The Study Of The Chinese Ischemic Stroke Subclassification And The Clinical Features Of Acute Cerebral Infarction

Objective The aim of this study is analysis the proportion of acute cerebral infarction patients with CISS criteria, and compare the difference and the agreement with the TOAST criteria.We also analysis the prognosis, the difference between the distribution of risk factors among the subtypes according to the CISS criteria.Methods We prospectively and consecutively registed310acute cerebral infarction patients who were in hospital in the Neurology Department of the guangxi zhuang autonomous region people’s hospital from1July2011to31December2011. All patients were subclassified according to the Chinese Ischemic Stroke Subclassification criteria and the TAOST criteria, and compared the difference and the agreement with the TOAST criteria. The risk factors (smoking, drinking, hypertension, diabetes, heart disease, lipid metabolic disorders, plasma homocysteine, uric acid and hyperfibrinogenemia) in each group were measured and compared with others. And neuronal function impairment degree was evaluated by the National Institutes of Health stroke scale score (NIHSS) on admission and hospitalized10days in order to evaluate the clinical short-term prognosis. Results Among310ACI patients, the frequent subtype was large artery atherosclerosis (LAA)141cases (45.5%), including3(1.0%) the aortic arch atherosclerotic and138(44.5%) intra-and extra-cranial large arteries atherosclerosis, followed by penetrating artery disease (PAD)(n=102,32.9%), undetermined etiology(UE)(n=44,14.2%), cardiac stroke (n=15,4.8%), other etiologies(OE)(n=8,2.6%). The underlying mechanism subtypes included70patients(50.4%) of artery to artery embolization,34cases (24.5%) of parent artery(plaque or thrombus) occluding penetrating artery,14cases (10.1%) of hypoperfusion/impaired emboli clearance and21cases (15.1%) of multiple mechanism. When CISS, more patients were classified as LAA (45.5%vs26.1%, P<0.001) and fewer as Undetermined Etiology (34.2%vs14.2%, P<0.001).The same patients were diagnosis as other etiology and cardiogenic stroke, Agreement for large artery atherosclerosis, small artery disease and undetermined etiology was medium (Kappa=0.595,0.604,0.433), and less agreement for undetermined etiology. Smoking, drinking, high uric acid hematic disease and hyperfibrinogenemia in the subtypes distribution was not statistically different (P>0.05). Hypertension, lipid metabolism disorders in LAA, PAD and UE was significantly higher than the CS group, with a statistically significant difference (P<0.05). While the frequency of patients with heart diseases(100%) in CS group was statistically higher than the other groups (P<0.001), patients with diabetes mellitus(43.1%) was significantly more common in PAD (P<0.05). High homocysteine in LAA was significantly higher than the proportion of PAD、CE and UE group (P<0.05). No further significantly difference was found among different subtypes regarding the related risk factors. The relationships between CISS subtypes and clinical outcomes of:The NIHSS on admission Patients with penetrating artery disease was obviously reduced, and clinical short-term prognosis (P<0.05). The NIHSS on admission Patients with cardiogenic stroke was obviously elevated, and clinical short-term prognosis is poor(P<0.05).Conclusions LAA was the most common cause of acute cerebral infarction, followed by penetrating artery disease. CISS can increase the accuracy and reliability of the diagnosis of the cause stroke, which was more in line with the pathological changes of the arteries, and significantly reduced the diagnosis of undetermined etiology. There were differences in the distribution of risk factors among etiological subtypes of acute cerebral infarction patients in with each CISS, and Hypertension, lipid metabolism disorders is closed related to LAA, PAD and UE; the high Hcy was more correlated to LAA, and diabetes mellitus was suggested to be the main related risk factor of PAD. Penetrating artery disease patients have the lightest admission condition and the best clinical short-term prognosis, while CS patients have the worst admission illness and clinical short-term prognosis.