From the Department of Neurology (J.T.M., R.L.S., D.W.D.), the Gertrude
H. Sergievsky Center (J.T.M., R.L.S.), and the Division of Biostatistics
(E.B., M.C.P.), Columbia University, College of Physicians and Surgeons, New
York, NY.
Background and
Purpose—Information regarding risk factors for early
recurrence is limited. Our aim was to identify the clinical
predictors of early recurrence after ischemic stroke.
Methods—We prospectively examined 297 patients (mean age,
72.0±8.4 years) hospitalized with ischemic stroke to identify
recurrent strokes occurring within 90 days of the index stroke.
Survival free of recurrence was estimated using Kaplan-Meier
analysis stratified by demographic variables; vascular risk
factors; stroke syndrome, subtype, vascular territory, and severity;
scores on the Barthel Index and Mini-Mental State Examination during
hospitalization; blood pressure on admission; and selected laboratory
data. We estimated the relative risk (RR) of early recurrence
associated with those variables using proportional hazards
analysis.
Results—We identified 22 recurrent events in the first 90 days
after the index stroke, resulting in an early stroke recurrence
rate of 7.4%, and death occurred immediately after recurrence
in 6 of the 22 patients. A major hemispheric stroke syndrome (RR=2.9;
95% confidence interval [CI]=1.2 to 7.1), atherothrombotic stroke
mechanism (RR=3.3; CI=1.3 to 8.3), and atrial fibrillation (RR=2.2;
CI=0.8 to 6.1) were independent predictors of early recurrence,
after adjustment for demographic variables.
Conclusions—Early recurrence was frequent and resulted in
increased mortality. Attention to the clinical features of the index
stroke, including the presenting syndrome and the ischemic
mechanism, and the recognition of atrial fibrillation may help in the
selection of patients for the initiation of targeted interventions to
prevent early recurrence and subsequent mortality.
© 1998 American Heart Association, Inc.
Original Contributions
Risk Factors for Early Recurrence After Ischemic Stroke
The Role of Stroke Syndrome and Subtype
Key Words: mortality • risk factors • stroke, ischemic • stroke outcome
This article has been cited by other articles:
 |
|
 |
|
  A. Ois, E. Cuadrado-Godia, A. Rodriguez-Campello, J. Jimenez-Conde, and J. Roquer High Risk of Early Neurological Recurrence in Symptomatic Carotid Stenosis Stroke, August 1, 2009; 40(8): 2727 - 2731. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. D. Easton, J. L. Saver, G. W. Albers, M. J. Alberts, S. Chaturvedi, E. Feldmann, T. S. Hatsukami, R. T. Higashida, S. C. Johnston, C. S. Kidwell, et al. Definition and Evaluation of Transient Ischemic Attack: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease: The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke, June 1, 2009; 40(6): 2276 - 2293. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Giannakopoulos, F. Passam, Y. Ioannou, and S. A. Krilis How we diagnose the antiphospholipid syndrome Blood, January 29, 2009; 113(5): 985 - 994. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Talelli and R. J. Greenwood Review: Recurrent stroke: where do we stand with the secondary prevention of noncardioembolic ischaemic strokes? Therapeutic Advances in Cardiovascular Disease, October 1, 2008; 2(5): 387 - 405. [Abstract] [PDF]
|
|
|
|
|
|
S. Aslanyan, C. J. Weir, K. W. Muir, K. R. Lees, and for the IMAGES Study Investigators Magnesium for Treatment of Acute Lacunar Stroke Syndromes: Further Analysis of the IMAGES Trial Stroke, April 1, 2007; 38(4): 1269 - 1273. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D.-W. Kang, S. U. Lattimore, L. L. Latour, and S. Warach Silent Ischemic Lesion Recurrence on Magnetic Resonance Imaging Predicts Subsequent Clinical Vascular Events Arch Neurol, December 1, 2006; 63(12): 1730 - 1733. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Jackson and C. Sudlow Comparing risks of death and recurrent vascular events between lacunar and non-lacunar infarction Brain, November 1, 2005; 128(11): 2507 - 2517. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G Tsivgoulis, K Spengos, N Zakopoulos, E Manios, K Xinos, D Vassilopoulos, and K N Vemmos Twenty four hour pulse pressure predicts long term recurrence in acute stroke patients J. Neurol. Neurosurg. Psychiatry, October 1, 2005; 76(10): 1360 - 1365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K Kimura, K Minematsu, T Yamaguchi, and for the Japan Multicenter Stroke Investigators' Co Atrial fibrillation as a predictive factor for severe stroke and early death in 15 831 patients with acute ischaemic stroke J. Neurol. Neurosurg. Psychiatry, May 1, 2005; 76(5): 679 - 683. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D.-W. Kang, L. L. Latour, J. A. Chalela, J. A. Dambrosia, and S. Warach Early and late recurrence of ischemic lesion on MRI: Evidence for a prolonged stroke-prone state? Neurology, December 28, 2004; 63(12): 2261 - 2265. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Ovbiagele, J. L. Saver, A. Fredieu, S. Suzuki, S. Selco, V. Rajajee, N. McNair, T. Razinia, and C. S. Kidwell In-Hospital Initiation of Secondary Stroke Prevention Therapies Yields High Rates of Adherence at Follow-up Stroke, December 1, 2004; 35(12): 2879 - 2883. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Aslanyan, C. J. Weir, S. C. Johnston, K. R. Lees, and for the GAIN International Steering Committee and Poststroke Neurological Improvement Within 7 Days Is Associated With Subsequent Deterioration Stroke, September 1, 2004; 35(9): 2165 - 2170. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Coull and P. M. Rothwell Underestimation of the Early Risk of Recurrent Stroke: Evidence of the Need for a Standard Definition Stroke, August 1, 2004; 35(8): 1925 - 1929. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. K. Lovett, A. J. Coull, and P. M. Rothwell Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies Neurology, February 24, 2004; 62(4): 569 - 573. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. C. Johnston and J. D. Easton Are Patients With Acutely Recovered Cerebral Ischemia More Unstable? Stroke, October 1, 2003; 34(10): 2446 - 2450. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.-C. Corvol, A. Bouzamondo, M. Sirol, J.-S. Hulot, P. Sanchez, and P. Lechat Differential Effects of Lipid-Lowering Therapies on Stroke Prevention: A Meta-analysis of Randomized Trials Arch Intern Med, March 24, 2003; 163(6): 669 - 676. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. G. Hart, S. Palacio, and L. A. Pearce Atrial Fibrillation, Stroke, and Acute Antithrombotic Therapy: Analysis of Randomized Clinical Trials Stroke, November 1, 2002; 33(11): 2722 - 2727. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. Desmond, J. T. Moroney, M. Sano, and Y. Stern Mortality in patients with dementia after ischemic stroke Neurology, August 27, 2002; 59(4): 537 - 543. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Sappok, A. Faulstich, E. Stuckert, H. Kruck, P. Marx, and H.-C. Koennecke Compliance With Secondary Prevention of Ischemic Stroke: A Prospective Evaluation Stroke, August 1, 2001; 32(8): 1884 - 1889. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A Hinchey and R. G Holloway Ischaemic stroke subtypes had different short term and long term functional outcomes, mortality, and recurrence rates Evid. Based Med., January 1, 2001; 6(1): 26 - 26. [Full Text]
|
|
|
|
|
|
G. W. Petty, R. D. Brown Jr, J. P. Whisnant, J. D. Sicks, W. M. O'Fallon, and D. O. Wiebers Ischemic Stroke Subtypes : A Population-Based Study of Functional Outcome, Survival, and Recurrence Stroke, May 1, 2000; 31(5): 1062 - 1068. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Estol and R. A. Swanson Intravenous heparin for acute stroke: What can we learn from the megatrials? Neurology, April 11, 2000; 54(7): 1542 - 1546. [Full Text] [PDF]
|
|
|
|
|
|
W. N. Kernan, C. M. Viscoli, L. M. Brass, R. W. Makuch, P. M. Sarrel, R. S. Roberts, M. Gent, P. Rothwell, R. L. Sacco, R.-C. Liu, et al. The Stroke Prognosis Instrument II (SPI-II) : A Clinical Prediction Instrument for Patients With Transient Ischemia and Nondisabling Ischemic Stroke Stroke, February 1, 2000; 31(2): 456 - 462. [Abstract] [Full Text] [PDF]
|
|