Difference of onset rhythm in acute ischemic stroke patients with different TOAST subtypes

OBJECTIVE: To delineate the onset changes of acute ischemic stroke (AIS) patients with different Trial of Org 10172 in Acute Stroke Treatment (TOAST) subtypes in circadian rhythm, seasonal distribution, and weekdays/holidays. MATERIALS AND METHODS: Patients with AIS admitted to the Emergency Stroke Center of the 960th Hospital of PLA between 1/4/2019 and 30/12/2024 were enrolled as study subjects. Based on medical history and examination results, enrolled patients were classifiedinto three subgroups: large-artery atherosclerosis (LAA), small-artery occlusion (SAO), and cardioembolism (CE). Onset time, laboratory test results, and clinical symptoms were compared among the three groups to investigate the rhythmic variations across different TOAST subtypes. RESULTS: A total of 722 AIS patients were enrolled. For diurnal distribution, LAA patients had higher incidence in early morning, while CE patients showed clustered onset at night. In seasonal distribution, LAA and CE had higher incidence in Quarter 1, whereas SAO patients had higher incidence in Quarter 3. Notable differences existed in onset patterns between weekdays and holidays: significant morning onset peak on weekdays, but irregular onset rhythm on holidays. CONCLUSION: This study identified the distribution patterns of different TOAST subtypes of cerebral infarction across circadian rhythm, seasonal variation, and weekdays/holidays differences, thereby providing a valuable reference for medical institutions to develop subtype-specific, rhythm-aligned, season-adapted precise prevention strategies.