From the Departments of Neurological Sciences (M.P., M.R., A.A., M.B.,
M.C., F.G., C.F.) and Experimental Medicine (F.C.), University "La
Sapienza," Rome, Italy.
Correspondence to Massimiliano Prencipe, MD, Dipartimento di Scienze Neurologiche, Universita degli Studi "La Sapienza," Viale dell'Università 30, 00185 Roma, Italy.
Background and Purpose—Determinants
of long-term outcome are not well defined in minor stroke patients.
This study aims to evaluate which factors are independent long-term
predictors of death and major stroke recurrence in a cohort of
minor ischemic strokes.
Methods—A cohort of 322 patients with first-ever minor
ischemic strokes (mean age, 55 years; 89% were treated with
antiplatelet or anticoagulant drugs) with minor (Rankin score=2) or
no disability (Rankin score <2) were followed for 10 years, with only
6% lost to follow-up. Death and major stroke recurrence rates
were evaluated by Kaplan-Meier analysis. Hazard ratios and 95%
confidence intervals (CI) of factors with P<.1 at the
log-rank test were evaluated by multivariate Cox
analysis.
Results—The 10-year mortality rate was 32%, with a relative risk
of 1.7 (95% CI, 1.4 to 2.1) compared with the age- and sex-matched
general population. The 10-year recurrence rate of major
strokes was 14%. The hazard ratio (95% CI) of death was 1.1 (1.05 to
1.09) for age (1-year increments), 3.4 (2.2 to 5.2) for minor
disability, 1.8 (1.1 to 3.1) for myocardial infarction (MI), 2.0 (1.1
to 3.7) for nonvalvular atrial fibrillation, and 1.8 (1.2 to
2.7) for hypercholesterolemia. The hazard ratio
(95% CI) of major stroke recurrence was 2.8 (1.3 to 6.2) for
recurrent minor strokes, 3.1 (1.9 to 4.6) for nonlacunar stroke, 2.9
(1.3 to 6.8) for MI, and 3.0 (1.4 to 6.4) for hypertension.
Conclusions—In minor ischemic strokes, age, minor
disability, MI, nonvalvular atrial fibrillation, and
hypercholesterolemia increase the risk of
death; recurrent minor strokes, nonlacunar stroke, MI, and hypertension
increase the risk of major stroke.
© 1998 American Heart Association, Inc.
Original Contributions
Long-term Prognosis After a Minor Stroke
10-Year Mortality and Major Stroke Recurrence Rates in a Hospital-Based Cohort
Key Words: disability • lacunar infarction • long-term survival • stroke, minor • stroke recurrence
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