Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C
Department of Rehabilitation Medicine, Southampton General Hospital, United Kingdom.
Stroke. 1994 Feb;25(2):333-7. doi: 10.1161/01.str.25.2.333.
There have been few community-based studies of long-term prognosis after acute stroke. This study aims to provide precise estimates of the absolute and relative risks of stroke recurrence in an unselected cohort of patients with a first-ever stroke.
Six hundred seventy-five patients were registered in a community-based stroke register (the Oxfordshire Community Stroke Project) and prospectively followed for up to 6.5 years. Their relative risk of recurrent stroke was calculated using age- and sex-specific incidence rates for first stroke in Oxfordshire.
One hundred eighty recurrent episodes of stroke were identified, of which 135 were first recurrences. Given survival, the actuarial risk of suffering a recurrence was 30% (95% confidence interval, 20% to 39%) by 5 years, about nine times the risk of stroke in the general population. The risk was highest early after the first stroke: 13% (95% confidence interval, 10% to 16%) by 1 year, 15 times the risk in the general population. After the first year the average annual risk was about 4%. The risk of stroke recurrence did not appear to be related to age or pathological type of stroke.
The absolute and relative risks of recurrent stroke are highest early after the first stroke but remain elevated for several years thereafter. Efforts at secondary prevention should be initiated as soon as possible and continued for several years to gain greatest benefit.
关于急性卒中后长期预后的社区研究较少。本研究旨在精确估计首次卒中患者未选择队列中卒中复发的绝对风险和相对风险。
675例患者登记于一个基于社区的卒中登记系统（牛津郡社区卒中项目），并进行了长达6.5年的前瞻性随访。使用牛津郡首次卒中的年龄和性别特异性发病率计算其复发性卒中的相对风险。
共识别出180次卒中复发事件，其中135次为首次复发。考虑到生存情况，5年时复发的精算风险为30%（95%置信区间，20%至39%），约为一般人群卒中风险的9倍。风险在首次卒中后早期最高：1年时为13%（95%置信区间，10%至16%），是一般人群风险的15倍。1年后平均年风险约为4%。卒中复发风险似乎与年龄或卒中病理类型无关。
复发性卒中的绝对风险和相对风险在首次卒中后早期最高，但此后数年仍持续升高。二级预防应尽早开始并持续数年以获得最大益处。
