Predictors of Long-Term Recurrent Vascular Events after Ischemic Stroke at Young Age: The Italian Project on Stroke in Young Adults

BACKGROUND: Data on long-term risk and predictors of recurrent thrombotic events after ischemic stroke (IS) at young age are limited. METHODS AND RESULTS: We followed 1,867 first-ever IS patients aged 18 to 45 years (mean age, 36.8±7.1 years; women, 49.0%), as part of the Italian Project on Stroke in Young Adults (IPSYS). Median follow-up was 40 months (25th to 75th percentile, 53). Primary endpoint was a composite of IS, transient ischemic attack (TIA), myocardial infarction (MI) or other arterial events. 163 patients had recurrent thrombotic events (average rate, 2.26 per 100 person-years at risk). At 10 years, cumulative risk was 14.7% (95% CI, 12.2-17.9%) for primary endpoint, 14.0% (95% CI, 11.4-17.1%) for brain ischemia, and 0.7% (95% CI, 0.4-1.3%) for MI or other arterial events. Familial history of stroke, migraine with aura, circulating anti-phospholipid antibodies, discontinuation of antiplatelet and anti-hypertensive medications, and any increase of 1 traditional vascular risk factor were independent predictors of composite endpoint in multivariable Cox proportional hazard analysis. A point-scoring system for each variable was generated by their β-coefficients and a predictive score (IPSYS score) calculated as the sum of the weighted scores. The area under the receiver operating characteristic curve (AUC) of the 0-to-5-year score was 0.66 (95% CI, 0.61-0.71; mean 10-fold internally cross-validated AUC, 0.65). CONCLUSIONS: Among patients with IS aged 18 to 45 years, the long-term risk of recurrent thrombotic events is associated with modifiable, age-specific, risk factors. The IPSYS score may serve as a simple tool for risk estimation.