Original articleStroke subtype and mortality: a follow-up study in 998 patients with a first cerebral infarct
Introduction
Stroke is a highly prevalent disease, which ranks third as cause of death in the Western World [1]. Survival is the most fundamental measure of stroke outcome [2]. Although the literature is rich in follow-up studies on survival after stroke, most are based on selected series of patients, and predictors of poststroke mortality have usually been analyzed without accounting for other prognostic variables. Few studies evaluated factors predicting long-term mortality after stroke in an unselected series of patients in whom the underlying cerebrovascular pathology had clearly been defined 2, 3, 4, 5.
The risk of death is not only elevated acutely following stroke, but also in the longer term 4, 5, 6, 7. The annual risk of dying after stroke is about 9%, which is approximately 2.3 times that of the general population, with an even higher risk of about 15% in the first year 4, 5. This excessive death risk also exists in younger patients [4]. Long-term follow-up studies showed that up to 20 years after stroke mortality was still higher than in controls [6]. Average loss of life after stroke is estimated to be 14 years [8]. Preventive measures would be important to lower mortality following stroke, but any effect may vary depending on stroke subtype. Apart from this, it is unknown whether treatment of risk factors lowers poststroke mortality. Several clinical trials have shown a protective effect from blood pressure reduction on recurrent stroke after minor ischemic stroke or transient ischemic attack (TIA), but it is not clear if this is true for mortality after stroke [9]. Time-trend studies show a decline in stroke mortality (stronger decline than coronary mortality) but geographic regions with the highest mortality rate also show the least favorable trend or even an increase 10, 11.
The present analysis was performed to gain more insight into factors, including stroke subtype, which predict mortality following a first cerebral infarct, and to identify possibly treatable risk factors.
Section snippets
General aspects
Patients had been registered in the Maastricht Stroke Registry (MSR), which is a prospective registry at the University Hospital of Maastricht of all stroke patients older than 18 years with symptoms lasting longer than 24 hr. Only patients with a supratentorial brain infarct were included in the study, as hindbrain infarcts may be rather heterogeneous in stroke cause and consequent subgroups too small for comprehensive analyses. However, some of the lacunar infarcts, especially those without
Results
There were 998 patients with a first-ever ischemic stroke. Duration of follow-up was 691 days (mean, SD 521) for the whole group, and for those surviving 881 days (mean, SD 465). CT was performed in 961 (96%); on the day of stroke in 153 (16%), within 1 week in 597 (62%), and within 3 weeks in 877 (91%). There were 138 recurrent strokes, with CT verification in 84 (61%). During follow-up 361 (36%) patients died. Table 1 shows baseline characteristics and mortality figures for all patients and
Discussion
We found a 30-day case fatality rate of ten percent in our 998 patients with a first cerebral infarct, which is similar to methodologically sound community-based studies 17, 18, 19, 20, 21. We found significant differences between the three stroke subtypes: LACI patients had the lowest, and CE infarct patients the highest 30-day case fatality. Others also found a low early death rate among lacunar stroke patients 2, 3, 17, 18, 19, 20, 21, 22, 23. A low early case fatality rate in LACI was also
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2015, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :Another study reported that an energetic and sustained program of risk factor control could reduce the stroke recurrence rate by 16%.3 In addition, the mortality after stroke is consistently high among different ages,4-6 severity,6 comorbidities,7 and stroke recurrence.6,8 Therefore, efforts should be made to reduce the recurrent stroke and mortality.