Stroke History is an Independent Risk Factor for Poor Prognosis in Ischemic Stroke Patients: Results from a Large Nationwide Stroke Registry.

Runhua Zhang,Penglian Wang,Guitao Zhang,Haiqiang Qin,Gaifen Liu,Yongjun Wang,Miaoxin Yu

doi:10.2174/1567202617666200817141837

Runhua Zhang, Penglian Wang + Show 5 more

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https://doi.org/10.2174/1567202617666200817141837

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Abstract

BackgroundThere is some controversy whether stroke history is an independent risk factor for poor prognosis of stroke or not. This study aimed to investigate the difference of mortality, disability and recurrent rate of ischemic stroke patients without and with stroke history, as well as to explore the effect of stroke history on stroke prognosis.MethodsWe analyzed patients with ischemic stroke enrolled in the China National Stroke Registry which was a nationwide, multicenter, and prospective registry of consecutive patients with acute cerebrovascular events from 2007 to 2008. Multivariable logistic regression was performed to assess the risk of worse prognosis of stroke history in patients with ischemic stroke.ResultsA total of 8181(65.9%) patients without stroke history and 4234(34.1%) patients with stroke history were enrolled in the study. The mortality, recurrence, modified Rankin Scale (mRS) 3-6 rate was 11.4%, 14.7% and 28.5% respectively at 1 year for patients without stroke history, which was significantly lower than that of 17.3%, 23.6%, 42.1% in patients with stroke history, respectively. Multivariable analysis showed that patients with stroke history had higher risk of death [odds ratio (OR) 1.34,95% confidence interval (CI) 1.17-1.54], recurrence (OR 1.47, 95 % CI 1.31-1.65) and mRS 3-6 (OR 1.49,95% CI 1.34-1.66) at 1 year.Conclusion After adjusting for the potential confounders, stroke history was still an independent risk factor for poor prognosis of ischemic stroke, which further emphasizes the importance of secondary prevention of ischemic stroke. The specific causes of poor prognosis in patients with history of stroke need to be furtherly investigated.

Highlights

Stroke is a major cause of death and disability worldwide
Multivariable analysis showed that patients with stroke history had higher risk of death [odds ratio (OR) 1.34,95% confidence interval (CI) 1.17-1.54], recurrence and modified Rankin Scale (mRS) 3-6 at 1 year
After adjusting for the potential confounders, stroke history was still an independent risk factor for poor prognosis of ischemic stroke, which further emphasizes the importance of secondary prevention of ischemic stroke

Summary

Introduction

Stroke is a major cause of death and disability worldwide. Approximately three-quarters of the global burden of stroke deaths (approximately 6.5 million per year) and associated disability-adjusted life years (approximately 113 million) occurred in low- and middle-income countries [1, 2]. Few studies have investigated the impact of stroke history on the prognosis of stroke. Recurrent stroke is considered to be more likely to be fatal or disabling than first-ever stroke [7,8,9], though there are studies showing that previous stroke history was not an independent predictor of case fatalities [10]. The study by TIAregistry.org showed that previous stroke or TIA is an independent predictor of stroke recurrence in non-Asians, but not in Asians [11]. There is some controversy whether stroke history is an independent risk factor for poor prognosis of stroke or not. This study aimed to investigate the difference of mortality, disability and recurrent rate of ischemic stroke patients without and with stroke history, as well as to explore the effect of stroke history on stroke prognosis.

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