Cause-specific mortality after first cerebral infarction: a population-based study
Steven Vernino1, Robert D Brown, James J Sejvar
1Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, Minn 55905, USA.
Insights
Mortality after cerebral infarction (stroke) remains high due to stroke complications, infections, and cardiovascular events. Aggressive management of heart and lung disease is crucial for improving long-term survival after stroke.
Area of Science:
- Neurology
- Cardiology
- Pulmonology
Background:
- Mortality rates after cerebral infarction (CI) have stagnated for two decades.
- Key factors influencing survival post-CI may be overlooked.
- Understanding mortality patterns is essential for improving patient outcomes.
Purpose of the Study:
- To determine the mortality rate following a first cerebral infarction (CI).
- To identify the primary causes of death after a first CI.
- To analyze predictors of mortality in patients with CI.
Main Methods:
- A population-based, case-control study was conducted.
- Medical records of Rochester, Minnesota residents experiencing their first CI between 1985-1989 were reviewed.
- Morbidities, causes of death, and mortality predictors were analyzed.
Main Results:
- 5-year survival after first CI was 46%.
- Leading causes of death included cardiovascular events (22%), respiratory infections (21%), and initial stroke complications (14%).
- Age, stroke severity, comorbidities (cardiac, respiratory), and stroke recurrence independently predicted mortality.
Conclusions:
- Early mortality post-CI is mainly due to neurologic complications.
- Later mortality is significantly influenced by respiratory and cardiovascular causes.
- Improving long-term survival requires aggressive management of pulmonary and cardiac conditions alongside secondary stroke prevention.
Background And Purpose:
Mortality after cerebral infarction (CI) has remained unchanged during the past 20 years, despite advances in neurologic care. Key factors affecting survival may be underrecognized. The purpose of this study was to determine the rate and cause of mortality after first CI.
Methods:
In this case-control, population-based study, all available medical records were reviewed for Rochester (Minnesota) residents with a first CI between 1985 and 1989 to identify morbidities and cause of death. Predictors for mortality were analyzed.
Results:
First CI was recorded for 444 patients. Survival was 83% at 1 month, 71% at 1 year, and 46% at 5 years. The most frequent causes of death were cardiovascular events (22%), respiratory infection (21%), and initial stroke complications (14%). Recurrent stroke and cancer accounted for 9% and 7.5% of deaths, respectively. In the first month after CI, 51% of deaths were attributed to the initial CI, 22% to respiratory infections, and 12% to cardiovascular events. During the first year, 26% of deaths resulted from respiratory infections and 28% from cardiovascular disease. Mortality was higher among patients than controls for at least 2 years after CI. Age, cardiac comorbid conditions, CI severity, stroke recurrence, seizures, and respiratory and cardiovascular morbidities were independent predictors of death.
Conclusions:
In the first month after CI, mortality resulted predominantly from neurologic complications. Later mortality remained high because of respiratory and cardiovascular causes. To improve long-term survival after CI, aggressive management of pulmonary and cardiac disease is as important as secondary stroke prevention.
