London, United Kingdom 2013 23 Epidemiology of stroke Smoking status and initial severity of cerebrovascular events. A population-based study. Y. Béjot1, B. Daubail2, V. Abadie3, C. Lainay4, M. Hervieu5, O. Rouaud6, G.V. Osseby7, M. Gir-oud8 Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, France, Dijon, FRANCE1, Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon, Universi-ty of Burgundy, France, Dijon, FRANCE2, Dijon Stroke Registry, EA4184, Department of Neu-rology, University Hospital and Medical School of Dijon, University of Burgundy, France, Dijon, FRANCE3, Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, France, Dijon, FRANCE4, Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon, Universi-ty of Burgundy, France, Dijon, FRANCE5, Dijon Stroke Registry, EA4184, Department of Neu-rology, University Hospital and Medical School of Dijon, University of Burgundy, France, Dijon, FRANCE6, Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, France, Dijon, FRANCE7, Dijon Stroke Registry, EA4184, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, France, Dijon, FRANCE8 Background: We aimed to investigate the impact of smoking status on clinical severity in patients with an isch-emic E-Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 561 cerebrovascular event (CVE). Methods: All patients with an ischemic CVE (stroke or transient ischemic attack) between 2006 and 2011 were prospectively identified among residents of the city of Dijon, France (151,000 inhabitants), us-ing a population-based registry. Demographic and clinical data were recorded. The initial clinical se-verity was quantified by the means of the National Institutes of Health Stroke Scale (NIHSS). Multi-variable ordinal logistic regression was used to assess the effect of smoking status on severity. Results: Among the 1353 patients with CVE, data about smoking status were available for 1263 (93.3%), of whom 861 (68.2%) were non-smokers, 224 (17.7%) were current smokers, and 178 (14.1%) were former smokers. Great differences in baseline characteristics according to smoking status were found. Greater clinical severity was observed in non-smokers (median NIHSS score 4, IQR: 0-8) compared with both current smokers (median NIHSS score 3, IQR: 1-6), and former smokers (medi-an NIHSS score 2, IQR: 0-5). In multivariable analyses, compared with non-smoking, former smok-ing was associated with less severe CVEs (OR 0.56; 95% CI: 0.39-0.79, p=0.001), whereas this as-sociation was not found for current smokers (OR 1.08; 95% CI: 0.79-1.48, p=0.615). Conclusion: This comprehensive population-based study demonstrates that former smoking is associated with a lesser clinical severity in patients presenting with ischemic CVE, independently of confounding fac-tors. The underlying mechanisms of this association remain to be investigated. 22 Epidemiology of stroke The Age of Uncertainty: Differences between Young Adults and older adults with stroke in the Canadian National Stroke Audit M.P. Lindsay1, T.L. Green2, J. Fang3, R. Swartz4 Canadian Stroke Network, University of Toronto, Toronto, CANADA1, University of Calgary, Calgary, CANADA2, Institute for Clinical Evaluative Sciences, Toronto, CANADA3, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, CANADA4 Background: In young adults (18 to 44 years) with neurological symptoms, stroke is often not an early diagnostic consideration. Stroke occurrence in this group is increasing; however, young pa-tients may have different risk profiles, presentations and outcomes than older stroke patients. The goal of this research is to determine differences in demographic profiles and outcomes between younger and older stroke populations. Methods: An extensive sub-analysis of the Canadian Stroke Audit data was performed. Dataset in-cluded 39,690 cases for the 2008-09 fiscal year. Descriptive and inferential analysis was conducted to look at demographic and outcome patterns for stroke patients aged 18 to 44 years and 45 years and older. Results: The incidence of stroke in younger adults was 3.8% of all strokes representing over 1500 strokes in patients aged 18-44. Occurrence by stroke type differed with fewer ischemic stroke and TIA’s and more hemorrhage in young patients (p<0.0001). Younger patients were less likely to have medical risk factors (all p<0.0001), but more likely to smoke. Fewer young patients had severe strokes (CNS score <=8 in 19.8% vs. 29.8%; p<0.0001), they were less likely to arrive by ambu-lance (59.7% vs. 70.4%; p=0.0001), and more likely to arrive more than 6 hours after symptom on-set. Post-stroke complications were less frequent in younger patients (5.4% vs. 13.9%, p<0.0001). There was no difference in 7-day in-hospital mortality but less delayed mortality among young pa-tients (8.8% vs. 14.4% p=0.0004). Conclusions: Young patients with stroke have more varied presentations. Outcomes were better in young strokes. Younger patients have fewer typical risk factors, smoke more, are less likely to ar-rive via ambulance and more likely to present late after a stroke. Clinicians must educate the public and patients to recognize acute stroke presentations in younger patients and respond appropriately.
Karger_ESC London_2013
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