher stroke recurrence of ESUS than previous reported. It was more likely to have nonstenosing large artery atherosclerosis in patients with ESUS than with cardioembolic strokes and small vessel disease.