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Current Neurovascular Research


ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Research Article

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

Author(s): Haiqiang Qin, Penglian Wang, Runhua Zhang, Miaoxin Yu, Guitao Zhang, Gaifen Liu* and Yongjun Wang*

Volume 17, Issue 4, 2020

Page: [487 - 494] Pages: 8

DOI: 10.2174/1567202617666200817141837

open access plus


Background: 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.

Methods: We 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.

Results: A 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.

Keywords: Ischemic stroke, risk factors, prognosis, registry, mortality, disability.

Feigin VL, Roth GA, Naghavi M, et al. Global Burden of Diseases, Injuries and Risk Factors Study 2013 and Stroke Experts Writing Group. Global burden of stroke and risk factors in 188 countries, during 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol 2016; 15(9): 913-24.
[] [PMID: 27291521]
Feigin VL, Krishnamurthi RV, Parmar P, et al. GBD 2013 Writing Group; GBD 2013 Stroke Panel Experts Group. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: The GBD 2013 Study. Neuroepidemiology 2015; 45(3): 161-76.
[] [PMID: 26505981]
Zhou M, Wang H, Zhu J, et al. Cause-specific mortality for 240 causes in China during 1990-2013: A systematic subnational analysis for the Global Burden of Disease Study 2013. Lancet 2016; 387(10015): 251-72.
[] [PMID: 26510778]
Wang W, Jiang B, Sun H, et al. NESS-China Investigators. Prevalence, Incidence, and Mortality of Stroke in China: Results from a Nationwide Population-Based Survey of 480 687 Adults. Circulation 2017; 135(8): 759-71.
[] [PMID: 28052979]
LaBresh KA, Reeves MJ, Frankel MR, Albright D, Schwamm LH. Hospital treatment of patients with ischemic stroke or transient ischemic attack using the “Get With The Guidelines” program. Arch Intern Med 2008; 168(4): 411-7.
[] [PMID: 18299497]
Hackam DG, Spence JD. Combining multiple approaches for the secondary prevention of vascular events after stroke: A quantitative modeling study. Stroke 2007; 38(6): 1881-5.
[] [PMID: 17431209]
Coull AJ, Rothwell PM. Underestimation of the early risk of recurrent stroke: Evidence of the need for a standard definition. Stroke 2004; 35(8): 1925-9.
[] [PMID: 15192248]
Hankey GJ, Jamrozik K, Broadhurst RJ, et al. Long-term risk of first recurrent stroke in the Perth Community Stroke Study. Stroke 1998; 29(12): 2491-500.
[] [PMID: 9836757]
Lee JD, Hu YH, Lee M, Huang YC, Kuo YW, Lee TH. High risk of one-year stroke recurrence in patients with younger age and prior history of ischemic stroke. Curr Neurovasc Res 2019; 16(3): 250-7.
[] [PMID: 31258085]
Lekoubou A, Nkoke C, Dzudie A, Kengne AP. Stroke admission and case-fatality in an urban medical unit in sub-Saharan Africa: A fourteen year trend study from 1999 to 2012. J Neurol Sci 2015; 350(1-2): 24-32.
[] [PMID: 25684340]
Hoshino T, Uchiyama S, Wong LKS, et al. Investigators. Differences in characteristics and outcomes between asian and non-asian patients in the Stroke 2017; 48(7): 1779-87.
[] [PMID: 28584002]
Wang Y, Cui L, Ji X, et al. China National Stroke Registry Investigators. The China National Stroke Registry for patients with acute cerebrovascular events: Design, rationale, and baseline patient characteristics. Int J Stroke 2011; 6(4): 355-61.
[] [PMID: 21609414]
Powers BJ, Oddone EZ, Grubber JM, Olsen MK, Bosworth HB. Perceived and actual stroke risk among men with hypertension. J Clin Hypertens (Greenwich) 2008; 10(4): 287-94.
[] [PMID: 18401226]
Asplund K, Ashburner S, Cargill K, Hux M, Lees K, Drummond M. GAIN International Investigators. Health care resource use and stroke outcome. Multinational comparisons within the GAIN International trial. Int J Technol Assess Health Care 2003; 19(2): 267-77.
[] [PMID: 12862185]
Chen Y, Wright N, Guo Y, et al. China Kadoorie Biobank Collaborative Group. Mortality and recurrent vascular events after first incident stroke: A 9-year community-based study of 0·5 million Chinese adults. Lancet Glob Health 2020; 8(4): e580-90.
[] [PMID: 32199124]
Qin H, Chen Y, Liu G, et al. Management characteristics and prognosis after stroke in China: Findings from a large nationwide stroke registry. Stroke Vasc Neurol 2020; [Epub ahead of print]
[] [PMID: 32571805]
Saposnik G, Hill MD, O’Donnell M, Fang J, Hachinski V, Kapral MK. Registry of the Canadian Stroke Network for the Stroke Outcome Research Canada (SORCan) Working Group. Variables associated with 7-day, 30-day, and 1-year fatality after ischemic stroke. Stroke 2008; 39(8): 2318-24.
[] [PMID: 18566303]
Fonarow GC, Reeves MJ, Zhao X, et al. Get With the Guidelines-Stroke Steering Committee and Investigators. Age-related differences in characteristics, performance measures, treatment trends, and outcomes in patients with ischemic stroke. Circulation 2010; 121(7): 879-91.
[] [PMID: 20142445]
Fonarow GC, Reeves MJ, Smith EE, et al. GWTG-Stroke Steering Committee and Investigators. Characteristics, performance measures, and in-hospital outcomes of the first one million stroke and transient ischemic attack admissions in get with the guidelines-stroke. Circ Cardiovasc Qual Outcomes 2010; 3(3): 291-302.
[] [PMID: 20177051]
Cumbler E, Wald H, Bhatt DL, et al. Quality of care and outcomes for in-hospital ischemic stroke: Findings from the National Get With The Guidelines-Stroke. Stroke 2014; 45(1): 231-8.
[] [PMID: 24253540]
Mohan KM, Wolfe CD, Rudd AG, Heuschmann PU, Kolominsky-Rabas PL, Grieve AP. Risk and cumulative risk of stroke recurrence: A systematic review and meta-analysis. Stroke 2011; 42(5): 1489-94.
[] [PMID: 21454819]
Minnerup J, Wersching H, Unrath M, Berger K. Explaining the decrease of in-hospital mortality from ischemic stroke. PLoS One 2015; 10(7): e0131473.
[] [PMID: 26154704]
Nimptsch U, Mansky T. Stroke unit care and trends of in-hospital mortality for stroke in Germany 2005-2010. Int J Stroke 2014; 9(3): 260-5.
[] [PMID: 24206775]
Wang W, Wang D, Liu H, et al. Trend of declining stroke mortality in China: reasons and analysis. Stroke Vasc Neurol 2017; 2(3): 132-9.
[] [PMID: 28989803]
Zia E, Engström G, Svensson PJ, Norrving B, Pessah-Rasmussen H. Three-year survival and stroke recurrence rates in patients with primary intracerebral hemorrhage. Stroke 2009; 40(11): 3567-73.
[] [PMID: 19729603]
Hill MD, Silver FL, Austin PC, Tu JV. Rate of stroke recurrence in patients with primary intracerebral hemorrhage. Stroke 2000; 31(1): 123-7.
[] [PMID: 10625726]
Merino JG, Lattimore SU, Warach S. Telephone assessment of stroke outcome is reliable. Stroke 2005; 36(2): 232-3.
[] [PMID: 15637321]

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