Early recurrence of ischemic stroke in Japanese patients: the Japan standard stroke registry study

BACKGROUND: To determine the factors that contribute to early ischemic stroke recurrence in Japanese patients. METHODS: A multicenter stroke registration study based on a computerized database from 54 Japanese institutes, involving 8,036 patients with brain infarction who were hospitalized within 48 h after symptom onset between January 2000 and March 2004. RESULTS: Within 30 days after the initial stroke, 395 patients (4.9%) developed a recurrent stroke. Recurrence most frequently occurred in atherothrombotic patients (6.6%), followed by cardioembolic patients (6.2%). Overall, hypertension (OR 1.348, 95% CI 1.071-1.696) and atrial fibrillation (OR 1.503, 95% CI 1.177-1.918), but not diabetes mellitus, were independently predictive of early recurrence. In atherothrombotic patients, diabetes mellitus (OR 1.485, 95% CI 1.058-2.085) and atrial fibrillation (OR 1.998, 95% CI 1.231-3.244) were independently related to early recurrence. At hospital discharge, the modified Rankin Scale score was higher in patients who had an early recurrence (p < 0.0001). CONCLUSIONS: This study was based on a large number of Japanese patients and confirmed that hypertension and atrial fibrillation contribute to early ischemic stroke recurrence. In addition, analysis by stroke subtype showed that diabetes mellitus was independently related to early recurrence in atherothrombotic patients.