Stroke-free Survival Research Articles

Racial differences in albuminuria, kidney function, and risk of stroke

The objective of this study was to examine the joint associations of estimated glomerular filtration rate (eGFR) and urinary albumin excretion with incident stroke in a large national cohort study. Associations of urinary albumin to creatinine ratio (ACR) and eGFR with incident stroke were examined in 25,310 participants of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a prospective study of black and white US adults ≥45 years of age. A total of 548 incident strokes were observed over a median of 4.7 years of follow-up. Higher ACR values were associated with lower stroke-free survival in both black and white participants. Among black participants, as compared to an ACR <10 mg/g, the hazard ratios of stroke associated with an ACR of 10-29.99, 30-300, and >300 mg/g were 1.41 (95% confidence interval [CI] 1.01-1.98), 2.10 (95% CI 1.48-2.99), and 2.70 (95% CI 1.58-4.61), respectively, in analyses adjusted for traditional stroke risk factors and eGFR. In contrast, the hazard ratios among white subjects were only modestly elevated and not statistically significant after adjustment for established stroke risk factors. eGFR <60 mL/min/1.73 m(2) was not associated with incident stroke in black or white participants after adjustment for established stroke risk factors. Higher ACR was independently associated with higher risk of stroke in black but not white participants from a national cohort. Elucidating the reasons for these findings may uncover novel mechanisms for persistent racial disparities in stroke.

Central serous chorioretinopathy and risk of ischaemic stroke: a population-based cohort study

BackgroundCentral serous chorioretinopathy (CSCR) is a common maculopathy that features choroidal circulatory disturbance. This population-based cohort study aimed to explore the relationship between CSCR and the future development of ischaemic...

Retinal Artery Occlusion and the 3-Year Risk of Stroke in Taiwan: A Nationwide Population-Based Study

To verify the association between retinal artery occlusion (RAO) and stroke with a large-scale nationwide study. Retrospective nationwide population-based administrative database study. Data were collected from the Longitudinal Health Insurance Database 2000 (LHID2000), which contains claim data from 1 million randomly selected beneficiaries among Taiwan's 23 million residents. The study cohort consisted of all patients with a diagnosis of RAO from January 1999 through December 2006 (n = 464). The control group consisted of randomly selected patients (n = 2748) matched with the study group by age, sex, date of index medical care, and comorbid hypertension. Patients were tracked from their index date for 3 years. The Kaplan-Meier method was used to compute the stroke-free survival rate. Cox proportional hazard regressions were used to compute the adjusted stroke-free survival rate after adjusting for possible confounding factors. Ninety-one RAO patients (19.61%) and 280 controls (10.05%) had a stroke (P < .0001) during the 3-year follow-up period. Compared with the controls, the incidence rate ratios of stroke in RAO patients were 9.46 at 0-1 month, 5.57 at 1-6 months, and 2.16 at 0-3 years after RAO (P < .0001). After adjusting for age, sex, and selected comorbid disorders, the hazard ratio of having a stroke for RAO patients was still 2.07 times higher than that of controls and 3.34 times higher in the ≤60-year-old subgroup. RAO increases the risk for subsequent stroke. Early neurologic evaluation and secondary prevention for stroke are recommended for RAO patients.

A Bridge Far Enough?

The publication in this issue of Circulation of the Evaluation of the HeartWare Left Ventricular Assist Device for the Treatment of Advanced Heart Failure (ADVANCE) trial by Aaronson, Slaughter, and colleagues1 tracks continuing advance in the rapidly expanding field of mechanical circulatory support. As implantable device technology and the clinical learning curve have supported better outcomes over time, the journey is leaving the critically ill patients behind and moving into populations with less imminent risk of death, and will soon include more ambulatory patients for whom pivotal outcomes extend beyond stroke-free survival. The success of this trial stimulates questions about routes to new device approval, the length of our bridges, and the directions for travel beyond a bridge. Article see p 3191 The ADVANCE trial demonstrated that the new continuous flow centrifugal device serves as an effective bridge for patients awaiting a donor heart for transplantation.1 Previous devices approved for this indication include several configurations of pulsatile pumps and most recently a continuous flow axial pump. Approval for the bridging indication has required progressively more rigorous data but has never been supported by a randomized trial, because randomization to death or to device support is not reasonable in the face of progressive organ compromise and anticipated death from native heart collapse. Of the first 3 devices approved for the bridging indication, 2 offered no control population and 1 included a small historical control of patients in the same institutions who, for various reasons, did not receive a device.2,3 The present report raises the standard for bridging device approval, offering the first prospective comparison of outcomes with the new device with outcomes without it during the same time period, in this case with other devices currently available for left ventricular support. The control data population was …

Long‐term Clinical and Angiographic Outcomes in Patients with Spontaneous Cervico‐Cranial Arterial Dissections Treated with Stent Placement

Limited data exist regarding the long-term clinical and angiographic outcomes of patients with spontaneous cervico-cranial arterial dissection treated with stent placement. To report the immediate and long-term clinical and angiographic outcomes of patients who received stent placement for spontaneous cervico-cranial arterial dissection. We reviewed clinical and angiographic data of consecutive patients with spontaneous, cervico-cranial arterial dissection treated with stent placement. Patients with recurrent ischemic symptoms or severe hemodynamic compromise despite maximal medical therapy, or those with compressive symptoms due to expanding pseudoaneurysms were considered for stent placement. Follow-up angiography and intravascular ultrasound (in select patients) was performed to detect in-stent restenosis, intimal flap, thrombus, or persistent pseudoaneurysm. A total of 14 patients were identified, with complete resolution of stenosis achieved in 10 patients immediately post-procedure. Clinical follow-up ranged from 26-900 days, during which there was 1 (7%) TIA, 1 (7%) minor ischemic stroke, and 1 (7%) in hospital death (unrelated to stent placement). Stroke-free survival was 93% at both 1 month and 6 months after the procedure. Follow-up angiography did not reveal any in-stent restenosis. This study demonstrates the feasibility, safety, and intermediate term effectiveness of endovascular stent reconstruction of spontaneous, cervico-cranial arterial dissection.

Chronic Kidney Disease Itself Is a Causal Risk Factor for Stroke beyond Traditional Cardiovascular Risk Factors: A Nationwide Cohort Study in Taiwan

BackgroundCardiovascular disease (CVD) is a leading cause of mortality and morbidity in patients with chronic kidney disease (CKD). In Taiwan, CVD is dominated by strokes but there is no robust evidence for a causal relationship between CKD and stroke. This study aimed to explore such causal association.MethodsWe conducted a nationwide retrospective cohort study based on the Taiwan National Health Insurance Research Database from 2004 to 2007. Each patient identified was individually tracked for a full three years from the index admission to identify those in whom any type of stroke developed. The study cohort consisted of patients hospitalized with a principal diagnosis of CKD and no traditional cardiovascular risk factors at baseline (n = 1393) and an age-matched control cohort of patients hospitalized for appendectomies (n = 1393, a surrogate for the general population). Cox proportional hazard regression and propensity score model were used to compare the three-year stroke-free survival rate of the two cohorts after adjustment for possible confounding factors.ResultsThere were 256 stroke patients, 156 (11.2%) in the study cohort and 100 (7.2%) in the control cohort. After adjusting for covariates, patients with primary CKD had a 1.94-fold greater risk for stroke (95% CI, 1.45–2.60; p<0.001) based on Cox regression and a 1.68-fold greater risk for stroke (95% CI, 1.25–2.25; p = 0.001) based on propensity score. This was still the case for two cohorts younger than 75 years old and without traditional cardiovascular risk factors.ConclusionsThis study of Taiwanese patients indicates that CKD itself is a causal risk factor for stroke beyond the traditional cardiovascular risk factors. Primary CKD patients have higher risk for stroke than the general population and all CKD patients, irrespective of the presence or severity of traditional cardiovascular risk factors, should be made aware of the stroke risk and monitored for stroke prevention.

Treatment for routine, symptomatic, carotid bulb atherosclerosis: Carotid endarterectomy and stenting are comparable.

![Graphic][1] The results of recent carotid artery stenting (CAS) vs carotid endarterectomy (CEA) randomized studies (CREST,1 SPACE,2 EVA3S,3 and ICSS4) have created conflict among surgical and endovascular communities over which procedure is preferred for secondary stroke prevention for symptomatic carotid stenosis. The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST) established CEA as the gold standard for surgical treatment in the early 1990s. Carotid stenting has been held to the high standard of CEA, and in order to present a viable alternative surgical therapy, it must be effective at preventing strokes, durable, and safe, with complication rates comparable to CEA. Carotid stenting is a clinically effective procedure. CREST, SPACE, and EVA3S showed equivalent annual stroke rates for the 2 treatments in symptomatic patients after the initial 30 days (CEA vs CAS: 0.8 vs 0.6, 1.3 vs 1.4, and 0.7 vs 0.4, percent per year, respectively). The stroke-free survival curves in CREST for CEA and CAS are parallel after the perioperative period out to 4 years, indicating clinical durability. > The increase in minor stroke in the CAS group and the increase in perioperative MI in the CEA group offset one another, leading to the equivalent primary endpoint. Perioperative safety remains the controversial point; the 30-day stroke and death rate for the stented patients was over 2 times that of the surgical group in the EVA3S trial. In the ICSS trial, the CAS group suffered stroke or death twice as often as the CEA group. Complications rates were, at best, equivalent in the 2 groups in the SPACE trial (6.3% for CEA and 6.8% for CAS), with CAS not achieving noninferiority. Why the … [1]: /embed/inline-graphic-1.gif

The incidence and relative risk of stroke in patients with schizophrenia: A five-year follow-up study

ObjectiveThis study aimed to estimate the incidence and relative risk of stroke and post-stroke all-cause mortality in patients with schizophrenia. MethodsThis study identified a study population from the National Health Insurance Research Database (NHIRD) between 1999 and 2003 that included 80,569 patients with schizophrenia and 241,707 age- and sex-matched control participants without schizophrenia. The participants were randomly selected from the 23,981,020-participant NHIRD, which consists of 96% Taiwanese participants. Participants who had experienced a stroke between 1999 and 2003 were excluded. Using data from the NHIRD between 2004 and 2008, the incidence of stroke (ICD-9-CM code 430-438) and patient survival after stroke were calculated for both groups. After adjusting for confounding risk factors, a Cox proportional-hazards model was used to compare the five-year stroke-free survival rate to the all-cause mortality rate across the two cohorts. ResultsOver five years, 1380 (1.71%) patients with schizophrenia and 2954 (1.22%) controls suffered from strokes. After adjusting for demographic characteristics and comorbid medical conditions, patients with schizophrenia were 1.13 times more likely to have a stroke (95% CI=1.05–1.22; P=0.0006). In addition, 1039 (24%) patients who had a stroke died during the follow-up period. After adjusting for patient, physician and hospital variables, the all-cause mortality hazard ratio for patients with schizophrenia was 1.23 (95% CI=1.06–1.41; P=0.0052). ConclusionsDuring a five-year follow-up, the likelihood of developing a stroke and the all-cause mortality rate were greater among patients with schizophrenia as compared with the control group.

Haemodialysis and the risk of stroke: A population‐based cohort study in Taiwan, a country of high incidence of end‐stage renal disease

Data regarding the occurrence of stroke in dialysis patients are limited and epidemiologic studies to date are controversial with respect to the stroke subtype among dialysis patients. The aim of this study was to perform a population-based study with a retrospective cohort design to investigate the risk of stroke after the initiation of haemodialysis (HD) among end-stage renal disease (ESRD) patients in Taiwan - a country with the highest incidence of ESRD in the world. Data were retrospectively obtained from the Taiwan National Health Insurance Research Database. In total, 644 patients who were beginning HD between 1999 and 2003 were recruited as the study cohort and 3220 patients matched for age and sex were included as the comparison cohort. Multivariate Cox proportional hazard regression models were used to adjust for confounding and to compare the 5 year stroke-free survival rate between these two cohorts. The incidence rate of stroke (41.76 per 1000 person-years) was significantly higher in the HD cohort than in the control cohort (24.29 per 1000 person-years). After adjusting for potential confounders, the adjusted hazard ratios of ischaemic stroke and haemorrhagic stroke were 2.16 (95% confidence interval = 1.57-2.97) and 3.78 (95% confidence interval = 1.90-7.55), respectively. We conclude that HD patients were at an increased risk for both ischaemic and haemorrhagic stroke compared with the general population.

Central sleep apnea is associated with increased risk of ischemic stroke in the elderly

Sleep apnea/hypopnea syndrome is a well-recognized independent risk factor for stroke in middle-aged population, but controversy remains in older subjects. We examined the possible association between different respiratory parameters and risk of stroke in a prospective population-based cohort of 394 stroke-free elderly subjects. Fully overnight polysomnography was performed at baseline. Over the 6 year follow-up period, 20 ischemic strokes occurred. Differences in stroke-free survival between subjects according to central apnea index (CAI) were assessed. We just observed association with incident ischemic stroke on central sleep apnea (CSA) episodes. Obstructive sleep apnea, time passed under 90% oxygen saturation, or arousal index were not associated. The event-free survival was lowest in the highest CAI group. This association was independent of any other vascular risk factors. CSA is the specific respiratory event associated with stroke in the elderly. Additionally, CSA could be a marker of silent brain ischemia, as a sign of disturbed regulation of central respiratory mechanisms, tentatively of ischemic origin.

Abstract 17704: The Association of Tooth Scaling and Decreased Cardiovascular Disease -A Nationwide Population-Based Study

Background: Poor oral hygiene has been associated with increased risk for cardiovascular disease frequent tooth brushing has been reported to decrease the risk for CVD recently. However, the association between preventive dentistry and cardiovascular risk reduction remained undetermined. The aim of this study is investigate the effect of mouth scaling on cardiovascular disease and stroke risk, using a nationwide, population-based study and a retrospective cohort design. Methods: 51108 adult subjects without previous history of stroke or myocardial infarction (MI) who had received full or partial mouth scaling at least once were rerolled from the Taiwan National Health insurance. Another 51512 age-, gender-, and cormobidities-matched subjects without history of stroke or MI and did not receive mouth scaling comprised the comparison control. Cox proportional hazard regressions were performed as a means of comparing the cardiovascular events rate between these two cohorts. Results: During an average follow-up period of 7 years, a total of 102,620 patients were enrolled, of which 51,108 patients who had ever received tooth mouth scaling had lower incidence of acute MI and stroke when compared to the control group (0.55% vs. 0.44%, p=0,013 and 2.57% vs. 2.27%, p=0.002, respectively). The log-rank test and Kaplan-Meier survival analysis showed that patients with tooth scaling have significantly higher AMI- free and higher stroke-free survival rates ( p =0.027 and p= 0.04 respectively). Cox proportional hazard regression model analysis showed that tooth scaling was the independent factor associated with less risk of developing future MI (Hazard Ratio, HR, 0.76, 95% CI, 0.60-0.96; p =0.021) and stroke (HR 0.87, 95% CI, 0.78-0.96; p =0.007). Furthermore, the frequency of tooth scaling correlated with the risk reduction of MI with HR of 0.76 (95% CI, 0.60-0.96; p =0.021) and HR of 0.87 (95% CI, 0.71-1.07; p= 0.188), comparing often and occasional with never tooth scaling, respectively; stroke with HR 0.87, (95% CI, 0.78-0.96; p =0.007) and HR of 0.91 (95% CI, 0.83-1.00; p =0.045), comparing often and occasional with never tooth scaling, respectively. Conclusions: Tooth scaling was associated with decreased risk for cardiovascular risk and stroke.

Gender-based outcomes after eversion carotid endarterectomy from 1998 to 2009

Although the benefit of carotid endarterectomy (CEA) in reducing the risk of stroke in selected symptomatic and asymptomatic patients has been well documented, the higher incidence of adverse events after CEA for women than for men remains controversial. The purpose of this study was to analyze the effect of female gender on perioperative (30-day) and long-term outcomes after eversion CEA (eCEA). Patients entered into a prospectively compiled computerized database of all primary consecutive eCEAs performed at our institution from September 1998 to December 2009 were analyzed. Endpoints were perioperative death and stroke, late carotid restenosis or occlusion, and long-term freedom from stroke and survival rates. Long-term follow-up was obtained in 96.8% of patients (97.5% of the women). Among 1294 patients who underwent 1458 eCEAs under general anesthesia with continuous electroencephalographic monitoring and selective shunting, 409 (31.6%) were women (466 eCEAs). More women than men were over 80 years old (P = .001), and female patients were more likely to have arterial hypertension (P = .02) or hyperlipidemia (P = .006) than male patients. Preoperative statin medication (P = .01), contralateral carotid occlusion (P = .02), and shunting use (P = .03) were more frequent among female patients. No perioperative deaths occurred in the series as a whole, while the perioperative stroke risk (0.6% vs 0.5%), and the combined late carotid restenosis and occlusion rate (1.1% vs 0.4%) were comparable between female and male patients. The 7-year stroke-free survival and overall survival rates did not differ significantly between female and male patients (98.3% vs 98.8% and 87.2% vs 93.8%, respectively). This single-center university hospital study shows that although women have a different cardiovascular risk profile from men when they undergo eCEA, there is no evidence of a different gender effect on perioperative and long-term outcomes.

TCT-552: Fast track Carotid Surgery is the gold standard for High-risk (HRP) Carotid Artery Intervention: Five year Cost-effectiveness and Quality Stroke Free Survival comparison

TCT-552: Fast track Carotid Surgery is the gold standard for High-risk (HRP) Carotid Artery Intervention: Five year Cost-effectiveness and Quality Stroke Free Survival comparison

The significance of new onset atrial fibrillation complicating acute myocardial infarction

Atrial fibrillation (AF) in the setting of acute myocardial infarction (AMI) independently predicts in-hospital and long-term morbidity and mortality. Very little data exist regarding the prognostic significance and management of new-onset AF in this setting in the era of dual anti-platelet therapy. We identified all patients admitted to our coronary care unit for AMI between 2002 and 2009 who developed new-onset AF. The control group was an age and gender matched group of AMI patients who did not have AF. Management and recurrent AF, non-fatal stroke, and mortality data were collected from subsequent hospitalizations and outpatient records. Of 1,991 AMI admissions, new-onset AF was diagnosed in 100 (4.1%). Patients' age was 70 (±12), 32% were female, 58% had ST-elevation AMI and 53% had moderate or worse systolic dysfunction. AF recurred during index admission in 33%. During mean follow-up of 41 months, AF recurred in 22 and 4.5%, and non-fatal stroke occurred in 13 and 1% of the AF and control groups, respectively (p < 0.01 for both). The composite of death and non-fatal stroke was also significantly higher in the AF group, 39 versus 29% (p = 0.02). Oral anti-coagulation was used in only 24% of the AF group and was a significant predictor of stroke-free survival (p = 0.04). New onset AF in the AMI setting carries a substantial future risk for stroke and should not be regarded as a benign, transient complication of the acute event. Long term anticoagulation is underused and is associated with improved stroke-free survival.

Increased risk of stroke in young head and neck cancer patients treated with radiotherapy or chemotherapy

Chemo-radiotherapy-induced carotid stenosis and cerebrovascular events in head and neck cancer patients can cause severe disability and death. We aimed to estimate the risk of stroke in such patients over a six-year follow-up period. The study cohort consisted of head and neck cancer patients (n=10,172). Cox proportional hazard model was used to compare the stroke-free survival rate between the patients treated with radiotherapy or chemotherapy, surgery alone, and surgery with adjuvant therapy after adjusting for possible confounding factors. At the end of follow-up, 384 patients had strokes: 126 (4.3%) from the surgery alone group, 167 (3.8%) from the radiotherapy or chemotherapy group, and 91 (3.2%) from the surgery with adjuvant therapy (P=0.222). Head and neck cancer patients aged less than 55 years treated with radiotherapy or chemotherapy conferred a 1.8-fold higher risk for stroke (95% CI, 1.22-2.56; P=0.003) after adjusting for patient characteristics, co-morbidities, geographic region, urbanization level, and socio-economic status. There was no statistical difference in stroke risk between different treatment modalities in head and neck cancer patients aged 55 years and more. Young head and neck cancer patients treated with radiotherapy or chemotherapy have higher risks for stroke. Different treatment strategies should be considered in such patients.

Durability and Stroke-Free Survival after Carotid Stenting: Long-Term Follow-up in a Community Setting

Durability and Stroke-Free Survival after Carotid Stenting: Long-Term Follow-up in a Community Setting

Association Between Stroke and Patients With Pelvic Inflammatory Disease

The aim of this study is to estimate the risk of stroke in a 3-year period after pelvic inflammatory disease (PID) using a nationwide population-based study. Our study cohort consisted of all patients with a diagnosis of PID (N = 64,515) between 2004 and 2005 with a control cohort (1:2) of age-matched controls (N = 129, 030). Each patient was tracked from hospitalization until the end of 2006. Cox regressions were performed to compute the 3-year stroke-free survival rates after adjusting for possible confounding factors. We found that women with PID were more likely to have strokes than the control population. After adjusting for potential confounding factors, the adjusted hazard ratio of stroke was 1.63 (95% CI, 1.45-1.85) for PID patients as compared to the general population cohort. Sensitivity analysis using a bootstrap approach further ensured the validity of the results of our study. We concluded that patients with PID have an association with stroke. Further research is necessary to investigate the pathophysiology between PID and stroke.

Increased Risk of Ischemic Stroke in Young Nasopharyngeal Carcinoma Patients

Radiation/chemoradiotherapy-induced carotid stenosis and cerebrovascular events in patients with nasopharyngeal carcinoma (NPC) can cause severe disability and even death. This study aimed to estimate the risk of ischemic stroke in this patient population over more than 10 years of follow-up. The study cohorts consisted of all patients hospitalized with a principal diagnosis of NPC (n=1094), whereas patients hospitalized for an appendectomy during 1997 and 1998 (n=4376) acted as the control group and surrogate for the general population. Cox proportional hazard model was performed as a means of comparing the stroke-free survival rate between the two cohorts after adjusting for possible confounding and risk factors. Of the 292 patients with ischemic strokes, 62 (5.7%) were from the NPC cohort and 230 (5.3%) were from the control group. NPC patients ages 35-54 had a 1.66 times (95% CI, 1.16-2.86; p=0.009) higher risk of ischemic stroke after adjusting for patient characteristics, comorbidities, geographic region, urbanization level of residence, and socioeconomic status. There was no statistical difference in ischemic stroke risk between the NPC patients and appendectomy patients ages 55-64 years (hazard ratio=0.87; 95% CI, 0.56-1.33; p=0.524) after adjusting for other factors. Young NPC patients carry a higher risk for ischemic stroke than the general population. Besides regular examinations of carotid duplex, different irradiation strategies or using new technique of radiotherapy, such as intensity modulated radiation therapy or volumetric modulated arc therapy, should be considered in young NPC patients.

Long-term success of vein-patch and carotid endarterectomy

Most patients with severe symptomatic carotid artery disease will benefit from a carotid endarterectomy to reduce the risk of a stroke. The long-term success of vein-patch angioplasty has been determined in this study. From 1974 to 1997, 507 patients had 587 carotid endarterectomies with a greater saphenous vein graft and 97 patients had 116 carotid endarterectomies with primary closure. Mean follow-up times were 3.6 and 3.7 years, respectively. Ten percent of the patients were followed for more than 10 years. Carotid duplex ultrasonography and/or angiography were used to determine patency. Graft occlusion or significant restenosis (>69%) of the carotid artery, and the occurrence of a stroke were determined. Life-table analyses of graft patency, stroke survival were done. Perioperative ipsilateral stroke rates were 0.5% and 2.6% with the vein patch graft and primary closure, respectively (p<0.01). At 14 years, ipsilateral stroke-free rates were 97% for patients with a patch graft and 94% with primary closure (p<0.001). The rates of freedom from restenosis were 94% with the patch graft and 70% with primary closure (p<0.001), and primary patency rates were 96% and 81%, respectively (p<0.002). Ipsilateral stroke-free survival rates were 52% and 37%, respectively for patients with a patch graft and primary closure (p<0.02). Carotid endarterectomy with the vein-patch angioplasty gave an excellent result. The long-term patency of the graft and artery, freedom from an ipsilateral stroke, and survival were good. The results with a primary closure were inferior.

Increased risk of stroke after trigeminal neuralgia – a population-based follow-up study

There are no reports on the risk of stroke after trigeminal neuralgia (TN). The aim of this population-based follow-up study was to investigate whether the occurrence of TN is associated with a higher risk of developing stroke. A total of 1453 people with at least three ambulatory visits in 2001 with the principal diagnosis of TN were enrolled in the TN cohort. The non-TN cohort consisted of 5812 age- and sex-matched, randomly sampled subjects without TN. The 2-year stroke-free survival rate between the two groups was compared using the Kaplan-Meier method. The Cox proportional hazards regression model was used to estimate the hazard ratio of stroke after adjustment for demographic and clinical covariates. In the TN cohort, 73 patients developed stroke during follow-up, while in the non-TN cohort, 157 subjects suffered a stroke. The crude hazard ratio of stroke for the subjects with TN was 1.86 (95% CI, 1.41-2.45; p<0.0001). The adjusted hazard ratio was 1.76 (95% CI, 1.33-2.33; p<0.0001) after adjusting for demographic characteristics and comorbid medical disorders. This study showed a significantly increased risk of developing stroke after TN. Further studies are needed to investigate the underlying mechanism of this association.