Proportion, Risk Factors and Outcome of Lacunar Infarction: A Hospital-Based Study in a Chinese Population

Abstract

Background: There is scant information on the proportion, risk factors and outcome of lacunar infarction in China. Methods: Prospective registry data entered within 1 month after a first-ever stroke between March 2002 and March 2007 were used from 4 Chinese hospitals. Data regarding stroke risk factors and baseline characteristics were examined in a long-term follow-up. Case fatality, death and dependency, and stroke recurrence were assessed at 30, 90, 180 days and 1 year. Predictive factors for death at 1 year in patients with lacunar infarction were tested by logistic regression analysis. We constructed Kaplan-Meier survival curves and compared groups with lacunar infarction and nonlacunar infarction by means of log rank tests for significant difference. Results: A total of 3,905 patients with first-ever cerebral infarction were included, of whom 1,650 (42.3%) had a lacunar infarction and 2,255 (57.7%) a nonlacunar infarction. Case fatality was lower in patients with lacunar infarction at all 4 time points (5.3, 6.4, 7.8 and 17.4%, respectively), as compared to patients with nonlacunar infarction (9.5, 14.3, 16.5 and 20.1%, respectively). Age, diabetes, smoking and NIHSS score at admission were the independent predictors for 1-year case fatality in patients with lacunar infarction. Death and dependency rates were also lower in patients with lacunar infarction than in those with nonlacunar infarction. Recurrent stroke was an important cause of death for lacunar infarction patients. Conclusions: The proportion of lacunar infarction in China is much higher than that in Western countries. The long-term prognosis of lacunar infarction is not benign.

Comparison of risk factors, severity and outcome between lacunar and non-lacunar stroke in a tertiary care center in Sri Lanka: A descriptive study

“…Contrary to studies demonstrating an increased incidence of hypertension, diabetes, dyslipidaemia, smoking in Caucasians and Asians with LAC, our study did not reveal a significant excess of these risk factors [1,[5][6][7]. But a later systematic meta-analysis, reported that except for a marginal excess of hypertension in LAC, none of the other risk factors were predictive of either stroke subtype [11].…”

“…He proposed that lacunar strokes, asymptomatic small infarcts in striatocapsule are due to small vessel disease in the penetrating arteries and was the result of lipohyalinosis or atherosclerosis. Thus emerged the 'lacunar hypothesis' and these findings have led to studies on the two subtypes of stroke further enumerating that hypertension, diabetes and hyperlipidaemia are common in lacunar stroke with cardio embolism and large artery disease deemed less important [1,5]. But recent studies show that the risk factor profile is not different in stroke subtypes questioning the validity of lacunar hypothesis [6][7][8].…”

“…This study showed a LAC occurrence of 41% among ischaemic stroke. Studies show that the early death rate as well as the risk of recurrence and disability are higher in non-lacunar strokes than lacunar strokes [5,8,11].…”

Diabetes and Poor Outcomes Within 6 Months After Acute Ischemic Stroke

“…14 However, data for the impact of DM on outcomes of patients with ischemic stroke in China are limited and conflicting. Some studies have suggested that DM is a predictive factor for early-or long-term death after ischemic stroke, [15][16][17] but several studies have not. 12,18,19 The literature on the associations between DM and dependency and recurrent stroke in patients with ischemic stroke remains scarce.…”

Totaled Health Risks in Vascular Events Score Predicts Clinical Outcomes in Patients With Cardioembolic and Other Subtypes of Ischemic Stroke

“…8 The overall registry project was approved by the Scientific Research Department of West China Hospital, Sichuan University, and procedures used to build the registry conformed to local and international standards of research ethics. West China Hospital is considered by some the largest single-site hospital in the world, with 4300 beds and >180 000 admissions in 2012.…”