Hankey G J, Jamrozik K, Broadhurst R J, Forbes S, Burvill P W, Anderson C S, Stewart-Wynne E G
Stroke Unit, Department of Neurology, Royal Perth Hospital, Perth, Western Australia.
Stroke. 1998 Dec;29(12):2491-500. doi: 10.1161/01.str.29.12.2491.
Few community-based studies have examined the long-term risk of recurrent stroke after an acute first-ever stroke. This study aimed to determine the absolute and relative risks of a first recurrent stroke over the first 5 years after a first-ever stroke and the predictors of such recurrence in a population-based series of people with first-ever stroke in Perth, Western Australia.
Between February 1989 and August 1990, all people with a suspected acute stroke or transient ischemic attack of the brain who were resident in a geographically defined region of Perth, Western Australia, with a population of 138 708 people, were registered prospectively and assessed according to standardized diagnostic criteria. Patients were followed up prospectively at 4 months, 12 months, and 5 years after the index event.
Three hundred seventy patients with a first-ever stroke were registered, of whom 351 survived >2 days. Data were available for 98% of the cohort at 5 years, by which time 199 patients (58%) had died and 52 (15%) had experienced a recurrent stroke, 12 (23%) of which were fatal within 28 days. The 5-year cumulative risk of first recurrent stroke was 22.5% (95% confidence limits [CL], 16.8%, 28.1%). The risk of recurrent stroke was greatest in the first 6 months after stroke, at 8.8% (95% CL, 5.4%, 12.1%). After adjustment for age and sex, the prognostic factors for recurrent stroke were advanced, but not extreme, age (75 to 84 years) (hazard ratio [HR], 2.6; 95% CL, 1.1, 6.2), hemorrhagic index stroke (HR, 2.1; 95% CL, 0.98, 4.4), and diabetes mellitus (HR, 2.1; 95% CL, 0.95, 4.4).
Approximately 1 in 6 survivors (15%) of a first-ever stroke experience a recurrent stroke over the next 5 years, of which 25% are fatal within 28 days. The pathological subtype of the recurrent stroke is the same as that of the index stroke in 88% of cases. The predictors of first recurrent stroke in this study were advanced age, hemorrhagic index stroke, and diabetes mellitus, but numbers of recurrent events were modest. Because the risk of recurrent stroke is highest (8.8%) in the first 6 months after stroke, strategies for secondary prevention should be initiated as soon as possible after the index event.
很少有基于社区的研究探讨首次急性卒中后复发性卒中的长期风险。本研究旨在确定首次卒中后最初5年内首次复发性卒中的绝对风险和相对风险，以及西澳大利亚珀斯一个基于人群的首次卒中患者系列中此类复发的预测因素。
1989年2月至1990年8月期间，对居住在西澳大利亚珀斯一个地理区域、人口为138708人的所有疑似急性卒中或短暂性脑缺血发作患者进行前瞻性登记，并根据标准化诊断标准进行评估。在索引事件发生后的4个月、12个月和5年对患者进行前瞻性随访。
登记了370例首次卒中患者，其中351例存活超过2天。5年时该队列98%的数据可用，此时199例患者（58%）死亡，52例（15%）发生了复发性卒中，其中12例（23%）在28天内死亡。首次复发性卒中的5年累积风险为22.5%（95%置信区间[CL]，16.8%，28.1%）。复发性卒中风险在卒中后的前6个月最高，为8.8%（95%CL，5.4%，12.1%）。在调整年龄和性别后，复发性卒中的预后因素为高龄但非极高龄（75至84岁）（风险比[HR]，2.6；95%CL，1.1，6.2）、出血性卒中（HR，2.1；95%CL，0.98，4.4）和糖尿病（HR，2.1；95%CL，0.95，4.4）。
首次卒中的幸存者中约六分之一（15%）在接下来的5年内会发生复发性卒中，其中25%在28天内死亡。88%的病例中复发性卒中的病理亚型与索引卒中相同。本研究中首次复发性卒中的预测因素为高龄、出血性卒中及糖尿病，但复发事件数量不多。由于复发性卒中风险在卒中后的前6个月最高（8.8%），二级预防策略应在索引事件后尽快启动。
