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(Stroke. 2009;40:3567.)
© 2009 American Heart Association, Inc.

Original Contributions

Three-Year Survival and Stroke Recurrence Rates in Patients With Primary Intracerebral Hemorrhage

Elisabet Zia, MD; Gunnar Engström, MD, PhD; Peter J. Svensson, MD, PhD; Bo Norrving, MD, PhD Hélène Pessah-Rasmussen, MD, PhD

From the Cardiovasular Epidemiology Research Group (E.Z., G.E., H.P.-R.), Department of Neurology (E.Z., H.P.-R.), and Department of Coagulation Disorders (P.J.S.), Malmö University Hospital, Institution of Clinical Sciences in Malmö, University of Lund, Lund, Sweden; Astra Zeneca R&D (G.E.), Lund, Sweden; and the Department of Neurology (B.N.), Lund University Hospital, Lund, Sweden.

Correspondence to Elisabet Zia, MD, Institution of Clinical Sciences, Malmö, University of Lund, Malmö, Sweden 205 02. E-mail elisabet.zia{at}med.lu.se

Background and Purpose— There are few studies on the prognosis after primary intracerebral hemorrhages, and they reported big differences in mortality rates. Our aim was to evaluate mortality and stroke recurrence rates in relation to hemorrhage characteristics, demographic and clinical factors, in a large unselected patient cohort.

Methods— We analyzed consecutive cases of first-ever primary intracerebral hemorrhages from 1993 to 2000 in a prospective stroke register covering the Malmö region, Sweden (population approximately 250 000). Mortality rates during 28 days and 3 years of follow-up and recurrence rates were analyzed.

Results— A total of 474 cases were identified (46% women). In patients <75 years of age, 20% of the women and 23% of the men died within 28 days (P=0.38). The corresponding figures in patients 75 years were 26% and 41%, respectively (P=0.02). Male sex was an independent risk factor both for 28-day (OR, 1.5; 95% CI, 1.008 to 2.2) and 3-year mortality (OR, 1.7; 95% CI, 1.3 to 2.3). Other independent predictors of death were high age, central and brain stem hemorrhage location, intraventricular hemorrhage, increased volume, and decreased consciousness level. The recurrence rate was 5.1 per 100 person-years, 2.3 per 100 person-years for intracerebral hemorrhage and 2.8 per 100 person-years for cerebral infarction. Only age >65 years was significantly related to recurrent stroke.

Conclusion— Women had better survival than men after primary intracerebral hemorrhages. The difference is largely explained by a higher 28-day mortality in male patients >75 years. However, the underlying reasons are yet to be explored.

Key Words: acute stroke • anticoagulation • cerebrovascular disease • diabetes mellitus • epidemiology • hemorrahage • ICH • intracerebral hemorrhage • intracranial hemorrhage • prognosis • smoking • stroke management • warfarin