Survival and Recurrent Strokes in Patients with Different Subtypes of Stroke: A Fourteen-Year Follow-Up Study

Abstract

In this study, 339 patients (154 men, 185 women) with a median age of 74 years (range 23–97) admitted to the Stroke Unit, Department of Neurology in 1986, have been followed up for 14 years. The diagnoses were intracerebral hemorrhage (ICH; 30, 8.8%), cardioembolic cerebral infarction (CE, 71, 20.9%), lacunar infarction (LI; 47, 13.9%) and atherosclerotic cerebral infarction (ACI; 191, 56.3%). The cumulative probabilities of recurrent stroke rates at 1-, 5- and 10-year follow-ups were 13.5% (95% confidence interval, CI, 9.6–17.4), 38.7% (95% CI 32.6–44.8) and 53.9% (95% CI 46.7–61.1). According to Cox proportional hazard regression analysis, age, severity of stroke, previous stroke and systolic blood pressure are each of importance in predicting recurrent stroke. During the observation period, 290 patients (85.5%) died. The mortality rate of 24.5% during the first year was 4.5 times higher compared to the normal population of the same age and gender. Patients with LI had lower mortality rates compared to ICH by the log rank test (p = 0.0275); to CE (p = 0.000) and to ACI (p = 0.049). Thirty-nine percent of all vascular deaths after the first year were caused by recurrent strokes. Fatal index/recurrent stroke occurred statistically more frequently in the CE group versus the non-CE one (p = 0.005). Cox proportional hazard regression analysis indicated that age, severity of stroke, previous stroke, heart failure and fasting blood glucose exceeding 6 mmol/l or history of diabetes were each predictors of mortality. In conclusion, this study has shown the worse outcomes for all subtypes of stroke compared to the normal population and also clearly pointed out independent predictors of recurrent stroke or death at the time of diagnosis.

Improving the One-Year Mortality of Stroke Patients: An 18-Year Observation in a Teaching Hospital

“…In addition, the 90-day survival rates of ischemic stroke patients noted in this study (92%) were slightly higher than those obtained from another medical center in Taiwan (Chang et al 2006). The one-year survival rates for cerebral hemorrhage (71%) and cerebral infarction (84%) in this study were higher than those of studies conducted in Perth, Australia (Anderson et al 1994) and in the Arcadia region of Greece (Vemmos et al 2000) but comparable to those conducted in Hong Kong (Wong and Li 2003), Canada (Saposnik et al 2008), and Sweden (Eriksson and Olsson, 2001). Age appears to be the most important predictor of the one-year mortality of stroke patients; however, a number of previous studies (Anderson et al 1994;Vemmos et al 2000;Eriksson and Olsson 2001;Wong and Li 2003) have not reported the exact risk estimates for various age levels.…”

“…Our study also showed that heart failure may also be a predictor of the one-year mortality of patients with cerebral infarction but not of those with cerebral hemorrhage. Previous studies (Eriksson and Olsson 2001;Koton et al 2010) similarly reported that congestive heart failure is a significant predictor of mortality in stroke patients. A small number of heart-failure patients with cerebral hemorrhage may have underpowered the statistical analysis in this study.…”

Comparison of risk factors, severity and outcome between lacunar and non-lacunar stroke in a tertiary care center in Sri Lanka: A descriptive study

“…This finding is comparable to data from other Asian countries such as Japan and China [1,13]. Studies on stroke in European and North American countries show a higher non-LAC burden [1,14]. Small vessel disease appears to be commoner in the Asian region than in the West.…”

Early stroke case-fatality rates in three hospital registries in the Northeast and Southeast of Brazil

“…Most early case-fatality risk factors for hemorrhagic and ischemic stroke are well-described in the literature 6,12 . Overall, we found that advanced age, diabetes and previous heart disease were associated with a high case-fatality rate at 28 days for the ischemic subtype.…”