Classification And Prognosis Of Ischemic Stroke Subtypes According To NEW-TOAST Criteria

Objective:The aim of this study was to analyze the subtypes of ischemic stroke patients in the 1^st affiliated hospital of Ji Nan University according to the Trial of Org 10172 in Acute Stroke Treatment(TOAST) criteria and the NEW-TOAST;To analyze the prognosis of different ischemic stroke subtypes according to the NEW-TOAST system;To test the interrater reliablity of NEW-TOAST system.Methods:All patients with acute ischemic stroke were selected from the Department of Neurology,the First Affiliated Hospital of Ji Nan University from January 2006 to December 2007.All patients met with the diagnostic criteria of the Fourth National Cerebrovarscular Academic Meeting and certainly diagnosed with CT or MRI examination.NEW-TOAST typing and TOAST typing:Based on patients' present and previous history,personal history,physical examination of neurology and imageology information and X-ray of thoracic part,heart doppler ultrasound,carotid duplex ultrasound,electronic cardial graphy,electrocardiography,blood routine,blood glucose,electrolyte,serum lipid level,blood coagulation test.All patients were classified by two experienced doctors respectively according to both of the two classifications in a double-blind way.Through one year of tel follow-up,we had taken over most of the compound end-points,which denote the recurrence of cardiovascular and cerebral vascular diseases and vascular death.The interrater reliability of the classification was tested by two neurologists who had not participated in this trial.The neurologists independently used the NEW-TOAST classification system to evaluate same 20 patients.For statistical data analysis,we used the SPSS program version 13.0.Results:A total of 296 adults with acute ischmic stroke were selected sequencely.All 296 accepted patients were involved in the final analysis.(1) NEW-TOAST typing: arterothrombosis(AT) counted for 39.86%;cerebral embolism(CE) counted for 6.42%;small artery disease(SAD) counted for 26.35%;some other disease(SOD), counted for 1.35%;some unidentified disease(SUD) counted for 26.01%.Among them,percentage of AT was the highest.(2) Compares to TOAST typing,There are thirty-seven cases were classified to different subtypes in the NEW-TOAST.(3) Using NEW-TOAST system,interphysician agreement was very high.The two physicians disagreed in only three patients and with an exellent Kappa value(Kappa=0.773). (4) Twenty-five cases lost to follow-up.Of all the remains,83.03%were free of recurrence;16.61%encountered another stroke or vascular death.Among patients met the compound endpoints,AT counted for 20.56%,CE counted for 44.44%,SAD counted for 8.45%,SUD counted for 12.68%,SOD non.CE possessed the highest reoccurrence rate and there was statistically significance(P＜0.05).Conclusions:All of the patients with ischemic cerebral infarction were classified with standard of NEW TOAST and analyzed the constituent ratio and prognosis and the conclusions were as following:1.Based on the NEW-TOAST,the most frequent subtype was AT,followed by SUD, SAD,CE,and SOD.2.For prognosis,the highest recurrence rate was CE,followed by AT,SUD,SAD.3.The NEW-TOAST stroke subtype classification system is easy to use and has good interrater reliability and can be investigated as a basis of prognosis of the ischemic stroke patients.