Risk Factors for Early Recurrence After Ischemic Stroke

Abstract

Background and Purpose-Information regarding risk factors for early recurrence is limited. Our aim was to identify the clinical predictors of early recurrence after ischemic stroke. Methods-We prospectively examined 297 patients (mean age, 72.0Ϯ8.4 years) hospitalized with ischemic stroke to identify recurrent strokes occurring within 90 days of the index stroke. Survival free of recurrence was estimated using Kaplan-Meier analysis stratified by demographic variables; vascular risk factors; stroke syndrome, subtype, vascular territory, and severity; scores on the Barthel Index and Mini-Mental State Examination during hospitalization; blood pressure on admission; and selected laboratory data. We estimated the relative risk (RR) of early recurrence associated with those variables using proportional hazards analysis. Results-We identified 22 recurrent events in the first 90 days after the index stroke, resulting in an early stroke recurrence rate of 7.4%, and death occurred immediately after recurrence in 6 of the 22 patients. A major hemispheric stroke syndrome (RRϭ2.9; 95% confidence interval [CI]ϭ1.2 to 7.1), atherothrombotic stroke mechanism (RRϭ3.3; CIϭ1.3 to 8.3), and atrial fibrillation (RRϭ2.2; CIϭ0.8 to 6.1) were independent predictors of early recurrence, after adjustment for demographic variables. Conclusions-Early recurrence was frequent and resulted in increased mortality. Attention to the clinical features of the index stroke, including the presenting syndrome and the ischemic mechanism, and the recognition of atrial fibrillation may help in the selection of patients for the initiation of targeted interventions to prevent early recurrence and subsequent mortality. (Stroke. 1998;29:2118-2124.)

A score to predict early risk of recurrence after ischemic stroke

“…We collected data on previously published clinical [1][2][3][4][5][6][7][14][15][16][17][18] and imaging features 7,[19][20][21][22][23] of index stroke associated with increased risk of re- Abbreviations: CCS ϭ Causative Classification of Stroke System; CI ϭ confidence interval; HR ϭ hazard ratio; IQR ϭ interquartile range.…”

“…First, our findings confirm the published evidence that conventional risk factors for long-term recurrence such as hypertension, diabetes mellitus, and smoking do not confer a risk for stroke over the short term (90 days). [1][2][3][4][5][6][7]14 Scores based on predictors of the long-term risk such as the Stroke Prognosis Instrument II and the Essen Stroke Risk Score, therefore, offer only limited predictive value in the short term. Second, as also reported previously, etiologic stroke subtype 6,7,16,17,29 and prior history of recent TIA/stroke 17 are significant clinical predictors of 90-day recurrence risk after ischemic stroke.…”

“…[1][2][3][4][5] Prevention of such events is critical because early recurrence is associated with severe consequences including longer duration of hospitalization and increased neurologic disability and death. 6,7 Several recent studies consistently indicate that early initiation of available treatments after TIA or minor stroke is imperative to avoid missed opportunities to prevent a recurrent stroke. [8][9][10] Nevertheless, prioritization occurs in clinical practice because diagnosis and treatment of stroke is often constrained by queues, limited resources, or even by patient reluctance.…”

Avaliação Clínica E Topográfica Dos Pacientes Diagnosticados Com Acidente Vascular Cerebral No Serviço De Emergência

“…A identificação de fatores de risco desencadeantes e a adoção de programas de tratamentos preventivos podem reduzir a recorrência da doença, garantindo melhor qualidade de vida 6,7 . O diagnóstico preciso do foco do AVC é importante para se determinar o manejo do paciente, além de analisar o prognóstico e prevenção de AVC secundário 6,[8][9][10] .…”

“…A prevenção secundária baseia-se além da correção de fatores de riscos, na utilização de fármacos como os antiagregantes plaquetários, antihipertensivos, neuroprotetores, dentre outros 10 . Existem muitos estudos que descrevem os fatores de risco para o AVC, mas não está claro como esses fatores de risco interferem no prognóstico dos pacientes na região do Centro Oeste de Minas Gerais 7,17 . Este estudo teve como objetivo avaliar o quadro clínico dos pacientes com AVC na UPA de uma cidade do Centro Oeste de Minas Gerais e relacionar os fatores de risco, prognóstico e exames de imagem quando existentes, buscando traçar um perfil epidemiológico local, permitindo aos profissionais do serviço de emergência uma melhor intervenção, prevenção e reabilitação dos pacientes atendidos.…”