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Epidemiology of Ischemic Stroke Subtypes According to TOAST Criteria: Incidence, Recurrence, and Long-Term Survival in Ischemic Stroke Subtypes: A Population-Based Study
Abstract
Background and Purpose — The purpose of this study was to determine the incidence, recurrence, and long-term survival rates of ischemic stroke subtypes by a mechanism-based classification scheme (Trial of ORG 10172 in Acute Stroke Treatment, or TOAST). Methods — We identified all 583 residents of the city of Erlangen, Bavaria, Germany, with a first ischemic stroke between 1994 and 1998. Multiple overlapping sources of information were used to ensure completeness of case ascertainment. The cause of ischemic stroke was classified according to the TOAST criteria. Patients were followed up at 3 months and 1 and 2 years after stroke onset. Results — The age-standardized incidence rates for the European population (per 100 000) regarding ischemic stroke subtypes were as follows: cardioembolism, 30.2 (95% CI 25.6 to 35.7); small-artery occlusion, 25.8 (95% CI 21.5 to 30.9); and large-artery atherosclerosis, 15.3 (95% CI 12 to 19.3). When age-adjusted to the European population, the incidence rate for large-artery atherosclerosis was more than twice as high for men than for women (23.6/100 000 versus 9.2/100 000). Two years after onset, patients in the small-artery occlusion subgroup were 3 times more likely to be alive than those with cardioembolism. Ischemic stroke subtype according to the TOAST criteria was a significant predictor for long-term survival, whereas subtype was not a significant predictor of long-term recurrence up to 2 years, both before and after adjustment for age and sex. Conclusions — Epidemiological observational studies that possess wide access to appropriate diagnostic technologies and apply standardized etiologic classifications provide a much better understanding of underlying risk factors for initial stroke, recurrence, and mortality.
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“Similarly, the consolidated results of 61 observational studies conducted in western countries (approximately 0.9 million subjects) found no relationship between the TC level and the mortality rate of cerebrovascular disease847).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [847]
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Zhang, Q., Wang, C., Zheng, M., Li, Y., Li, J., Zhang, L., Shang, X., & Yan, C. (2014) · Cerebrovascular Diseases · doi:10.1159/000369778 · Cited by 11,609
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Cryptogenic stroke and underlying atrial fibrillation
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Metadata
- Authors
- Kolominsky-Rabas, P. L., Weber, M., Gefeller, O., Neundoerfer, B., & Heuschmann, P. U.
- Affiliations
- From the Unit for Stroke Research and Public Health Medicine, Department of Neurology (P.L.K.-R., M.W., B.N., P.U.H.) and Department of Epidemiology (O.G.), Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- Venue
- Stroke
- Published
- 2001-12
- Volume
- 32
- Issue
- 12
- Pages
- 2735-2740
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W2049663681
- Cited by
- 1,281
- References
- 28
- Citations by year
- 2026: 29 · 2025: 44 · 2024: 55 · 2023: 54 · 2022: 67 · 2021: 69 · 2020: 66 · 2019: 61 · 2018: 58 · 2017: 77 · 2016: 74 · 2015: 93 · 2014: 70 · 2013: 68 · 2012: 69
- FWCI
- 12.41
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Bundesministerium für Gesundheit
- Topics
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cerebrovascular and Carotid Artery Diseases
- Health Sciences › Medicine › Clinical Neurology › Intracerebral and Subarachnoid Hemorrhage Research
- Keywords
- ischemic stroke, TOAST classification, stroke subtypes, cardiac embolism, small artery occlusion, large artery atherosclerosis, stroke incidence, stroke recurrence, long-term survival, sex differences, Erlangen
- MeSH terms
- Aged, Aged, 80 and over, Brain Ischemia, Female, Follow-Up Studies, Germany, Humans, Male, Middle Aged, Recurrence, Risk Factors, Observer Variation, Comorbidity, Incidence, Survival Rate, Age Distribution, Sex Distribution, Survivors, Stroke
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