22. European Stroke Conference 2 Stroke prognosis 8:40 - 8:50 The “age-paradox” in stroke: Early case-fatality rates level off at the highest ages T.S. Olsen1, C. Dehlendorff2, K.K. Andersen3 The Stroke Unit, Frederiksberg University Hospital, Frederiksberg, DENMARK1,Danish Cancer Society Research Center, Copenhagen, DENMARK2, Danish Cancer Society Research Center, Copenhagen, DENMARK3 Background: Epidemiologic data indicate that mortality rates level off at the highest ages. In stroke early case-fatality rates also level off in patients at the highest ages. This paradox has been attributed to a better cardiovascular risk profile of those who achieve longevity. The aim of this study was to investigate if this ”age-paradox” is present also when adjusting for differences in the cardiovascular risk factor profile. Methods: A registry of all hospitalized stroke patients in Denmark included 93 931 patients with evaluations of age, sex, civil status, stroke severity (Scandinavian Stroke Scale (SSS) 0-58), computed tomography, and cardiovascular risk. We constructed age trajectories of 3-day, 1-week, and 1-month case-fatality rates adjusted for stroke severity, sex, civil status, and cardio-vascular risk factors. Analyses were based on logistic regression modeling. To allow for nonlin-ear associations, age and stroke severity were modeled as continuous variables using restricted cubic splines. Results: Mean age 72.0 years, 48% women, mean SSS 41.5. Age trajectories of 3-days, 1-week and 1-month case-fatality were constructed. Age-trajectory of 3-day case-fatality: Case-fatality rates increased almost linearly to the age of 68 years. Thereafter, case-fatality leveled off and after the age of 84 years case-fatality even tended to decline with increasing age. Age trajectory of 1-week case-fatality: Case-fatality continuously increased to the age of 87 years. Thereafter, case-fatality leveled off and remained the same in older ages. Age trajectory of 1-month case-fa-tality: Case-fatality rates increased almost exponentially throughout the entire life span. Conclusion: Very early case-fatality rates (3-day and 1-week) leveled of in stroke patients of the highest ages. This “age-paradox” was independent of the cardiovascular risk factor profile sug-gesting that other factors (maybe hereditary) may play a role for elderly stroke patients’ ability to survive in the acute phase. 3 Stroke prognosis 8:50 - 9:00 Headache during cerebral ischemia and the long-term risk of vascular events A. Maino1, A. Algra2, P.J. Koudstaal3, E.W. Zwet4, M.D. Ferrari5, M.J.H. Wermer6 on behalf of the LiLAC Study Group Department of Internal Medicine, Universitá degli Studi di Milano, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milano, ITALY1,UMC Utrecht Stroke Center, Department of Neurology and Neurosurgery and Julius Centre for Health Sciences and Primary Care, University Medical Center, Utrecht, THE NETHERLANDS2, Department of Neurology, Erasmus Medical Center, Rotterdam, THE NETHERLANDS3, Department of Biostatistics, Leiden University Medical Center, Leiden, THE NETHERLANDS4, Department of Neurology, Leiden University Medical Center, Leiden, THE NETHERLANDS5, Department of Neurology, Leiden University Medical Center, Leiden, THE NETHERLANDS6 Background: Cerebral ischemia is frequently associated with headache, presumably due to stimulation of sensory afferents of the trigeminovascular system. Whether headache has a role in prognosis after stroke is unknown. We compared the long-term risk of recurrent vascular events in patients in whom a transient ischemic attack (TIA) or minor ischemic stroke was as-sociated with headache with those without headache. Methods: We used data from the LiLAC (Life Long After Cerebral ischemia) cohort. Partici-pants were grouped based on the presence or absence of headache at presentation. We calcu-lated the hazard ratios (HRs) and corresponding 95% confidence intervals (CI) for any first vascular event (primary outcome) or any cardiac or cerebral event (secondary outcomes). Ad-justments were made for baseline clinical characteristics. Cumulative incidence ratios (CIRs) of cardiac events to cerebral events were calculated from non-parametric cumulative incidence functions at 5, 10 and 15 years of follow-up. Results: Of 2473 participants, 420 (17%) experienced headache during the acute event. Medi-an follow-up was 14.1 years. For the primary outcome, crude HR of headache vs. no headache was 0.75 (95% CI 0.66-0.88) and adjusted HR 0.83 (95% CI 0.71-0.97). Participants with head-ache had a non-significantly lower risk of cardiac events (adjusted HR 0.88, 95% CI 0.67-1.14), whereas the risk of cerebral events was comparable to participants without headache (adjusted HR 0.97, 95% CI 0.76-1.23). Participants with headache were at lower risk of vascular death (adjusted HR 0.73; 95% CI 0.61-0.87). The CIRs at 5, 10 and 15 years did not differ between the two groups (Figure). Conclusion: Patients with headache during a TIA or minor ischemic stroke have a reduced risk of subsequent vascular events compared with patients without headache. This suggests that headache in patients with acute cerebral ischemia might reflect, at least partly, a different patho-genesis. 16 © 2013 S. Karger AG, Basel Scientific Programme
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