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Frequency and predictors for the risk of stroke recurrence up to 10 years after stroke: the South London Stroke Register
  1. K M Mohan1,
  2. S L Crichton1,
  3. A P Grieve1,
  4. A G Rudd2,
  5. C D A Wolfe1,3,
  6. P U Heuschmann1,4
  1. 1
    King’s College London, Division of Health and Social Care Research, London, UK
  2. 2
    Department of Health and Ageing, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London, UK
  3. 3
    NIHR Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK
  4. 4
    Center for Stroke Research Berlin, Charite—Universitaetsmedizin Berlin, Berlin, Germany
  1. Correspondence to Dr K Mohan, King’s College London, Division of Health and Social Care Research, 7th Floor Capital House, 42 Weston Street, London SE1 3QD, UK; kitty.mohan{at}kcl.ac.uk

Abstract

Background: Data estimating the risk of, and predictors for, long-term stroke recurrence are lacking.

Methods: Data were collected from the population-based South London Stroke Register. Patients were followed up for a maximum of 10 years. Kaplan–Meier estimates and Cox proportional hazards models were used to assess the cumulative risk of and predictors for first stroke recurrence. Variables analysed included sociodemographic factors, stroke subtype (defined as cerebral infarction, intracerebral haemorrhage and subarachnoid haemorrhage), stroke severity markers and prior-to-stroke risk factors.

Results: Between 1995 and 2004, 2874 patients with first-ever stroke were included. The mean follow-up period was 2.9 years. During 8311 person-years of follow-up, 303 recurrent events occurred. The cumulative risk of stroke recurrence at 1 year, 5 years and 10 years was 7.1%, 16.2% and 24.5% respectively. No differences in stroke recurrence were noted between the stroke subtypes. Factors increasing the risk of recurrence at 1 year were previous myocardial infarction (HR 1.73; 95% CI 1.08 to 2.78) and atrial fibrillation (HR 1.61; 95% CI 1.04 to 4.27); at 5 years, hypertension (HR 1.47; 95% CI 1.08 to 1.99) and atrial fibrillation (HR 1.79; 95% CI 1.29 to 2.49); and at 10 years, older age (p = 0.04), and hypertension (HR 1.38, 95% CI 1.04 to 1.82), myocardial infarction (HR 1.50, 95% CI 1.06 to 2.11) and atrial fibrillation (HR 1.51, 95% CI 1.09 to 2.09).

Conclusions: Very-long-term risk of stroke recurrence is substantial. Different predictors for stroke recurrence were identified throughout the follow-up period. Risk factors prior to initial stroke have a significant role in predicting stroke recurrence up to 10 years.

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Footnotes

  • Funding This study was funded by the Stanley Thomas Johnson Foundation, the Northern and Yorkshire NHS R&D Programme in Cardiovascular Disease and Stroke, the Department of Health UK, and Guy’s and St Thomas’ Hospital Charity. The authors acknowledge financial support from the Department of Health via the National Institute for Health Research (NIHR) Biomedical Research Centre and the Programme Grant award to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London (RP-PG-0407-10184).

  • Competing interests APG has consultancy agreements with Pfizer Global R&D, Takeda Global R&D (Europe), Schwarz Biosciences, Solace Pharmaceuticals, Cytel Novartis and Organon.

  • Ethics approval Ethics approval was provided by the ethics committees of Guy’s and St Thomas’ Hospital Trust, King’s College Hospital, Queens Square and Westminster Hospital (London).

  • Patient consent Obtained.

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