Cause-Specific Mortality After First Cerebral Infarction

Abstract

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.

Time Course of Evolution of Disability and Cause‐Specific Mortality After Ischemic Stroke: Implications for Trial Design

“…Our finding that 3‐month mRS score predicts 5‐year mortality, suggesting that reduction of early disability might reduce long‐term mortality, is in agreement with 4 prior studies that examined early stroke disability and long‐term mortality 9, 10, 11, 13. Our study adds a robust population‐based design, high rates of ascertainment of all incident strokes, assessment of causes of late poststroke death, completeness of follow‐up (1.5% missing), and replication of findings in important subgroups.…”

Microglia and Monocyte-Derived Macrophages in Stroke

“…Other studies have demonstrated that stroke-induced immune suppression increases the risk of secondary infections and increases mortality rates in patients [16,17]. Up to 65 % of patients with stroke suffer from pneumonia and urinary tract infections [18,19], and approximately 30 % of them die from stroke-related infections [20][21][22]. Studies focusing on the innate immune system have shown that stroke impairs the respiratory burst and subsequent generation of inflammatory mediators in granulocytes and monocytes [23,24].…”

Epidemiology of Upper Gastrointestinal Bleeding

“…My findings contrast with that for other acute life limiting medical events where three quarters of the excess death following a myocardial infarction were shown to be due to the cardiovascular disease, and two thirds of the excess death following a stroke were shown to be due to related respiratory infections, cardiovascular or the cereberovascular disease itself. 195,196 The main strengths of this study compared to previous studies are its larger size, follow up, competing risk adjustment, and general population setting.…”

“…For example three quarters of deaths following a myocardial infarction were due to the cardiovascular disease itself, but after a stroke, two fifths of deaths were due to related respiratory infections and cardiovascular disease. 195,196 In contrast, the long term outcomes of upper gastrointestinal haemorrhage are poorly understood, despite it being the most frequent gastroenterology admission to acute medicine. There has rightly been a focus on the high mortality in the first 30 days of which 60-80% was attributed to co-morbidity.…”