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Title: Oxford Vascular Study : design and initial results of a population-based study of the incidence and outcome of all acute vascular events
Author: Coull, Andrew John
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2005
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Methods: OXVASC is a population-based study of all acute vascular events (TIA, stroke, ACS and PVE) and those interventions for vascular disease in Oxfordshire. The pilot study covered a population of 90542 in 9 general practices. Summary of main findings: 1. The methods used in OXVASC achieved near-complete ascertainment. However, my analyses suggested that differences in case definition and ascertainment strategies between studies could each lead to differences in measured stroke incidence of up to 20%. 2. The early risk of recurrence can very twofold depending on which definition is used. The 90 day risks (95%CI) of recurrent stroke with a 24 hour definition of recurrence were 18.3%(10.8-25.8) in OXVASC and 14.5%(11.5-17.5) in OCSP. The equivalent risks using a 28 day definition of recurrence were 5.9%(1.0-10.9) in OXVASC and 4.8%(2.8-6.7) in OCSP. Recurrences occurring after 24 hours should be used as the standard to avoid underestimation and to allow valid comparison between studies. 3. In OXVASC the risks of stroke at 7 days after a TIA and minor stroke were 8.0% (95%CI=2.3-13.7) and 11.5%(95%CI=4.8-11.2) respectively. This is much higher than commonly quoted. 4. Recurrent stroke risk varies significantly between aetiological (TOAST) subtypes (p<0.001). Large artery atherosclerosis strokes have the highest odds of recurrence at 7 days (OR=3.3, 95%CI=1.5-7.0). They account for 37% of recurrences within 7 days highlighting the importance of urgent carotid imaging and avoiding delays before endarterectomy. 5. Incident stroke cases and their brain imaging were reviewed with the original OCSP principal investigator and neuroradiologist. 6. In OXVASC, acute cerebrovascular events accounted for 41.2% of all incident acute vascular events.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available