Subtypes and one-year survival of first-ever stroke in Chinese patients: The Nanjing Stroke Registry

BACKGROUND: Morbidity and mortality of stroke have been investigated extensively in Western populations, while data concerning case fatality and cause of death after stroke are very limited in mainland China. This study aimed to analyze the 1-year survival and predictors of case fatality in Chinese patients with first-ever stroke. METHODS: Subjects are patients registered in the Nanjing Stroke Registry Program. Information concerning cardiovascular risk factors and stroke characteristics were collected, and patients were followed after registration. Ischemic strokes were classified according to TOAST criteria as large-artery atherosclerosis (LAA), cardiac embolism stroke (CES), small-vessel stroke (SVS), or other determined and undetermined causes (UND). One-year case fatality was analyzed by the Kaplan-Meier method, and predictors of case fatality were evaluated by the Cox proportional hazards model. RESULTS: A total of 752 patients with first-ever stroke were included, of which 142 (18.9%) were identified as intracerebral hemorrhage (ICH), 120 (16.0%) as LAA, 123 (16.4%) as SVS, 160 (21.3%) as CES and 216 (28.7%) as UND. The overall survival rate was 86.4% at the end of the 1-year follow-up. Patients with SVS have the highest survival rate (92.7%), followed by UND (89.4%), CES (88.1%) and LAA (84.2%). Patients with ICH have the lowest survival rate (76.8%). Survival rates of patients with different subtypes of stroke presented a significant difference (chi2 = 19.3, p < 0.001). For patients deceased during the first year after the index stroke, 33.3% of deaths were caused by the first stroke, 18.6% by recurrent stroke, 16.7% by cardiovascular comorbidities, 14.7% by nonvascular conditions and 16.7% died of undetermined causes. Advanced age, hypertension, hyperlipidemia, diabetes mellitus (DM), atrial fibrillation (AF), history of transient ischemic attack and cigarette smoking were associated with an increased risk of death 1 year after stroke. CONCLUSIONS: The case fatality rate and predictors for mortality of Chinese patients with first-ever stroke are similar to those reported for other populations. The significant influence of cardiovascular disease on the first-year survival rate emphasizes the importance of acute stroke management and control of hypertension, DM, AF and other predictors for decreasing case fatality and improving prognosis.     

Prediction of in-hospital mortality after first-ever stroke: the Lausanne Stroke Registry.

We aimed to study in-hospital mortality after a first-ever stroke (brain infarction or parenchymatous hemorrhage) and to determine its predictors using easily obtainable variables. The main outcome measure was vital status at hospital discharge. Clinical features and type of stroke, with a particular emphasis on age, stroke topography and presumed causes of stroke, were studied in 3362 consecutive patients from the Lausanne Stroke Registry. Overall mortality was 4.8%. Brain hemorrhage mortality was 14.4% (48/333) and brain infarction mortality was 3.70% (112/3029). Localizations with high mortality included infratentorial (17.5%) and deep hemispheric (15.9%) territories for brain hemorrhage and, for brain infarction, multiple localizations in the posterior circulation (18.4%) and large middle cerebral artery territory (15.5%). Presumed causes of stroke associated with high mortality included saccular aneurysm (58.3%) and hypertensive arteriopathy (13.0%) for brain hemorrhage and, for brain infarction, dissection (10.4%), arteritis (8.3%), hematologic conditions (6.7%) and coexisting arterial and cardiac sources of embolism (5.2%). Multivariate logistic analysis showed that impaired consciousness on admission and limb weakness were good predictors of mortality for brain hemorrhage, while impaired consciousness and the cumulative effect of progressive worsening, limb weakness, left ventricular hypertrophy, past history of cardiac arrhythmia and previous transient ischemic attack were predictors of mortality for brain infarction. Age was not an independent predictor of stroke mortality, but for brain infarction the number of cumulative factors considered in the model increased with age. Our study shows that several factors associated with death risk are available during the first few hours after onset of stroke. Age alone is not critical, although its interaction with other factors should be considered.     

Stroke in the Lehigh Valley: risk factors for recurrent stroke

Age-specific risk of recurrent stroke for various risk factors, calculated independently, was estimated using the first year of data from the Lehigh Valley Stroke Register. The register is based on a population of more than one-half million. Among the risk factors examined, the highest overall risk of recurrent stroke, 41.4, occurred with a history of at least one transient ischemic attack (TIA). After myocardial infarction (MI), the relative risk of a recurrent stroke was 8.0, while with all other heart diseases combined it was 8.4. With diabetes, the relative risk of a recurrent stroke was 5.6; with hypertension, it was 4.5. The relative risk increased with age after TIA and MI, but not for other heart disease, diabetes, and hypertension, except in the 85+-year-old age group.     

Predictors of death and vascular events in the elderly : the Perth Community Stroke Study

BACKGROUND AND PURPOSE: The goal of the present study was to identify risk factors for vascular disease in the elderly. METHODS: We conducted a prospective study of control subjects from a population-based study of stroke in Perth, Western Australia, that was completed in 1989 to 1990 and used record linkage and a survey of survivors to identify deaths and nonfatal vascular events. Data validated through reference to medical records were analyzed with the use of Cox proportional hazards models. RESULTS: Follow-up for the 931 subjects was 88% complete. By June 24, 1994, 198 (24%) of the subjects had died (96 from vascular disease), and there had been 45 nonfatal strokes or myocardial infarctions. The hazard ratio for diabetes exceeded 2.0 for all end points, whereas the consumption of meat >4 times weekly was associated with a reduction in risk of 相似文献   

Incidence and occurrence of total (first-ever and recurrent) stroke

BACKGROUND AND PURPOSE: It has recently been hypothesized that the figure of approximately half a million strokes substantially underestimates the actual annual stroke burden for the United States. The majority of previously reported studies on the epidemiology of stroke used relatively small and homogeneous population-based stroke registries. This study was designed to estimate the occurrence, incidence, and characteristics of total (first-ever and recurrent) stroke by using a large administrative claims database representative of all 1995 US inpatient discharges. METHODS: We used the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, release 4, which contains approximately 20% of all 1995 US inpatient discharges. Because the accuracy of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) coding is suboptimal, we performed a literature review of ICD-9-CM 430 to 438 validation studies. The pooled results from the literature review were used to make appropriate adjustments in the analysis to correct for some of the inaccuracies of the diagnostic codes. RESULTS: There were 682 000 occurrences of stroke with hospitalization (95% CI 660 000 to 704 000) and an estimated 68 000 occurrences of stroke without hospitalization. The overall incidence rate for occurrence of total stroke (first-ever and recurrent) was 259 per 100 000 population (age- and sex-adjusted to 1995 US population). Incidence rates increased exponentially with age and were consistently higher for males than for females. CONCLUSIONS: We conservatively estimate that there were 750 000 first-ever or recurrent strokes in the United States during 1995. This new figure emphasizes the importance of preventive measures for a disease that has identifiable and modifiable risk factors and for the development of new and improved treatment strategies and infrastructures that can reduce the consequences of stroke.     

Three-year survival after first-ever ischemic stroke is predicted by initial stroke severity: A hospital-based study

Objective

We aimed to report 3-year survival and causes of death of first-ever ischemic stroke stratified by initial stroke severity.

Study design and setting

From September 1998 to October 1999, 360 acute first-ever ischemic stroke patients consecutively admitted were followed up prospectively. Patients’ vital status and causes of death were identified from the National Death Registry, till December 31, 2002. Potential prognostic factors available at admission were evaluated using Cox proportional hazards regression analysis with bootstrap validation.

Results

Three hundred and sixty patients, 58% males with age 64.9 years on average, were followed up for 43.4 months with no lost follow-up. Ninety-two (25.6%) patients died, 25 in the first month. The cumulative case–fatality rates were 12.2%, 15.8%, 20.5% and 25.6% for years 1–4. The proportion of vascular deaths was 84% during the first 30 days and 71% for the subsequent 5 months. The hazard ratio (95% CI) was 1.08 (1.05–1.11) for age (1-year increment), 335.90 (20.72–5446.23) for NIHSS 16–38, 2.48 (1.39–4.42) for NIHSS 7–15, and 0.95 (0.91–0.99) for an interaction term of age and NIHSS 16–38.

Conclusion

This study confirmed that the initial stroke severity and age were early prognostic factors for 3-year survival after first-ever ischemic stroke, and further demonstrated that the influence of age on survival time was slightly lower in patients with severe stroke.     

Stroke in the Lehigh Valley: combined risk factors for recurrent ischemic stroke

We used the Lehigh Valley Stroke Register and a logistic regression model for the odds ratio to study the relative contribution of several factors, considered jointly, to the risk of recurrent ischemic stroke. The factors were hypertension (HT), transient ischemic attack (TIA), myocardial infarction (MI), other heart diseases (OHD), diabetes mellitus (DM), age, and sex. Among these factors MI, OHD, and TIA constituted significantly greater risk than HTN, DM, age, or sex for ischemic stroke recurrence.     

The risk of recurrent stroke after intracerebral haemorrhage

Background and aim

The risks of recurrent intracerebral haemorrhage (ICH) vary widely (0–24%). Patients with ICH also have risk factors for ischaemic stroke (IS) and a proportion of ICH survivors re‐present with an IS. This dilemma has implications for prophylactic treatment. This study aims to determine the risk of recurrent stroke events (both ICH and IS) following an index bleed and whether ICH recurrence risk varies according to location of index bleed.

Patients and methods

All patients diagnosed with an acute ICH presenting over an 8.5 year period were identified. Each ICH was confirmed by reviewing all of the radiology results and, where necessary, the clinical case notes or post‐mortem data. Recurrent stroke events (ICH and IS) were identified by reappearance of these patients in our stroke database. Coronial post‐mortem results for the same period were also reviewed. Each recurrent event was reviewed to confirm the diagnosis and location of the stroke.

Results

Of the 7686 stroke events recorded, 768 (10%) were ICH. In the follow‐up period, there were 19 recurrent ICH and 17 new IS in the 464 patients who survived beyond the index hospital stay. Recurrence rate for ICH was 2.1/100 in the first year but 1.2/100/year overall. This compares with 1.3/100/year overall for IS. Most recurrences were “lobar–lobar” type.

Conclusion

The cumulative risk of recurrent ICH in this population is similar to that of IS after the first year.Strokes caused by an intracerebral haemorrhage (ICH) are less common than ischaemic strokes (IS), but they have a much higher early case fatality.^1,2 ICH contributes to approximately 10–15% of all strokes in Caucasians, but this proportion is increased in some Asian and South American populations.^1,3,4,5,6 This variation in incidence may be due to genetic influences, prevalence and treatment of hypertension and medication use (for example, antiplatelet and anticoagulant drugs) or a combination of these factors.Given the high mortality, survivors of an ICH are justifiably fearful of another event. They ask, “What are my chances of having a further stroke (ICH), doctor?” Answering this with confidence is challenging. Just as incidence rates are diverse, the reported risk of recurrence following an ICH also varies enormously from 0% to 24% (table 1​1).). This may be explained in part by small sample sizes or short follow‐up periods.^7,8,9,15,22 Differences in the mean age and ethnicity of the populations studied, as well as location of the bleed and prevalence of hypertension, are alternative reasons.Table 1 Risk of recurrence of intracerebral haemorrhage

Recurrence and survival after first-ever stroke in the area of Bajo Aragon, Spain. A prospective cohort study

OBJECTIVE: There have been no prospective studies in Spain focused on stroke recurrence. The purpose of this work is to estimate the risk of stroke recurrence and mortality in the community of Bajo Aragón, Spain and to compare it with previous studies conducted in other countries. METHODS: A cohort of 425 patients with first ever stroke was followed-up for a mean period of 4 years (range: 20-78 months). The mean age was 75.4 years. The survival function for recurrence and mortality was analysed by means of the actuarial method. Survival comparisons were made for the different vascular risk factors with the Kaplan-Meier method. The risk of recurrence and death was adjusted for relevant variables with the Cox proportional hazards model. We also made a separate analysis by stroke subtypes. RESULTS: At the end of the follow-up we found an overall mortality of 38% (163/425) with 69 patients dying in hospital, and an overall recurrence rate of 17.6% (63/356). The cumulative risk of recurrence was 2.1% at 30 days, 9.5% at 1 year and 26% at 5 years. The cumulative risk of mortality was 16% at 30 days, 30% at 1 year and 48% at 5 years. Only age (Hazard Ratio: 1.05, 95% CI: 1.02-1.08) and the addition of risk factors (Hazard Ratio: 1.32, 95% CI: 1.12-1.57) were significant predictors of recurrence. In general, none of the risk factors individually predicted stroke recurrence. The highest risk of recurrence was observed in large-vessel atherothrombotic infarction followed by cardioembolic infarction. In cardioembolic stroke, the association of atrial fibrillation plus either valvular disease or congestive heart failure significantly predicted recurrence of the same type (Relative Risk: 3.1; 95% CI: 2.2-4.4). CONCLUSION: The risk of early stroke recurrence in our area was lower than those observed in most studies, so was the risk of long-term mortality. However, the risk of long-term recurrence was similar. Age was the main predictor of death and recurrence. The patients with atrial fibrillation plus another heart disease are at increased risk of recurrent cardioembolic stroke.