Survival and recurrence after first cerebral infarction

Abstract

We used the Kaplan-Meier product limit method to estimate rates and Cox proportional hazards regression analysis with bootstrap validation to model significant independent predictors of and temporal trends in survival and recurrent stroke among 1,111 residents of Rochester, MN, who had a first cerebral infarction from 1975 through 1989. The risk of death after first cerebral infarction was 7% +/- 0.7% at 7 days, 14% +/- 1.0% at 30 days, 27% +/- 1.3% at 1 year, and 53% +/- 1.5% at 5 years. Independent risk factors for death after first cerebral infarction were age (p< 0.0001), congestive heart failure (p < 0.0001), persistent atrial fibrillation (p < 0.0001), recurrent stroke (p < 0.0001), and ischemic heart disease (p < 0.0001 for age < or =70, p > 0.05 for age >70). The risk of recurrent stroke after first cerebral infarction was 2% +/- 0.4% at 7 days, 4% +/- 0.6% at 30 days, 12% +/- 1.1% at 1 year, and 29% +/- 1.7% at 5 years. Age (p = 0.0002) and diabetes mellitus (p = 0.0004) were the only significant independent predictors of recurrent stroke. Neither the year nor the quinquennium of the first cerebral infarction was a significant determinant of survival or recurrence. The temporal trend toward improving survival after first cerebral infarction documented in Rochester, MN, in the decades before 1975 has ended.

Thirty‐day recurrence after ischemic stroke or TIA

“…Recurrent stroke is associated with increased disability and mortality compared to the index stroke (Petty et al, 1998; Sacco, Wolf, Kannel, & McNamara, 1982). And even with appropriate prevention, the risk of recurrence after ischemic stroke (IS) and transient ischemic attack (TIA) is high, especially in the early phase after stroke (Lovett, Coull, & Rothwell, 2004; Sacco, Shi, Zamanillo, & Kargman, 1994).…”

Epidemiology of transient ischemic attack and ischemic stroke in patients with underlying cardiovascular disease

“…6 The 5-year estimated recurrence rate is 25 to 29% or higher, which underscores the importance of implementing preventive strategies in patients who have suffered a stroke. 6, 43 Furthermore, despite frequent concerns about other cardiovascular events in stroke patients, evidence indicates that the most likely event to occur is another stroke, with more than 75% of secondary events in stroke patients being strokes. 14 Transient ischemic attack is a significant independent risk factor for ischemic stroke and carries an average annual risk of approximately 4%.…”

“…Other important determinants of mortality are congestive heart failure, persistent AF, and ischemic heart disease, with the interaction of ischemic heart disease and age conferring the highest risk of death. 43 However, age and diabetes mellitus are significant independent predictors of stroke recurrence. 43 …”

“…43 However, age and diabetes mellitus are significant independent predictors of stroke recurrence. 43 …”

Secondary stroke prevention: Review of clinical trials

“…1 The 5-year cumulative recurrence in Rochester, Minnesota, was 29%, with no difference between genders. 3 In northern Manhattan, stroke recurred in 12% of patients within 1 year, and in 25% within 5 years following ischemic stroke. 4 Patients with TIA are similarly at very high risk of subsequent events.…”