Department of Neurology, University Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Iras 39, Gerakas Attikis, 15344, Athens, Greece.
J Neurol. 2018 Oct;265(10):2379-2387. doi: 10.1007/s00415-018-9005-6. Epub 2018 Aug 20.
Up to date there is no population-based study from Greece providing long-term data on incidence of both all-cause mortality and stroke recurrence for patients with first ever stroke (FES). Adult patients with FES were registered during a 24-month period (2010-2012) and followed-up for 12 months. We calculated cumulative incidences of stroke mortality and recurrence. Univariable and multivariable Cox proportional hazards regression analyses were used to identify independent determinants of 1-year mortality and 1-year stroke recurrence. We prospectively documented 703 first ever stroke cases (mean age 75 ± 12 years; 52.8% males; ischemic stroke 80.8%, intracerebral hemorrhage 11.8%, subarachnoid hemorrhage 4.4%, undefined 3.0%) with a total follow-up time of 119,805 person-years. The cumulative incidence rates of mortality of all FES patients at 28 days, 3 months and 1 year were 21.3% (95% CI 18.5-24.5%), 26% (95% CI 22.9-29.4%) and 34.7% (95% CI 31.3-38.3%), respectively. The risk of 1-year mortality was independently (p < 0.05) associated with advancing age, history of hypertension, increased stroke severity on admission, and hemorrhagic FES type. Cumulative 1-year stroke mortality differed according to both index FES type (ischemic vs. hemorrhage; p < 0.001), but also across different ischemic stroke subtypes (p = 0.025). The cumulative incidence rates of recurrent stroke at 28 days, 3 months and 1 year were 2.0% (95% CI 1.2-3.6%), 4.2% (2.8-6.2%) and 6.7% (5.1-8.8%), respectively. Comparable to other population-based surveys, our study reports 1-year mortality and stroke recurrence rates in patients with FES. These findings highlight the need for effective secondary prevention strategies in a border region of southeastern Europe, which exhibits very high FES incidence rates.
目前，希腊尚无基于人群的研究提供首次卒中（FES）患者全因死亡率和卒中复发的长期数据。2010 年至 2012 年期间，我们对 24 个月内登记的 FES 成年患者进行了随访 12 个月。我们计算了卒中死亡率和复发的累积发生率。采用单变量和多变量 Cox 比例风险回归分析来确定 1 年死亡率和 1 年卒中复发的独立决定因素。我们前瞻性地记录了 703 例首次卒中病例（平均年龄 75±12 岁；52.8%为男性；缺血性卒中 80.8%，脑出血 11.8%，蛛网膜下腔出血 4.4%，未定义 3.0%），总随访时间为 119805 人年。所有 FES 患者在 28 天、3 个月和 1 年的死亡率累积发生率分别为 21.3%（95%CI 18.5-24.5%）、26%（95%CI 22.9-29.4%）和 34.7%（95%CI 31.3-38.3%）。1 年死亡率的风险独立（p<0.05）与年龄增长、高血压病史、入院时卒中严重程度增加以及出血性 FES 类型有关。1 年卒中死亡率的累积发生率不仅根据指数 FES 类型（缺血性 vs. 出血性；p<0.001）而有所不同，而且还根据不同的缺血性卒中亚型（p=0.025）而有所不同。28 天、3 个月和 1 年的卒中复发累积发生率分别为 2.0%（95%CI 1.2-3.6%）、4.2%（2.8-6.2%）和 6.7%（5.1-8.8%）。与其他基于人群的调查类似，我们的研究报告了 FES 患者的 1 年死亡率和卒中复发率。这些发现突出表明，在东南欧一个卒中发生率非常高的边境地区，需要采取有效的二级预防策略。
