Two-Year Recurrence After First-Ever Stroke in a General Population of 1.4 Million Japanese Patients　― The Shiga Stroke and Heart Attack Registry Study ―

Abstract

Background: Despite many effective strategies for the prevention of recurrent stroke, individuals who survive an initial stroke have been shown to be at high risk of recurrent stroke. The aim of this study was to investigate the current status of stroke recurrence after first-ever stroke using a population-based stroke registry in Japan. Methods and Results:As part of the Shiga Stroke and Heart Attack Registry, the Shiga Stroke Registry is an ongoing populationbased stroke registry study that covers approximately 1.4 million residents of Shiga Prefecture, Japan. A total of 1,883 first-ever stroke survivors at 28 days was registered in 2011 and followed-up until the end of 2013. Recurrence was defined as any type of stroke after 28 days from the onset of an index event. Two-year cumulative recurrence rates were estimated using cumulative incidence function methods. Over a mean 2.1-year follow-up period, 120 patients experienced recurrent stroke and 389 patients died without recurrence. The 2-year cumulative recurrence rate was higher in patients with index ischemic stroke (6.8%) than in those with index hemorrhagic stroke (3.8%).Conclusions: Two-year cumulative recurrence rate after first-ever stroke remained high, particularly among patients with ischemic stroke, in the present population-based registry study in a real-world setting in Japan. Further intensive secondary prevention strategies are required for these high-risk individuals.

Impacts of treatments on recurrence and 28-year survival of ischemic stroke patients

“…However, as the rate of stroke recurrence was higher in first two years of follow-up period, this may not substantially affect the final results. According to the previous studies from UK and Japan, they reported the proportions of 75% 11 and 92% 39 of those recurrent stoke patients who recurred within 2 years of follow-up since first stroke. Besides, there was 77% of recurrent stroke patients who recurred within first 3 years of follow-up among Chinese population 40 .…”

Indicators Predicting Inpatient Mortality in Post-Stroke Patients Admitted to a Chronic Care Hospital: A Retrospective Pilot Study

“…Age was a prognostic indicator for mortality during admission in our study. Takashima et al analyzed clinical factors that increase the 2-year and 5-year mortality after stroke in the Japanese population of 1.4 million persons [ 12 , 13 ]. In their study, patients with subarachnoid hemorrhage were also enrolled.…”

“…Likewise, regarding mortality risk, five years after stroke onset, the post hemorrhagic stroke patients aged from 75 to 84 years and those aged 85 years old or more had a hazard ratio of 29.18 and 57.69, respectively, when compared to those aged less than 45 years old. The post-ischemic stroke patients aged 75 to 84 and those aged 85 years old or older had a hazard ratio of 15.67 and 37.03, respectively, when compared to those aged less than 45 years old [ 12 , 13 ]. In our study, the mean age of the patients in the non-survival group was 85.7 years old.…”

“…With polytomous logistic regression analysis in our study, being male was identified as a predictor of mortality of post-stroke patients while hospitalized in a chronic-phase hospital. An association between male sex and high risk of 5-year mortality after an ischemic and hemorrhagic stroke was observed [ 13 ]. The male patients had a shorter life expectancy than the female patients [ 18 ]; this study finding and those from previous studies are consistent with life expectancy data.…”

“…In Japan, stroke is the third leading cause of death after cancer and heart disease [ 11 ]. Therefore, mortality after stroke is a concern for clinicians, and research on this topic is ongoing [ 12 , 13 , 14 , 15 ]. In a 2-year study by Takashima et al [ 12 ] involving Japanese patients with first-ever stroke, older age, male sex, history of stroke, higher Japan Coma Scale scores on admission, and subtypes of stroke (such as cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage) were associated with a risk of all-cause mortality.…”