Skajaa Nils, Adelborg Kasper, Horváth-Puhó Erzsébet, Rothman Kenneth J, Henderson Victor W, Thygesen Lau Caspar, Sørensen Henrik Toft
From the Department of Clinical Epidemiology and Clinical Medicine, Aarhus University (N.S., K.A., E.H-P., K.J.R., V.W.H., H.T.S.), and Department of Clinical Biochemistry, Thrombosis and Hemostasis Research Unit (K.A.), Aarhus University Hospital; National Institute of Public Health (N.S., L.C.T.), University of Southern Denmark, Copenhagen; Department of Epidemiology (K.J.R., H.T.S.), Boston University School of Public Health, MA; RTI Health Solutions (K.J.R.), Research Triangle Institute, Research Triangle Park, NC; and Departments of Epidemiology and Population Health (V.W.H., H.T.S.) and Neurology and Neurological Sciences (V.W.H.), Stanford University, CA.
Neurology. 2022 Jan 24;98(4):e329-e342. doi: 10.1212/WNL.0000000000013118.
To examine risks of stroke recurrence and mortality after first and recurrent stroke.
Using Danish nationwide health registries, we included patients age ≥18 years with first-time ischemic stroke (n = 105,397) or intracerebral hemorrhage (ICH) (n = 13,350) from 2004 to 2018. Accounting for the competing risk of death, absolute risks of stroke recurrence were computed separately for each stroke subtype and within strata of age groups, sex, stroke severity, body mass index, smoking, alcohol use, Essen stroke risk score, and atrial fibrillation. Mortality risks were computed after first and recurrent stroke.
After adjusting for competing risks, the overall 1-year and 10-year risks of recurrence were 4% and 13% following first-time ischemic stroke and 3% and 12% following first-time ICH. For ischemic stroke, the risk of recurrence increased with age and was higher for men and following mild vs more severe stroke. The most marked differences were across Essen risk scores, for which recurrence risks increased with increasing scores. For ICH, risks were similar for both sexes and did not increase with Essen risk score. For ischemic stroke, the 1-year and 10-year risks of all-cause mortality were 17% and 56% after a first-time stroke and 25% and 70% after a recurrent stroke; corresponding estimates for ICH were 37% and 70% after a first-time event and 31% and 75% after a recurrent event.
The risk of stroke recurrence was substantial following both subtypes, but risks differed markedly among patient subgroups. The risk of mortality was higher after a recurrent than first-time stroke.
研究首次及复发性卒中后卒中复发和死亡的风险。
利用丹麦全国健康登记系统，我们纳入了2004年至2018年年龄≥18岁的首次缺血性卒中患者（n = 105,397）或脑出血（ICH）患者（n = 13,350）。考虑到死亡的竞争风险，分别计算每种卒中亚型以及年龄组、性别、卒中严重程度、体重指数、吸烟、饮酒、埃森卒中风险评分和心房颤动分层内的卒中复发绝对风险。计算首次和复发性卒中后的死亡风险。
在调整竞争风险后，首次缺血性卒中后1年和10年的总体复发风险分别为4%和13%，首次ICH后分别为3%和12%。对于缺血性卒中，复发风险随年龄增加而增加，男性以及轻度卒中后的复发风险高于重度卒中。最显著的差异在于埃森风险评分，复发风险随评分增加而增加。对于ICH，两性的风险相似，且不随埃森风险评分增加。对于缺血性卒中，首次卒中后1年和10年的全因死亡风险分别为17%和56%，复发性卒中后分别为25%和70%；ICH首次事件后相应的估计值为37%和70%，复发性事件后为31%和75%。
两种亚型卒中后卒中复发风险都很高，但患者亚组之间风险差异显著。复发性卒中后的死亡风险高于首次卒中。
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