This Article Full Text Full Text (PDF) All Versions of this Article: 34/8/1828    most recent 01.STR.0000080534.98416.A0v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Vernino, S. Articles by O’Fallon, W. M. Search for Related Content PubMed PubMed Citation Articles by Vernino, S. Articles by O’Fallon, W. M. Related Collections Acute Cerebral Infarction

(Stroke. 2003;34:1828.)
© 2003 American Heart Association, Inc.

Original Contributions

Cause-Specific Mortality After First Cerebral Infarction

A Population-Based Study

Steven Vernino, MD, PhD; Robert D. Brown, Jr, MD, MPH; James J. Sejvar, MD; JoRean D. Sicks, MS; George W. Petty, MD W. Michael O’Fallon, PhD

From the Department of Neurology (S.V., R.D.B., J.J.S., G.W.P.) and the Department of Health Sciences Research (J.D.S., W.M.O.), Mayo Clinic, Rochester, Minn.

Reprint requests to Robert D. Brown, Jr, MD, Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail brown.robert{at}mayo.edu

Background and Purpose— Mortality after cerebral infarction (CI) has remained unchanged during the past 20 years, despite advances in neurologic care. Key factors affecting survival may be underrecognized. The purpose of this study was to determine the rate and cause of mortality after first CI.

Methods— In this case-control, population-based study, all available medical records were reviewed for Rochester (Minnesota) residents with a first CI between 1985 and 1989 to identify morbidities and cause of death. Predictors for mortality were analyzed.

Results— First CI was recorded for 444 patients. Survival was 83% at 1 month, 71% at 1 year, and 46% at 5 years. The most frequent causes of death were cardiovascular events (22%), respiratory infection (21%), and initial stroke complications (14%). Recurrent stroke and cancer accounted for 9% and 7.5% of deaths, respectively. In the first month after CI, 51% of deaths were attributed to the initial CI, 22% to respiratory infections, and 12% to cardiovascular events. During the first year, 26% of deaths resulted from respiratory infections and 28% from cardiovascular disease. Mortality was higher among patients than controls for at least 2 years after CI. Age, cardiac comorbid conditions, CI severity, stroke recurrence, seizures, and respiratory and cardiovascular morbidities were independent predictors of death.

Conclusions— In the first month after CI, mortality resulted predominantly from neurologic complications. Later mortality remained high because of respiratory and cardiovascular causes. To improve long-term survival after CI, aggressive management of pulmonary and cardiac disease is as important as secondary stroke prevention.

Key Words: cerebral infarction • epidemiology • heart disease • mortality • pneumonia

This article has been cited by other articles:

				M. S. Dhamoon, W. Tai, B. Boden-Albala, T. Rundek, M. C. Paik, R. L. Sacco, and M. S.V. Elkind Risk of Myocardial Infarction or Vascular Death After First Ischemic Stroke: The Northern Manhattan Study Stroke, June 1, 2007; 38(6): 1752 - 1758. [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]

				D. A. Levine, C. I. Kiefe, G. Howard, V. J. Howard, O. D. Williams, and J. J. Allison Reduced Medication Access: A Marker for Vulnerability in US Stroke Survivors Stroke, May 1, 2007; 38(5): 1557 - 1564. [Abstract] [Full Text] [PDF]

				D. L. Brown, F. Al-Senani, L. D. Lisabeth, M. A. Farnie, L. A. Colletti, K. M. Langa, A. M. Fendrick, N. M. Garcia, M. A. Smith, and L. B. Morgenstern Defining Cause of Death in Stroke Patients: The Brain Attack Surveillance in Corpus Christi Project Am. J. Epidemiol., March 1, 2007; 165(5): 591 - 596. [Abstract] [Full Text] [PDF]

				A. Chamorro, X. Urra, and A. M. Planas Infection After Acute Ischemic Stroke: A Manifestation of Brain-Induced Immunodepression Stroke, March 1, 2007; 38(3): 1097 - 1103. [Abstract] [Full Text] [PDF]

				D. A. Levine, C. I. Kiefe, T. K. Houston, J. J. Allison, E. P. McCarthy, and J. Z. Ayanian Younger Stroke Survivors Have Reduced Access to Physician Care and Medications: National Health Interview Survey From Years 1998 to 2002 Arch Neurol, January 1, 2007; 64(1): 37 - 42. [Abstract] [Full Text] [PDF]

				P. Ryvlin, A. Montavont, and N. Nighoghossian Optimizing therapy of seizures in stroke patients Neurology, December 26, 2006; 67(12_suppl_4): S3 - S9. [Abstract] [Full Text]

				K. Prass, J. S. Braun, U. Dirnagl, C. Meisel, and A. Meisel Stroke Propagates Bacterial Aspiration to Pneumonia in a Model of Cerebral Ischemia Stroke, October 1, 2006; 37(10): 2607 - 2612. [Abstract] [Full Text] [PDF]

				M. S. Dhamoon, R. R. Sciacca, T. Rundek, R. L. Sacco, and M.S.V. Elkind Recurrent stroke and cardiac risks after first ischemic stroke: The Northern Manhattan Study Neurology, March 14, 2006; 66(5): 641 - 646. [Abstract] [Full Text] [PDF]

				M. Fenchel, A. M. Scheule, N. I. Stauder, U. Kramer, K. Tomaschko, T. Nagele, C. Bretschneider, H.-P. Schlemmer, C. D. Claussen, and S. Miller Atherosclerotic Disease: Whole-Body Cardiovascular Imaging with MR System with 32 Receiver Channels and Total-Body Surface Coil Technology--Initial Clinical Results Radiology, December 1, 2005; 238(1): 280 - 291. [Abstract] [Full Text] [PDF]

				H.-J. Bae, D.-S. Yoon, J. Lee, B.-K. Kim, J.-S. Koo, O. Kwon, and J.-M. Park In-Hospital Medical Complications and Long-Term Mortality After Ischemic Stroke Stroke, November 1, 2005; 36(11): 2441 - 2445. [Abstract] [Full Text] [PDF]

				D. Kleindorfer, P. Panagos, A. Pancioli, J. Khoury, B. Kissela, D. Woo, A. Schneider, K. Alwell, E. Jauch, R. Miller, et al. Incidence and Short-Term Prognosis of Transient Ischemic Attack in a Population-Based Study Stroke, April 1, 2005; 36(4): 720 - 723. [Abstract] [Full Text] [PDF]

				W. N. Kernan, C. M. Viscoli, S. E. Inzucchi, L. M. Brass, D. M. Bravata, G. I. Shulman, and J. C. McVeety Prevalence of Abnormal Glucose Tolerance Following a Transient Ischemic Attack or Ischemic Stroke Arch Intern Med, January 24, 2005; 165(2): 227 - 233. [Abstract] [Full Text] [PDF]

				Z. G. Nadareishvili, H. Li, V. Wright, D. Maric, S. Warach, J. M. Hallenbeck, J. Dambrosia, J. L. Barker, and A. E. Baird Elevated pro-inflammatory CD4+CD28- lymphocytes and stroke recurrence and death Neurology, October 26, 2004; 63(8): 1446 - 1451. [Abstract] [Full Text] [PDF]

				P. C. Esselman Inpatient Rehabilitation Outcome Trends: Implications for the Future JAMA, October 13, 2004; 292(14): 1746 - 1748. [Full Text] [PDF]

				A. Terent Cerebrovascular Mortality 10 Years After Stroke: A Population-Based Study Stroke, July 1, 2004; 35(7): e343 - e345. [Abstract] [Full Text] [PDF]

				O. Camilo and L. B. Goldstein Seizures and Epilepsy After Ischemic Stroke Stroke, July 1, 2004; 35(7): 1769 - 1775. [Abstract] [Full Text] [PDF]

				Other articles noted: 25 Jul 03 to 7 Nov 03 Evid. Based Nurs., January 1, 2004; 7(1): e1 - 1. [Full Text] [PDF]