Different clinical classifications of ischemic stroke may lead to different conclusions

Abstract

Objectives: To compare the differences in three ischemic stroke classification systems and their impact on the conclusions of gene polymorphism.

Methods: Prospective analysis of inpatient data of acute ischemic stroke at Wenzhou Central Hospital from May 2022 to December 2022. Patients were classified using the Trial of Org 10172 in acute stroke treatment (TOAST) classification, Korean modified TOAST (KM TOAST) classification, and Chinese ischemic stroke subclassification (CISS). The PAI-1 4G/5G, eNOS G894T, ACE gene I/D and MTHFR Gene C677T loci were detected.

Results: A total of 305 patients were included in this study. In TOAST, KM TOAST, and CISS systems, large- artery atherosclerosis (LAA) subtype accounted for 34.4%, 59.4% and 41.9% correspondingly, small- artery occlusion (SAO) subtype accounted for 37.4%, 21.3% and 26.2% respectively. And the lowest proportion was other definite cause (ODC) (1.3%, 1.3%, 1.3%). There were significant differences among the etiology subtypes of LAA, SAO, and Stroke of undetermined cause (UND). In the four gene loci detected, the genotype distribution of the PAI-1 4G/5G locus was different among the three etiological classification systems.

Conclusions: There are differences in the distribution of subtypes in the three ischemic stroke classification systems. The different etiological classification may have an impact on the conclusion of gene polymorphisms.