Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
Acta Neurol Scand. 2019 Jul;140(1):3-8. doi: 10.1111/ane.13093. Epub 2019 Apr 11.
Recurrent ischemic stroke (IS) or TIA is frequent with a considerable variation in incidence and mortality across populations. Current data on stroke recurrence and mortality are useful to examine trends, risk factors, and treatment effects. In this study, we calculated the incidence of recurrent IS or TIA in a hospital-based stroke population in Western Norway, investigated recurrence factors, and estimated the effect of recurrence on all-cause mortality.
This prospective cohort study registered recurrence and mortality among 1872 IS and TIA survivors admitted to the stroke unit at Haukeland University Hospital between July 2007 and December 2013. Recurrence and death until September 1, 2016, were identified by medical chart review. Cumulative incidences of recurrence were estimated with a competing risks Cox model. Multivariate Cox models were used to examine recurrence factors and mortality.
During follow-up, 220 patients had 277 recurrent IS or TIAs. The cumulative recurrence rate was 5.4% at 1 year, 11.3% at 5 years, and 14.2% at the end of follow-up. Hypertension (HR = 1.65, 95% CI 1.21-2.25), prior symptomatic stroke (HR = 1.63, 95% CI 1.18-2.24), chronic infarcts on MRI (HR = 1.48, 95% CI 1.10-1.99), and age (HR 1.02/year, 95% CI 1.00-1.03) were independently associated with recurrence. A total of 668 (35.7%) patients died during follow-up. Recurrence significantly increased the all-cause mortality (HR = 2.55, 95% CI 2.04-3.18).
The risk of recurrent IS stroke or TIA was modest in our population and was associated with previously established risk factors. Recurrence more than doubled the all-cause mortality.
复发性缺血性卒中（IS）或短暂性脑缺血发作（TIA）较为常见，其发病率和死亡率在不同人群中存在较大差异。目前有关卒中复发和死亡率的数据可用于检查趋势、风险因素和治疗效果。在本研究中，我们计算了挪威西部一家医院卒中人群中复发性 IS 或 TIA 的发生率，研究了复发的相关因素，并评估了复发对全因死亡率的影响。
本前瞻性队列研究纳入了 2007 年 7 月至 2013 年 12 月期间入住豪克兰德大学医院卒中病房的 1872 例 IS 和 TIA 幸存者，记录其复发和死亡情况。通过病历回顾确定截至 2016 年 9 月 1 日的复发和死亡情况。使用竞争风险 Cox 模型估计复发的累积发生率。采用多变量 Cox 模型分析复发的相关因素和死亡率。
随访期间，220 例患者发生了 277 次 IS 或 TIA 复发。1 年时的累积复发率为 5.4%，5 年时为 11.3%，随访结束时为 14.2%。高血压（HR=1.65，95%CI 1.21-2.25）、有症状性卒中既往史（HR=1.63，95%CI 1.18-2.24）、MRI 上有慢性梗死（HR=1.48，95%CI 1.10-1.99）和年龄（HR 每增加 1 岁/年，95%CI 1.00-1.03）与复发独立相关。随访期间共有 668 例（35.7%）患者死亡。复发显著增加了全因死亡率（HR=2.55，95%CI 2.04-3.18）。
在我们的人群中，IS 卒中或 TIA 的复发风险适中，与已确定的风险因素相关。复发使全因死亡率增加了一倍以上。
