Recurrent ischemic stroke: Incidence, predictors, and impact on mortality.

Area of Science:

• Neurology
• Epidemiology
• Public Health

Background:

• Recurrent ischemic stroke (IS) and transient ischemic attack (TIA) incidence and mortality vary significantly across populations.
• Understanding trends, risk factors, and treatment effects in recurrent stroke is crucial for public health.
• Existing data on stroke recurrence and mortality necessitates localized studies for accurate risk assessment.

Purpose of the Study:

• To determine the incidence of recurrent IS or TIA in a hospital-based stroke population in Western Norway.
• To investigate factors associated with stroke recurrence.
• To estimate the impact of recurrent stroke on all-cause mortality.

Main Methods:

• A prospective cohort study involving 1872 IS and TIA survivors from Haukeland University Hospital (July 2007–December 2013).
• Follow-up for recurrence and mortality until September 1, 2016, through medical chart review.
• Cumulative incidence estimated using a competing risks Cox model; recurrence factors and mortality analyzed with multivariate Cox models.

Main Results:

• The cumulative recurrence rate was 5.4% at 1 year, 11.3% at 5 years, and 14.2% by the end of follow-up.
• Hypertension, prior symptomatic stroke, chronic infarcts on MRI, and increasing age were independently associated with recurrence.
• Recurrence significantly increased all-cause mortality (HR = 2.55, 95% CI 2.04–3.18), more than doubling the risk.

Conclusions:

• The risk of recurrent IS or TIA in this Western Norwegian population was modest.
• Recurrence was associated with established risk factors, including hypertension and prior stroke.
• Recurrent stroke substantially elevates the risk of all-cause mortality.