Title
Recurrent vascular events after embolic stroke of undetermined source in young adults.

Background and Aims
The existing knowledge about baseline characteristics and recurrent vascular events in young patients with embolic stroke of undetermined source (ESUS) is scarce. We compared baseline characteristics and risk of recurrent vascular events and vascular death between ESUS and non-ESUS young patients.

Methods
We included consecutive patients aged 18 to 55 years with first-ever ischemic stroke admitted between January 1, 2009, and November 30, 2017. ESUS patients were identified and recurrent cerebrovascular events, composite vascular events and vascular death were compared between ESUS and non-ESUS patients. Survival analysis using incidence-rate (IR) ratios was performed. Adjusted risks were calculated using Cox proportional hazard analyses.

Results
294 patients were included, 88 (30%) classified as ESUS. This subgroup was younger (mean age 45.0±7.5 years versus 47.1±7.8 years), less often diabetic (10.2% versus 20.0%) and had more frequently migraine (18.2% versus 7.3%). Mean follow-up time was 3.8±2.7 years. IR ratios for recurrent cerebrovascular events, composite vascular events and vascular death were respectively 0.64 (IR: 2.6 person/year vs 4.1 person/year; 95% CI 0.25–1.46), 0.47 (IR: 3.3 person/year vs 7.1 person/year; 95% CI 0.21–0.94) and 0.50 (IR: 0.9 person/year vs 1.8 person/year 95% CI 0.09–1.79). After adjusting for baseline characteristics there were no differences in the risk of composite vascular events (hazard ratio 0.57, 95% CI 0.29–1.15).

Conclusions
In our cohort, ESUS patients were younger, less often diabetic and had more frequently migraine. There were no differences in recurrent vascular events and vascular death between ESUS and non-ESUS young patients.

RECURRENT VASCULAR EVENTS AFTER EMBOLIC STROKE OF UNDETERMINED SOURCE IN YOUNG ADULTS