Document Detail


Long-term risk of first recurrent stroke in the Perth Community Stroke Study.
MedLine Citation:
PMID:  9836757     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Few community-based studies have examined the long-term risk of recurrent stroke after an acute first-ever stroke. This study aimed to determine the absolute and relative risks of a first recurrent stroke over the first 5 years after a first-ever stroke and the predictors of such recurrence in a population-based series of people with first-ever stroke in Perth, Western Australia.
METHODS: Between February 1989 and August 1990, all people with a suspected acute stroke or transient ischemic attack of the brain who were resident in a geographically defined region of Perth, Western Australia, with a population of 138 708 people, were registered prospectively and assessed according to standardized diagnostic criteria. Patients were followed up prospectively at 4 months, 12 months, and 5 years after the index event.
RESULTS: Three hundred seventy patients with a first-ever stroke were registered, of whom 351 survived >2 days. Data were available for 98% of the cohort at 5 years, by which time 199 patients (58%) had died and 52 (15%) had experienced a recurrent stroke, 12 (23%) of which were fatal within 28 days. The 5-year cumulative risk of first recurrent stroke was 22.5% (95% confidence limits [CL], 16.8%, 28.1%). The risk of recurrent stroke was greatest in the first 6 months after stroke, at 8.8% (95% CL, 5.4%, 12.1%). After adjustment for age and sex, the prognostic factors for recurrent stroke were advanced, but not extreme, age (75 to 84 years) (hazard ratio [HR], 2.6; 95% CL, 1.1, 6.2), hemorrhagic index stroke (HR, 2.1; 95% CL, 0.98, 4.4), and diabetes mellitus (HR, 2.1; 95% CL, 0.95, 4.4).
CONCLUSIONS: Approximately 1 in 6 survivors (15%) of a first-ever stroke experience a recurrent stroke over the next 5 years, of which 25% are fatal within 28 days. The pathological subtype of the recurrent stroke is the same as that of the index stroke in 88% of cases. The predictors of first recurrent stroke in this study were advanced age, hemorrhagic index stroke, and diabetes mellitus, but numbers of recurrent events were modest. Because the risk of recurrent stroke is highest (8.8%) in the first 6 months after stroke, strategies for secondary prevention should be initiated as soon as possible after the index event.
Authors:
G J Hankey; K Jamrozik; R J Broadhurst; S Forbes; P W Burvill; C S Anderson; E G Stewart-Wynne
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  29     ISSN:  0039-2499     ISO Abbreviation:  Stroke     Publication Date:  1998 Dec 
Date Detail:
Created Date:  1999-01-08     Completed Date:  1999-01-08     Revised Date:  2014-02-06    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  2491-500     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Aged, 80 and over
Cerebral Hemorrhage / complications
Cerebrovascular Disorders / etiology*
Diabetes Complications
Female
Forecasting
Humans
Male
Proportional Hazards Models
Prospective Studies
Recurrence
Risk Factors
Time Factors
Comments/Corrections
Comment In:
ACP J Club. 1999 May-Jun;130(3):77

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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