Frequency and predictors for the risk of stroke recurrence up to 10 years after stroke: the South London Stroke Register
Frequency and predictors for the risk of stroke recurrence up to 10 years after stroke: the South London Stroke Register
复制标题
DOI：
10.1136/jnnp.2008.170456
复制
发表时间：
2009-09-01
影响因子：
11
通讯作者：
Heuschmann, P. U.
中科院分区：
文献类型：
--
作者：
Mohan, K. M.;Crichton, S. L.;Heuschmann, P. U.
背景：目前缺乏估计卒中长期复发风险和预测因素的数据。方法：数据来自以人群为基础的南伦敦卒中登记。患者的随访时间最长为10年。Kaplan-Meier估计和Cox比例风险模型用于评估首次中风复发的累积风险和预测因素。分析的变量包括社会人口学因素、脑卒中亚型（定义为脑梗死、脑出血和蛛网膜下腔出血）、脑卒中严重程度指标和既往卒中危险因素。结果：1995年至2004年间，2874例首次中风患者被纳入研究。平均随访时间为2.9年。在8311人年的随访中，发生了303例复发事件。1年、5年和10年脑卒中累计复发风险分别为7.1%、16.2%和24.5%。卒中亚型间卒中复发率无差异。增加1年复发风险的因素是既往心肌梗死（HR 1.73, 95% CI 1.08 ~ 2.78）和房颤（HR 1.61, 95% CI 1.04 ~ 4.27）；5年时，高血压（HR 1.47, 95% CI 1.08 - 1.99）和房颤（HR 1.79, 95% CI 1.29 - 2.49）；10岁时，年龄较大（p = 0.04）、高血压（HR 1.38, 95% CI 1.04 ~ 1.82）、心肌梗死（HR 1.50, 95% CI 1.06 ~ 2.11）和房颤（HR 1.51, 95% CI 1.09 ~ 2.09）。结论：非常长期的卒中复发风险是巨大的。在整个随访期间确定了不同的中风复发预测因素。初次中风前的危险因素对预测10年内中风复发有重要作用。
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.