(Stroke. 1998;29:2491-2500.)
© 1998 American Heart Association, Inc.
Original Contributions |
Long-Term Risk of First Recurrent Stroke in the Perth Community Stroke Study
From the Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Western Australia (G.J.H., E.G.S-W.); Departments of Public Health (K.J., R.J.B., S.F.) and Psychiatry and Behavioral Science (P.W.B.), University of Western Australia, Perth; and Faculty of Medicine and Health Science, University of Auckland, Auckland, New Zealand (C.S.A.).
Correspondence to Dr Graeme J Hankey, Stroke Unit, Department of Neurology, Royal Perth Hospital, GPO Box X2213, Perth, Western Australia 6001, Australia. E-mail gjhankey{at}cyllene.uwa.edu.au
Background and Purpose—Few community-based studies have examined the long-term risk of recurrent stroke after an acute first-ever stroke. This study aimed to determine the absolute and relative risks of a first recurrent stroke over the first 5 years after a first-ever stroke and the predictors of such recurrence in a population-based series of people with first-ever stroke in Perth, Western Australia.
Methods—Between February 1989 and August 1990, all people with a suspected acute stroke or transient ischemic attack of the brain who were resident in a geographically defined region of Perth, Western Australia, with a population of 138 708 people, were registered prospectively and assessed according to standardized diagnostic criteria. Patients were followed up prospectively at 4 months, 12 months, and 5 years after the index event.
Results—Three hundred seventy patients with a first-ever stroke were registered, of whom 351 survived >2 days. Data were available for 98% of the cohort at 5 years, by which time 199 patients (58%) had died and 52 (15%) had experienced a recurrent stroke, 12 (23%) of which were fatal within 28 days. The 5-year cumulative risk of first recurrent stroke was 22.5% (95% confidence limits [CL], 16.8%, 28.1%). The risk of recurrent stroke was greatest in the first 6 months after stroke, at 8.8% (95% CL, 5.4%, 12.1%). After adjustment for age and sex, the prognostic factors for recurrent stroke were advanced, but not extreme, age (75 to 84 years) (hazard ratio [HR], 2.6; 95% CL, 1.1, 6.2), hemorrhagic index stroke (HR, 2.1; 95% CL, 0.98, 4.4), and diabetes mellitus (HR, 2.1; 95% CL, 0.95, 4.4).
Conclusions—Approximately 1 in 6 survivors (15%) of a first-ever stroke experience a recurrent stroke over the next 5 years, of which 25% are fatal within 28 days. The pathological subtype of the recurrent stroke is the same as that of the index stroke in 88% of cases. The predictors of first recurrent stroke in this study were advanced age, hemorrhagic index stroke, and diabetes mellitus, but numbers of recurrent events were modest. Because the risk of recurrent stroke is highest (8.8%) in the first 6 months after stroke, strategies for secondary prevention should be initiated as soon as possible after the index event.
Key Words: Australia • prognosis • recurrence • stroke outcome
This article has been cited by other articles:
 |
|
 |
|
  K M Mohan, S L Crichton, A P Grieve, A G Rudd, C D A Wolfe, and P U Heuschmann Frequency and predictors for the risk of stroke recurrence up to 10 years after stroke: the South London Stroke Register J. Neurol. Neurosurg. Psychiatry, September 1, 2009; 80(9): 1012 - 1018. [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]
|
|
|
|
 |
|
 F. Cosentino, L. Rydén, P. Francia, and L. G. Mellbin CHAPTER 14 Diabetes Mellitus and Metabolic Syndrome ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Sander, K. Sander, and H. Poppert Review: Stroke in type 2 diabetes The British Journal of Diabetes & Vascular Disease, September 1, 2008; 8(5): 222 - 229. [Abstract] [PDF]
|
|
|
|
 |
|
 E. L. Air and B. M. Kissela Diabetes, the Metabolic Syndrome, and Ischemic Stroke: Epidemiology and possible mechanisms Diabetes Care, December 1, 2007; 30(12): 3131 - 3140. [Full Text] [PDF]
|
|
|
|
|
|
H C Hanger, T J Wilkinson, N Fayez-Iskander, and R Sainsbury The risk of recurrent stroke after intracerebral haemorrhage J. Neurol. Neurosurg. Psychiatry, August 1, 2007; 78(8): 836 - 840. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Benbassat and R. Baumal The time horizons of formal decision analyses QJM, June 1, 2007; 100(6): 383 - 388. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Carter, A. J. Catto, M. W. Mansfield, J. M. Bamford, and P. J. Grant Predictive Variables for Mortality After Acute Ischemic Stroke Stroke, June 1, 2007; 38(6): 1873 - 1880. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. T. Meenan, S. Saha, R. Chou, K. Swarztrauber, K. Pyle Krages, M. C. O'Keeffe-Rosetti, M. McDonagh, B. K. S. Chan, M. C. Hornbrook, and M. Helfand Cost-Effectiveness of Echocardiography to Identify Intracardiac Thrombus among Patients with First Stroke or Transient Ischemic Attack Med Decis Making, March 1, 2007; 27(2): 161 - 177. [Abstract] [PDF]
|
|
|
|
|
|
H. Arima, C. Tzourio, K. Butcher, C. Anderson, M.-G. Bousser, K. R. Lees, J. L. Reid, T. Omae, M. Woodward, S. MacMahon, et al. Prior Events Predict Cerebrovascular and Coronary Outcomes in the PROGRESS Trial Stroke, June 1, 2006; 37(6): 1497 - 1502. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. I. Paraskevas, S. S. Daskalopoulou, M. E. Daskalopoulos, and C. D. Liapis Secondary Prevention of Ischemic Cerebrovascular Disease. What Is the Evidence? Angiology, September 1, 2005; 56(5): 539 - 552. [Abstract] [PDF]
|
|
|
|
 |
|
 P. M.W. Bath, L. Zhao, and S. Heptinstall Current status of stroke prevention in patients with atrial fibrillation Eur. Heart J. Suppl., May 1, 2005; 7(suppl_C): C12 - C18. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.K. Lovett, J.N.E. Redgrave, and P.M. Rothwell A Critical Appraisal of the Performance, Reporting, and Interpretation of Studies Comparing Carotid Plaque Imaging With Histology Stroke, May 1, 2005; 36(5): 1085 - 1091. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J Hata, Y Tanizaki, Y Kiyohara, I Kato, M Kubo, K Tanaka, K Okubo, H Nakamura, Y Oishi, S Ibayashi, et al. Ten year recurrence after first ever stroke in a Japanese community: the Hisayama study J. Neurol. Neurosurg. Psychiatry, March 1, 2005; 76(3): 368 - 372. [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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
K.M.A. Welch Statins for the prevention of cerebrovascular disease: the rationale for robust intervention Eur. Heart J. Suppl., July 1, 2004; 6(suppl_C): C34 - C42. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. S. Patel, C. Kyriakides, P. Norman, J. Semmens, C. Laurvick, and M. Lawrence-Brown Long-Term Relative Survival in Elderly Patients After Carotid Endarterectomy * Response Stroke, June 1, 2004; 35(6): e148 - e148. [Full Text] [PDF]
|
|
|
|
 |
|
 F. O'Rourke, N. Dean, N. Akhtar, and A. Shuaib Current and future concepts in stroke prevention Can. Med. Assoc. J., March 30, 2004; 170(7): 1123 - 1133. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Chapman, R. Huxley, C. Anderson, M.G. Bousser, J. Chalmers, S. Colman, S. Davis, G. Donnan, S. MacMahon, B. Neal, et al. Effects of a Perindopril-Based Blood Pressure-Lowering Regimen on the Risk of Recurrent Stroke According to Stroke Subtype and Medical History: The PROGRESS Trial Stroke, January 1, 2004; 35(1): 116 - 121. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. E. Ho, F. Paultre, and L. Mosca Is Diabetes Mellitus a Cardiovascular Disease Risk Equivalent for Fatal Stroke in Women?: Data From the Women's Pooling Project Stroke, December 1, 2003; 34(12): 2812 - 2816. [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]
|
|
|
|
 |
|
 T. F. Luscher, M. A. Creager, J. A. Beckman, and F. Cosentino Diabetes and Vascular Disease: Pathophysiology, Clinical Consequences, and Medical Therapy: Part II Circulation, September 30, 2003; 108(13): 1655 - 1661. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Flossmann and P. M. Rothwell Prognosis of vertebrobasilar transient ischaemic attack and minor stroke Brain, September 1, 2003; 126(9): 1940 - 1954. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Cherian, G. J. Hankey, J. W. Eikelboom, J. Thom, R. I. Baker, A. McQuillan, J. Staton, and Q. Yi Endothelial and Platelet Activation in Acute Ischemic Stroke and Its Etiological Subtypes Stroke, September 1, 2003; 34(9): 2132 - 2137. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. E. Norman, J. B. Semmens, C. L. Laurvick, and M. Lawrence-Brown Long-Term Relative Survival in Elderly Patients After Carotid Endarterectomy: A Population-Based Study Stroke, July 1, 2003; 34 (7): e95 - e98. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Hillen, C. Coshall, K. Tilling, A. G. Rudd, R. McGovern, and C. D.A. Wolfe Cause of Stroke Recurrence Is Multifactorial: Patterns, Risk Factors, and Outcomes of Stroke Recurrence in the South London Stroke Register Stroke, June 1, 2003; 34(6): 1457 - 1463. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Vermeer, T. den Heijer, P. J. Koudstaal, M. Oudkerk, A. Hofman, and M. M.B. Breteler Incidence and Risk Factors of Silent Brain Infarcts in the Population-Based Rotterdam Scan Study Stroke, February 1, 2003; 34(2): 392 - 396. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Appelros, I. Nydevik, and M. Viitanen Poor Outcome After First-Ever Stroke: Predictors for Death, Dependency, and Recurrent Stroke Within the First Year Stroke, January 1, 2003; 34(1): 122 - 126. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Bak, S. H. Sindrup, T. Alslev, O. Kristensen, K. Christensen, and D. Gaist Cessation of Smoking After First-Ever Stroke: A Follow-Up Study Stroke, September 1, 2002; 33(9): 2263 - 2269. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Vermeer, A. Algra, C. L. Franke, P. J. Koudstaal, and G. J.E. Rinkel Long-term prognosis after recovery from primary intracerebral hemorrhage Neurology, July 23, 2002; 59(2): 205 - 209. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. H. Messerli, D. F. Hanley Jr., and P. B. Gorelick Blood pressure control in stroke patients: What should the consulting neurologist advise? Neurology, July 9, 2002; 59(1): 23 - 25. [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Beckman, M. A. Creager, and P. Libby Diabetes and Atherosclerosis: Epidemiology, Pathophysiology, and Management JAMA, May 15, 2002; 287(19): 2570 - 2581. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Lalouschek, W. Lang, and M. Mullner Current Strategies of Secondary Prevention After a Cerebrovascular Event: The Vienna Stroke Registry Stroke, December 1, 2001; 32(12): 2860 - 2866. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. D. Bailey, R. G. Hart, O. Benavente, and L. A. Pearce Recurrent brain hemorrhage is more frequent than ischemic stroke after intracranial hemorrhage Neurology, March 27, 2001; 56(6): 773 - 777. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. J. Hankey, K. Jamrozik, R. J. Broadhurst, S. Forbes, P. W. Burvill, C. S. Anderson, and E. G. Stewart-Wynne Five-Year Survival After First-Ever Stroke and Related Prognostic Factors in the Perth Community Stroke Study Stroke, September 1, 2000; 31(9): 2080 - 2086. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|